A Deadly Virus Spreads in India, Despite Vaccines Within Reach

But the Indian vaccine is expensive, time-consuming to produce and relatively short-lived in its effectiveness. Because the government has resisted importing better versions from China and elsewhere, or licensing their production at home, India has adopted what Julie Jacobson, a virologist, calls a "firefighting approach" to Japanese encephalitis, ramping up domestic vaccine production in response to each outbreak, by which time it is often too late.

"It's just amazing that with that kind of technical capability, the problem of Japanese encephalitis has not been solved" in India, Jacobson said in a telephone interview from Seattle, where she directs a $27 million Japanese encephalitis initiative for the Program for Appropriate Technology in Health, a nongovernmental group. The effort is funded by the Bill & Melinda Gates Foundation.

"It hasn't been a high enough priority," added Jacobson, although she described the 15-month-old government of Prime Minister Manmohan Singh as "very interested in moving forward right now and solving this problem."

The human costs of the latest outbreak are all too evident in Gorakhpur, a city of about 300,000 roughly 400 miles east of New Delhi, the capital, on the swampy sub-Himalayan plain near the border with Nepal. Since late July, the epidemic has been raging in the poor farming villages that surround the city, where the public BRD Medical College hospital has treated the majority of the underage victims.

Because there is no cure for the disease, medical staff members can try only to ease its symptoms, providing drugs to treat fevers and convulsions or inserting feeding tubes when children become unconscious. A grimy four-story structure whose grounds are covered in weeds and trash, the hospital is treating about 230 encephalitis patients in three wards with a bed capacity of 180, according to Kushwaha, the senior pediatrician.

Children at the hospital are dying at the rate of about one every two hours, and doctors and nurses are in such short supply that in many cases parents are the only ones keeping their unconscious children alive, using foot-operated suction pumps, for example, to clear airways of mucus and saliva. But the mostly illiterate villagers are not always up to the task. More than half of the deaths in the encephalitis wards are caused by aspiration choking, which occurs when the internal airway is blocked, according to Bhupendra Sharma, a senior resident physician.

The sickest patients are in Ward 6. On Wednesday night, mothers in colorful saris and fathers in simple work clothes clustered around their mostly inert children, sometimes sponging their feverish bodies with damp cloths. A few dozed on straw mats unrolled beneath iron-framed beds. Some children breathed through oxygen masks.

Kiran Kumari, the 11-year-old, lived with her parents and six siblings in a mud-and-straw hut about 40 miles from Gorakhpur. After she began having seizures, her parents and teenage sister brought her to the hospital last Sunday in a motorized rickshaw. A few days later, when the girl became unconscious, medical staff members inserted a plastic tube in her airway and showed her family how to use the hand-operated ventilator, as the mechanical ones were all taken.

"For four days, we haven't been able to eat or cook any food," said Kumari's mother, Gulaicha Devi, 40, a slight, careworn woman with a prominent gold nose stud and glass bangles on both wrists. "We're so tired. We didn't bring anything with us. Not a glass of water to drink from. Not a change of clothes."

Despite their exhaustion, Kumari's parents and sister kept substituting for each other on the ventilator, refusing to give up hope. It was no use. On Thursday morning, they and their daughter were nowhere to be found, and another sick child had taken her bed.

A doctor said the girl had died at 5:15 a.m.