Preventive medicine: General principles of prevention and control of diseases CHIKUNGUNYA and DENGUE

1. MrAshishR. Chaudhari
ASST. PROFESSOR, M.PHARM (QA)
P.R.PATIL, INSTITUTE OF PHARMACY, TALEGAON
(SP), DIST- WARDHA
Presented by :
Preventive medicine:
General principles of prevention and control of diseases
CHIKUNGUNYA and DENGUE

2. Chicken Guinea

3. What is Chikungunya
• An arboviral disease (genus Alphavirus)
• Transmitted to humans by infected
mosquitoes –Aedes aegypti and
Aedes albopictus.
• The name chikungunya originates from a verb
in the Kimakonde language, meaning 'to
become contorted'. This refers to the
'stooped' appearance of those suffering with
joint pain

4. Aedes aegypti
Aedes albopictus

5. Geographical distribution
• First isolated Tanzania 1952
• Caused periodic outbreak Asia and Africa since
1960
• 2006: Outbreak in India, more than 1 500 000
cases of chikungunya were reported with Ae.
aegypti implicated as the vector.
• Between 2001 and 2011, a number of
countries reported on chikungunya outbreaks.
• 2016 at Delhi

6. Clinical Manifestation
• Incubation period: 3-7 days(may be 2-12 days)
• Acute phase: < 3weeks
• Sub-Acute phase: 3wks to 3 month
• Chronic phase: > 3 months

7. Symptoms
• High fever (40°C/ 104°F)
• Joint pain (lower back, ankle, knees, wrists or
phalanges)
• Joint swelling
• Rash
• Headache
• Muscle pain
• Nausea
• Fatigue

8. Some others symptoms in children
• Retro-orbital pain
• Photophobia
• Vomiting
• Diarrhea
• Meningeal syndrome
• Acute encephalopathy

9. Course of disease
• Chikungunya is rarely fatal.
• Symptoms are generally self-limiting and last for 2–3
days.
• The virus remains in the human system for 5-7 days
and mosquitoes feeding on an infected person during
this period can also become infected.
• Chikungunya shares some clinical signs with dengue
and can be misdiagnosed in areas where dengue is
common.
• Chikungunya can be detected using serological tests
• Recovery from an infection will confer life-long
immunity.

10. Continued….
• Clinical criteria:Acute onset of fever and severe arthralgia / arthritis with or
without skin rash and residing or having left an epidemic area 15 days prior to
onset of symptoms
• Laboratory criteria: At least one of the following tests done in the acute phase of
illness 1.Direct evidence Virus isolation / Presence of viral RNA by RT-PCR
2.Indirect evidence
•Presence of virus specific IgM antibodies in single serum sample collected in
acute or convalescent stage.
• Four-fold increase in IgG values in samples collected at least three weeks apart.

11. Pathogenesis
Complement
activated
immune
complex
mediated
arthritis

12. Laboratory diagnosis
• MAC-ELISA –IgM for CHIKV (AFTER 7 DAYS)
• Paired sera IgG(4 FOLD RISE)
• RT-PCR(POSITIVE ≤ 8DAYS): E1 and C genome
from serum,CSF
• VIRAL ISOLATION( TAKE LONG TIME)

13. Outbreak criteria:
• One or more cases in an area where no case was
reported before.
• For the Public Health action, it is not necessary to
confirm the diagnosis of each and everysuspected
Chikungunya case.
• Remedial measures for containment of the diseases,
• symptomatic treatment of the suspected Chikungunya
fever cases should be started immediately on the basis
of Epidemiological diagnosis of the disease

14. Treatment
• SUPPORTIVE
• Rest in Acute phase
• Paracetamol and NSAIDS
• Avoid Aspirin
• Plenty of water and adequate hydration
• Protection against mosquito bites
• Timely referral if indicated
• Cold compress to inflamed joint and physiotherapy

15. Indications for Referral to PHC
• Fever more than 5 days
• Hemorrhagic manifestation
• Reduced urine output
• Severe vomiting
• Altered sensorium
• Jaundice
• Postural dizziness ,cold extremities

16. Management of chronic arthritis
• NSAIDS
• Short course of steroid ( In case of refractory
to NSAID after 2-3 weeks)
• Hydroxychloroquine ( During sub-acute stage)
• Physiotherapy
• Surgery

17. Prevention
• Personal protection(Full sleeve clothing)
• Integrated Vector Management
• Source Reduction
• Larvicidal agents (Temephos)
• Adult mosquito control(Pyrethrum extract)
• Biological Control
• Legislative measures
• Operational research
• Capacity building

18. Dengue fever (also known as breakbone fever, is
an infectious tropical disease

19. Family: Flaviviridae
dengue virus.
(DENV)
showing dengue virus
virions (the cluster of
dark dots near the
center

20.  include fever,
 headache,
 muscle and joint pains,
 a characteristic skin rash
 common cold
 gastroenteritis
 (vomiting and diarrhea)

22. transmitted by Aedes mosquitoes
An infection can be acquired via a
single bite

23. A female mosquito that takes a blood
meal from a person infected with dengue
fever becomes itself infected with the virus
in the cells lining its gut.
About 8–10 days later, the virus spreads to
other tissues including the mosquito's
salivary glands subsequently released into
its saliva.

24. Dengue can also be transmitted via
infected blood products and through
organ donation
Vertical transmission (from mother to
child) during pregnancy

25. mosquito carrying dengue virus bites a
person
the virus enters the skin enters white blood
cells
reproduces inside the cells while they
move throughout the body

26. Warning signs
Abdominal pain
Ongoing vomiting
Liver enlargement
Mucosal bleeding
High hematocrit with low platelets

27. cell cultures, nucleic acid detection
antibodies (serology)
Tests for dengue virus-specific antibodies,
types IgG and IgM, can be useful in
confirming a diagnosis

28. oral rehydration therapy
administration of intravenous fluids
intramuscular injections
Paracetamol (acetaminophen) is
used for fever

29. Ading insecticides or biological control
agents
wearing clothing that fully covers the skin
using mosquito netting