PATNA, Sept. 15 -- Bihar's health authorities have issued an advisory to eight districts along the Nepal border, warning of a heightened risk of acute encephalitis syndrome (AES) and Japanese encephalitis (JE) in the aftermath of severe flooding across the border last month. Amit Kumar Pandey, executive director of the State Health Society, Bihar, in a letter of September 11 to civil surgeons of Araria, Kishanganj, Madhubani, Muzaffarpur, East Champaran, West Champaran, Sitamarhi and Supaul flagged the changing river water levels, waterlogging in border areas and a likely rise in mosquito breeding sites as conditions ripe for an outbreak of water-borne and vector-borne disease. Urging the civil surgeons to tighten surveillance at the community level, he directed them to instruct health workers to watch for red-flag symptoms - severe headache, high fever, convulsions, disorientation or unconsciousness - and refer suspected cases without delay to health facilities. The department has directed swift use of the 102 ambulance service. Districts must also ensure that cerebral spinal fluid (CSF) and serum samples from suspected cases are collected on time and sent for testing, with reports uploaded to the Integrated Disease Surveillance Programme (IDSP) portal. The advisory calls for hospitals to maintain adequate supplies of intra-venous fluids, oxygen, anticonvulsants, oral rehydration solution (ORS) and encephalitis treatment kits at health facilities across the eight districts. Civil surgeons must verify the JE vaccination status of all eligible beneficiaries and ensure no child misses a dose under routine immunisation. Children from flood-affected and displaced families are to be specially screened, with any pending doses completed on priority. ASHA (accredited social health activist), ANM (auxiliary nursing midwife), CHO (community health officer) and other frontline workers have been asked to go door-to-door with awareness messages on preventing brain fever, paying special attention to flood-affected families, the displaced, and those living in relief camps. Every suspected AES case is to be referred immediately to the nearest AES treatment centre, the letter said. Vector control is also being scaled up. The letter directs immediate larval control in waterlogged pockets, including adding a few drops of kerosene to stagnant water to stop mosquito breeding, along with indoor residual spraying and fogging wherever needed. Frontline workers have been asked to push the message on regular use of mosquito nets, especially to protect children in the evenings. Districts have been told to draw up a joint preparedness plan, coordinating with urban local bodies, panchayati raj institutions, the integrated child development scheme (ICDS), education and animal husbandry departments, public health engineering department (PHED), the disaster management department and Jeevika. The department has also spelt out simple messages for public awareness campaigns: rush a patient to the nearest health centre at once if high fever is accompanied by unconsciousness, convulsions or abnormal behaviour; use mosquito nets regularly; maintain cleanliness around pig-rearing areas; stay away from stagnant water in paddy fields, ponds and flood water; and feed children a full meal - with something sweet if possible - before they sleep at night....