Title : From Mystery to Clarity: A Public Health Investigation into Unexplained Deaths in the Himalayan Foothills, India.
Abstract:
Background: Acute febrile illness (AFI) is a major public health challenge in tropical and subtropical regions, particularly during monsoon seasons when vector-borne diseases such as dengue, malaria, and scrub typhus increase. During August-September 2022, an unusual cluster of sudden mystery deaths was reported in Kalka sub-division of Panchkula – the Himalayan foothills, amidst a rise in acute febrile illness (AFI) cases. The absence of a definitive diagnosis led to an urgent investigation to identify the cause and assess its public health implications.
Methods: A cross-sectional observational study was conducted by the Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, between August and September 2022. Verbal autopsies were performed using the standardized Sample Registration System (SRS) questionnaire with consent from the deceased’s relatives. Medical case records were reviewed, and environmental and entomological assessments were conducted to identify potential vector breeding sites. Epidemiological data from the Integrated Disease Surveillance Programme (IDSP) were analyzed to assess trends in AFI cases. Data were analyzed using SPSS v22, with descriptive epidemiology presented in terms of time, place, and person variables.
Results: Verbal autopsies were conducted for 18 out of 26 reported deaths. The mean age of the deceased was 23.9 years (SD=13.4), with a male-to-female ratio of 1.57. The highest mortality (44%) was observed in the 15–29-year age group. Fever was present in all cases, along with symptoms such as nausea, vomiting, muscular pain, chills, and abdominal discomfort. Complications included shock (83%), multi-organ dysfunction (44%), and bleeding manifestations (22%).
Medical records confirmed that 13 deaths were caused by dengue and its complications, while 4 were categorized as probable dengue based on clinical and epidemiological evidence. Delayed diagnosis, inadequate clinical monitoring, and improper administration of intravenous fluids were identified as contributing factors. Entomological assessments revealed the presence of Aedes aegypti mosquitoes and active breeding sites in affected households. IDSP data indicated a sharp rise in dengue cases, with laboratory confirmation of Dengue virus serotype 2. Epidemiological linkage was established in 11 cases through the presence of confirmed dengue cases among family members or neighbors.
Conclusion: The study confirms that the mystery deaths in Kalka subdivision were due to dengue and its complications, primarily dengue shock syndrome and hemorrhagic manifestations. The findings highlight the need for improved AFI management, including early diagnosis, timely clinical intervention, and judicious fluid management. Strengthening epidemiological surveillance, enhancing healthcare preparedness, and promoting community-driven vector control measures are crucial for preventing future outbreaks and reducing dengue-related mortality.
