2405:201:1009:4084:594F:2FB5:8FFD:A3A2 at 03:19, 23 January 2021

2021-01-23T03:19:39Z

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{{MEDREF|date=December 2020}}
{{short description|Unknown disease outbreak in Andhra Pradesh, India, 2020}}
{{Use Indian English|date=December 2020}}
{{Use dmy dates|date=December 2020}}
{{Infobox outbreak
| name = Eluru outbreak
| width =
| image = West Godavari map.svg
| image_size =
| image_upright =
| alt =
| caption = Location of [[West Godavari District]], where Eluru and surrounding areas are located, in Andhra Pradesh
| map1 =
| legend1 =
| map2 =
| legend2 =
| map3 =
| legend3 =
| map4 =
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| disease = [[Idiopathic disease]] (initially)
| first_outbreak = [[Eluru]], [[Andhra Pradesh]], [[India]]
| first_reported = 5 December 2020
| index_case = 
| arrival_date = 
| date = {{start and end dates|2020|12|05|2020|12|12|df=y}}
| source = Pesticide contamination in the water supply
| confirmed_cases = 614<ref name="NIE">{{cite web|accessdate=2020-12-13|title=Felt dizzy and suffered seizure after breakfast, recalls Eluru mystery illness survivor|url=https://www.newindianexpress.com/states/andhra-pradesh/2020/dec/13/felt-dizzy-and-suffered-seizure-after-breakfast-recalls-eluru-mystery-illness-survivor-2235612.html|website=The New Indian Express}}</ref>
| active_cases = 0 <ref name="NIE"/>
| suspected_cases =
| severe_cases =
| hospitalized_cases = 0<ref name="NIE"/>
| critical_cases =
| ventilator_cases =
| ecmo_cases =
| recovery_cases = 700 name="NIE"/>
| deaths = 1<ref name="HT">{{cite web|accessdate=2020-12-10|title=2 more persons hospitalised with symptoms of Eluru’s mysterious disease die|url=https://www.hindustantimes.com/india-news/2-more-persons-hospitalised-with-symptoms-of-eluru-s-mysterious-disease-die/story-Pqw8UIUyQdC2CcEAHkU1bM.html|date=10 December 2020|website=Hindustan Times}}</ref>
| fatality_rate =
| quarantined =
| number of tests =
| territories = [[Eluru]], [[Denduluru]] & [[Kovvali, West Godavari district|Kovvali]]
| total_ili =
| website =
| Symptoms = [[Headaches]], [[Nausea]], [[Seizures]], [[memory loss]]
}}
{{Eluru outbreak chart|barwidth=medium}}
In early December 2020, an [[idiopathic disease]] broke out in [[Eluru]], a city located in the southern [[India]]n [[states and union territories of India|state]] of [[Andhra Pradesh]]. The first case was reported on 5 December, with hundreds more falling ill and one person dying over the next week. The cause was initially unknown, but on 20 December, AIIMS and NEERI Research Institute came to a conclusion that pesticides leaching into the water supply is the most likely reason.

== Symptoms ==
Reported symptoms include [[headache]], [[vomiting]], [[dizziness]], [[convulsion]]s, [[seizure]]s, [[nausea]], [[anxiety]], [[Unconsciousness|loss of consciousness]] and other [[Neurological disorder|neurological symptoms]], which have been described as being similar to [[epilepsy]]. The individuals who have been reported to have the disease, especially children, have reported a sudden onset of vomiting after complaining of burning eyes.<ref>{{Cite web|title=1 Dead, 292 Fall Sick In Andhra Pradesh Due To Mysterious Disease|url=https://www.ndtv.com/andhra-pradesh-news/1-dead-292-taken-ill-in-andhra-pradeshs-eluru-due-to-mysterious-disease-2335128|access-date=2020-12-07|website=NDTV.com}}</ref><ref name="BBC News">{{Cite news|last=|first=|date=2020-12-07|title=Andhra Pradesh: 'Mystery' illness puts hundreds in hospital|work=[[BBC News]]|url=https://www.bbc.com/news/world-asia-india-55209763|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207172057/https://www.bbc.com/news/world-asia-india-55209763|archive-date=2020-12-07}}</ref>

==Outbreak==
The first case was recorded on the evening of 5 December. By the next day, a few hundred more people were admitted to hospital with similar symptoms. The only reported death was a 45-year-old man who had reported similar symptoms.<ref name="IT">{{cite web|last=Ghosh|first1=Raya|date=2020-12-07|title=What is happening in Eluru? Andhra town trends online after mysterious disease outbreak|url=https://www.indiatoday.in/trending-news/story/what-is-happening-in-eluru-andhra-town-trends-online-after-mysterious-disease-outbreak-1747422-2020-12-07|accessdate=2020-12-07|website=India Today}}</ref> According to CNN, he died of an unrelated cardiac arrest on 5 December, but the Eluru hospital superintendent stated he died due to the symptoms and put him on the official death toll for the illness.<ref name="Mogul">{{Cite news|last=Mogul|first=Rhea|last2=Mitra|first2=Esha|last3=Sud|first3=Vedika|last4=Rao|first4=Deepak|date=2020-12-07|title=Unidentified illness hospitalizes more than 300 people in India|work=[[CNN]]|url=https://edition.cnn.com/2020/12/07/asia/india-mystery-illness-intl-hnk-scli/index.html|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207171104/https://edition.cnn.com/2020/12/07/asia/india-mystery-illness-intl-hnk-scli/index.html|archive-date=2020-12-07}}</ref><ref name="HT"/><ref name="TNM2"/> The disease was originally found in the [[One Town, Eluru|One Town]] area before spreading to other parts of the city as well as the [[Eluru (rural)|rural area]] and [[Denduluru]] village. Most patients were admitted in the Eluru government hospital, but some that needed better care were sent to institutions in [[Vijayawada]] and [[Guntur]].<ref>{{cite web|accessdate=2020-12-08|title=Chemical substance found in pesticides suspected to be behind mysterious illness in AP|url=https://www.thenewsminute.com/article/chemical-substance-found-pesticides-suspected-be-behind-mysterious-illness-ap-139179|date=8 December 2020|website=The News Minute}}</ref>

By the night of 7 December, more than 400 people had been stricken by the disease. While the disease affects all age groups, over 300 of the infected are children.<ref name="rt">{{cite news|first1=Jatindra|last1=Dash|first2=Sudarshan|last2=Varadhan|accessdate=2020-12-07|title=Hundreds rushed to hospital in India, one dead from unknown illness|url=https://uk.reuters.com/article/india-infection-idUKKBN28H22X|newspaper=Reuters|date=7 December 2020|via=uk.reuters.com}}</ref><ref>{{cite web|title=Mystery illness lands over 300 people in the hospital in southern India|url=https://www.cbsnews.com/news/india-mystery-illness-eluru-over-300-in-hospital-epilepsy-like-symptoms/|accessdate=2020-12-07|website=www.cbsnews.com}}</ref> The total reported number of infected had risen to 450 and the discharged to 200 by 7 December.<ref name=":02" /><ref name="Ellis-Petersen" /> While the symptoms have been reported as being "the same across age groups and gender," a majority of patients are in the age group of 20-30 years old.<ref name=":1"/><ref name=":02"/> Hundreds of children were affected by the disease.<ref name="rt" />

The rate of new cases drastically decreased on 8 December, although six people who were previously discharged suffered a second seizure and were readmitted.<ref>{{cite web|accessdate=2020-12-09|title=Eluru ‘mystery’ illness: At least six suffer second seizure, readmitted|url=https://indianexpress.com/article/cities/hyderabad/eluru-mystery-illness-at-least-six-readmitted-after-seizures-vomiting-7097713/|newspaper=The Indian Express|date=9 December 2020}}</ref> On 10 December, two other people who got the disease died, causing some media to speculate that their deaths were due to the disease. However, the district's health commissioner announced they had died from unrelated conditions - one from a stroke and one from COVID-19 - and that only the original death remained on the official count.<ref name="HT"/><ref name="TNM2">{{cite web|accessdate=2020-12-10|title=Eluru mystery illness: Officials deny news of two more persons dying|url=https://www.thenewsminute.com/article/eluru-mystery-illness-officials-deny-news-two-more-persons-dying-139381|date=10 December 2020|website=The News Minute}}</ref> Only two people were admitted into the hospital the next day, with most patients having recovered and thirteen still requiring treatment as of 12 December.<ref>{{cite web|accessdate=2020-12-11|title=A week since the onset, cause of Eluru mystery illness remains elusive|url=https://www.deccanherald.com/national/south/a-week-since-the-onset-cause-of-eluru-mystery-illness-remains-elusive-926270.html|date=11 December 2020|website=Deccan Herald}}</ref> On 12 December, no new cases were recorded, and state health minister [[Alla Nani|Alla Kali Krishna Srinivas]] stated that "the city is heading towards a zero mystery illness situation."<ref>{{cite web|accessdate=2020-12-13|title=Eluru limps back to normalcy as mystery illness subsides|url=https://www.newindianexpress.com/states/andhra-pradesh/2020/dec/13/eluru-limps-back-to-normalcy-as-mystery-illness-subsides-2235472.html|website=The New Indian Express}}</ref>

==Possible causes==
Samples from patients and of the local water were collected the same day to determine the cause of the outbreak.<ref name="IT"/> Specialists from several worldwide and Indian scientific and medical institutions, such as the [[National Centre for Disease Control]],<ref>https://www.indiatvnews.com/news/india/mystery-disease-andhra-pradesh-eluru-central-team-investigation-december-7-669899</ref> [[All India Institutes of Medical Sciences]],<ref name="Ellis-Petersen">{{Cite news|last=Ellis-Petersen|first=Hannah|date=2020-12-07|title=Mystery illness puts 450 in hospital in Indian state of Andhra Pradesh|work=[[The Guardian]]|url=https://www.theguardian.com/world/2020/dec/07/mystery-illness-puts-450-in-hospital-in-indian-state-of-andhra-pradesh|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207181341/https://www.theguardian.com/world/2020/dec/07/mystery-illness-puts-450-in-hospital-in-indian-state-of-andhra-pradesh|archive-date=2020-12-07}}</ref> the [[World Health Organization]], the [[Indian Council of Medical Research]], the [[National Institute of Nutrition, Hyderabad|National Institute of Nutrition]], [[Centre for Cellular and Molecular Biology]], and the [[Indian Institute of Chemical Technology]] had been sent to assess the situation and analyze the samples.<ref name=":1" /> However, the tests did not detect any water pollution or known virus infections (including [[COVID-19]]) upon analysis.<ref name="IT" /><ref name=":0" /><ref name=":1" />

Andhra Pradesh's Health Department reported that "initial blood test[s] did not find any evidence of [[Viral disease|viral infection]]."<ref name="Mogul"/> Blood samples have also been tested for antibodies and for bacterial infections such as [[meningitis]]. Viruses such as [[SARS-CoV-2]], [[Japanese encephalitis]], [[dengue]], [[chikungunya]], [[hepatitis]] and [[rabies]] were ruled out as the cause. Since "people not linked to the municipal water supply [have also] fallen ill", water contamination was also initially discarded,<ref name=":0">{{Cite news|last=|first=|date=2020-12-07|title=Unidentified disease in India leaves hundreds hospitalized, 1 dead|work=[[USA Today]]|url=https://www.usatoday.com/story/news/world/2020/12/07/mystery-illness-andhra-pradesh-india-200-hospitalized-one-dead/3855842001/|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207182309/https://www.usatoday.com/story/news/world/2020/12/07/mystery-illness-andhra-pradesh-india-200-hospitalized-one-dead/3855842001/|archive-date=2020-12-07}}</ref> and so was air pollution.<ref name=":1">{{Cite news|last=Sudhir|first=Uma|last2=Sanyal|first2=Anindita|date=2020-12-07|title=Mystery Disease Strikes In Andhra Pradesh, One Person Dead, 380 Ill|work=[[NDTV]]|url=https://www.ndtv.com/andhra-pradesh-news/mystery-disease-strikes-in-andhra-pradesh-one-person-dead-380-ill-2335276|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207171823/https://www.ndtv.com/andhra-pradesh-news/mystery-disease-strikes-in-andhra-pradesh-one-person-dead-380-ill-2335276|archive-date=2020-12-07}}</ref><ref name="BBC News" /> Blood tests and [[CT scan]]s were not able to establish the cause or origin of the disease and [[cerebrospinal fluid]] tests "turned out to be normal."<ref>{{Cite news|last=Pandey|first=Ashish|date=2020-12-07|title=1 dead, 350 in hospital in Andhra Pradesh as mystery illness hits Eluru|work=[[India Today (TV channel)]]|url=https://www.indiatoday.in/india/andhra-pradesh/story/andhra-pradesh-eluru-mystery-illness-cm-jaganmohan-reddy-1747287-2020-12-07|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207183037/https://www.indiatoday.in/india/andhra-pradesh/story/andhra-pradesh-eluru-mystery-illness-cm-jaganmohan-reddy-1747287-2020-12-07|archive-date=2020-12-07}}</ref> As of 7 December 2020, the disease has been determined to be non-contagious.<ref name=":02">{{Cite news|last=|first=|date=2020-12-07|title='Mysterious disease' in Andhra Pradesh's Eluru: What we know so far|work=[[The Times of India]]|url=https://timesofindia.indiatimes.com/india/cause-of-mysterious-disease-in-andhra-pradeshs-eluru-remains-unknown-what-we-know-so-far/articleshow/79609472.cms|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207174632/https://timesofindia.indiatimes.com/india/cause-of-mysterious-disease-in-andhra-pradeshs-eluru-remains-unknown-what-we-know-so-far/articleshow/79609472.cms|archive-date=2020-12-07}}</ref>

BJP Member of Parliament Narasimha Rao suspected that [[organochloride]]s might be the cause after talking to medical experts. Organochlorides are used as pesticides as well as in anti-mosquito fogging.<ref name=":02" /><ref>{{Cite web|date=2020-12-08|title=Did Pesticides Lead to Mystery Illness in Andhra Pradesh's Eluru? Probe On After Over 400 Affected|url=https://www.news18.com/news/india/did-pesticides-lead-to-mystery-illness-in-andhra-pradeshs-eluru-probe-on-after-over-300-affected-3156053.html|access-date=2020-12-08|website=News18|language=en}}</ref> On 7 December 2020, Indian health authorities unofficially declared: "Mostly yes, but we are waiting for the laboratory report [for confirmation]" when asked about organochlorine being the disease-triggering agent.<ref name=":02"/> This theory was later ruled out by authorities because there would have been a higher rate of respiratory issues and fatalities.<ref name="TNM">{{cite web|accessdate=2020-12-09|title=Eluru mystery illness: Officials rule out air, water as source of poisoning|url=https://www.thenewsminute.com/article/eluru-mystery-illness-officials-rule-out-air-water-source-poisoning-139311|date=9 December 2020|website=The News Minute}}</ref>

Later preliminary results pointed to high lead and [[nickel#toxicity|nickel]] content in drinking water and milk as possible agents via [[lead poisoning]].<ref name="TSD">{{cite news|accessdate=2020-12-08|title=Heavy metal content in water caused mysterious disease in AP|url=https://www.siasat.com/heavy-metal-content-in-water-caused-mysterious-disease-in-ap-2040974/|newspaper=The Siasat Daily|date=8 December 2020}}</ref> Blood tests also found high concentrations of the same materials in patients.<ref name="TW">{{cite web|accessdate=2020-12-08|title=Andhra Pradesh: High Quantities of Lead, Nickel in Blood of Eluru Patients; Pesticide in Water|url=https://thewire.in/health/andhra-pradesh-eluru-disease-high-quantities-of-lead-nickel-pesticides|website=The Wire}}</ref> State authorities later ruled out air and water as the medium for heavy metals and started testing vegetable and fruit samples.<ref name="TNM"/> It has also been speculated that pesticides may have leached into the water supply after flash floods.<ref>{{cite web|accessdate=2020-12-09|title=Andhra ‘mystery’ illness: Latest tests disclose presence of pesticide residues in drinking water|url=https://www.hindustantimes.com/cities/andhra-mystery-illness-latest-tests-disclose-presence-of-pesticide-residues-in-drinking-water/story-0ijMz4H1sUZ1hVCEKiQEdL.html|date=9 December 2020|website=Hindustan Times}}</ref> Other theories include improper disposal of batteries as well as excessive bleaching and chlorinating of the water supply to prevent COVID-19 transmission.<ref>{{cite web|accessdate=2020-12-12|title=Eluru mystery illness: Recycling of batteries might be the cause of disease, AIIMS experts tell CM|url=https://www.newindianexpress.com/states/andhra-pradesh/2020/dec/10/eluru-mystery-illness-recycling-of-batteries-might-be-the-cause-of-disease-aiims-experts-tellcm-2234208.html|website=The New Indian Express}}</ref>

On December 16, the Andhra Pradesh government concluded that pesticide residue in the water was the "main reason" for the illness, based on findings from studies conducted by the [[All India Institute of Medical Sciences]] (AIIMS) and the [[National Environmental Engineering and Research Institute]] (NEERI). AIIMS also reported on high heavy metal content in milk, while NEERI found mercury in surface water higher than the allowed concentration.<ref>{{cite web|accessdate=2020-12-18|title=Eluru mystery disease: Experts say ‘high residues of pesticides in water main reason’|url=https://www.hindustantimes.com/andhra-pradesh/high-residues-of-pesticides-in-water-main-reason-behind-mysterious-disease-in-eluru-experts/story-KxSkrWhnMoMwjpTvaYXXxL.html|date=16 December 2020|website=Hindustan Times}}</ref>

==Responses and reactions==
[[Y. S. Jaganmohan Reddy]], the current [[List of chief ministers of Andhra Pradesh|chief minister of Andhra Pradesh]], has faced criticism from the opposition for his perceived failure to prevent the outbreak by neglecting water sanitation in the area.<ref>{{cite web|title=Mystery illness lands over 300 people in the hospital in southern India|url=https://www.cbsnews.com/news/india-mystery-illness-eluru-over-300-in-hospital-epilepsy-like-symptoms/|accessdate=2020-12-07|website=www.cbsnews.com}}</ref>

[[Chandrababu Naidu]], the leader of the state's opposition [[Telugu Desam Party]], blamed the ruling government for the outbreak, claiming that it had not taken action to decontaminate the local drinking water.<ref>{{cite web|accessdate=2020-12-07|title=‘Mysterious disease in Andhra’s Eluru due to Jagan govt’s apathy’: Chandrababu Naidu|url=https://www.thenewsminute.com/article/mysterious-disease-andhra-s-eluru-due-jagan-govt-s-apathy-chandrababu-naidu-139136|date=7 December 2020|website=The News Minute}}</ref> The Telugu Desam Party called for a full enquiry, claiming that the spread of the illness was caused by contamination.<ref name="BBC News" />

Srinivas initially reported “[a]ll the patients are out of danger. Of the 300-odd affected, about 125 have been discharged by Sunday evening."<ref name=":03">{{Cite news|last=Janyala|first=Sreenivas|date=2020-12-07|title=Andhra Pradesh: 300 fall sick in Eluru, health minister says ‘mystery illness’|work=[[The Indian Express]]|url=https://indianexpress.com/article/india/150-fall-ill-in-andhra-pradesh-officials-suspect-water-contamination-7093702/|url-status=live|access-date=2020-12-07|archive-url=https://web.archive.org/web/20201207173724/https://indianexpress.com/article/india/150-fall-ill-in-andhra-pradesh-officials-suspect-water-contamination-7093702/|archive-date=2020-12-07}}</ref>

On 7 December, the government announced it had commenced "a door-to-door survey".<ref name=":03" /> The same day, CM Reddy visited the patients in Eluru and gave instructions to his ministers on patient care and supervision, ordering that discharged patients be observed for a month afterwards.<ref>{{cite news|accessdate=2020-12-08|title=Mystery disease: Andhra CM asks official to seek experts view in Eluru|url=https://www.siasat.com/mystery-disease-andhra-cm-asks-official-to-seek-experts-view-in-eluru-2040567/|newspaper=The Siasat Daily|date=7 December 2020}}</ref> The central government announced that a three-person team would be sent to Eluru on 8 December to probe the situation.<ref>{{cite web|accessdate=2020-12-08|title=Centre rushes 3-member team to Eluru in wake of mystery disease|url=https://www.thestatesman.com/world/centre-rushes-3-member-team-to-eluru-in-wake-of-mystery-disease-1502939458.html|newspaper=The Statesman|date=8 December 2020}}</ref> The state government later formed a 21-member council which included representatives from the [[All India Institutes of Medical Sciences]] and the [[World Health Organization]] to investigate the outbreak.<ref>{{cite news|first1=Rajulapudi|last1=Srinivas|accessdate=2020-12-11|title=A.P. govt. sets up high-level panel to probe mysterious illness|url=https://www.thehindu.com/news/national/andhra-pradesh/ap-govt-sets-up-high-level-panel-to-probe-mysterious-illness/article33306363.ece|newspaper=The Hindu|date=11 December 2020|location=Vijayawada|issn=0971-751X}}</ref>

Due to reports that lead in vegetables was possibly causing the illness, sales by local vendors were severely reduced as people bought more meat and went to other cities to buy vegetables instead.<ref>{{cite web|accessdate=2020-12-15|title=Fear of mystery illness makes people avoid vegetables, vendors hit|url=https://www.newindianexpress.com/states/andhra-pradesh/2020/dec/14/fear-of-illness-makes-people-avoid-vegetables-vendors-hit-2235935.html|website=The New Indian Express}}</ref>

==See also==
* [[2019 Bihar encephalitis outbreak]]
* [[2017 Gorakhpur hospital deaths]]
* [[COVID-19 pandemic in Andhra Pradesh]]

==References==
{{reflist}}

{{Disasters in India in 2020}}

{{DEFAULTSORT:Eluru outbreak}}
[[Category:2020 disasters in India]]
[[Category:2020 health disasters]]
[[Category:2020s disease outbreaks]]
[[Category:2020s in Andhra Pradesh]]
[[Category:December 2020 events in India]]
[[Category:Disasters in Andhra Pradesh]]
[[Category:Disease outbreaks in India]]
[[Category:Eluru|Outbreak]]
[[Category:Idiopathic diseases]]
[[Category:West Godavari district]]

Eluru outbreak - Revision history

2405:201:1009:4084:594F:2FB5:8FFD:A3A2 at 03:19, 23 January 2021