(1) Chikungunya is a viral illness transmitted through mosquito bites that causes fever and severe joint pain. (2) It was first documented in an outbreak in Tanzania and has since spread throughout Africa and parts of Asia. (3) There is no vaccine or specific treatment, so prevention through mosquito control and protection from bites is the primary strategy to control the disease.

1. CHIKUNGUNYA
Kuldeep Vyas
Asst. Prof. Community Health Nursing
1Kuldeep Vyas M.Sc. CHN

2. I DON’T GET IT
 Chikungunya (has nothing to do with chickens) is
pronounced “Chik-un-goon-ya” or“Chik–un-gun-ya”
2Kuldeep Vyas M.Sc. CHN

3. Introduction
Chikungunya fever (CF) is a viral illness
caused by an arbovirus transmitted by the
Aedes mosquitoes.
The disease was documented first time in the
form of an outbreak in Tanzania.
The name is derived from the ‘makonde’
dialect which means ‘that which bends up’,
indicating the physical appearance of a
patient with severe clinical features. The fever
locally also named as ‘LangraJor’
3Kuldeep Vyas M.Sc. CHN

4. OBJECTIVES
 Historical epidemiology of CHIKUNGUNYA
 What is CHKV
 Clinical presentation
 Vector borne diseases, Differential Diagnosis,
Transmission
 At risk groups ,Dengue /CHIKV dengue snapshot
 Treatment
 Prevention
4Kuldeep Vyas M.Sc. CHN

5. Historicalepidemiology
 A viral infection transmitted to humans by the bite
of an infected mosquito
 It has become endemic in south and central India
 Chikungunya (CHIK) virus first isolated from the
serum of a febrile human in Tanzania in 1953.
 Chik virus has caused numerous out breaks in
Africa and South Eastern Asia,
5Kuldeep Vyas M.Sc. CHN

6. A disease of Africa andAsia
.
6Kuldeep Vyas M.Sc. CHN

7.  French island of Réunion in the Indian Ocean-
2005
 After an extensive outbreak during the beginning
of current millennium in the French territory of
Reunion Islands in the Indian Ocean, the disease
has been reported from almost 60 countries from
various WHO regions including South-East Asia
 Chikungunya virus strains isolated in India during
the 2004-2006 outbreaks are closely related to
strains isolated from Réunion islands
7Kuldeep Vyas M.Sc. CHN

8. Why is this sudden epidemic ?
 Analysis of the recent Indian epidemic
has suggested that the increased
severity of the disease is due to a
change in the genetic sequence, altering
the virus’ coat protein, which potentially
allows it to multiply more easily in
mosquito cells*.
8Kuldeep Vyas M.Sc. CHN

9. THE CHIKUNGUNYA VIRUS
9Kuldeep Vyas M.Sc. CHN

10. The CHIK Virus
 Causative agent is an RNA – VIRUS
 Class – Arbor Virus (Arthropod Borne)
 Family – Togaviridae
 Genus – Alpha Virus
 Species – Chikungunya Virus
10Kuldeep Vyas M.Sc. CHN

11. CHIKUNGUNYAVIRUS
spread by bite of Aedes aegypti
mosquito which usually bite during
day light hours.
 the name is derived from Swahili
word meaning “that which bends
up”.
Describes the posture patient
assumes to relieve the severe joint
pains
11Kuldeep Vyas M.Sc. CHN

12. TheVector
 Aedes aegypti mosquito, flight range < 100
meters
 Aggressive daytime biter – under lights – bites
ankles
 Once infected – it has the virus until death (30
days)
 It is a man made mosquito – prefers its owner
Breeds in man made household containers
Indoor, peridomestic, fresh water mosquito
Metallic, plastic, rubber, cement and earthen
containers open, left or unused - get filled with
water 12Kuldeep Vyas M.Sc. CHN

13. Aedes aegypti/alboptycus/Tiger mosquito
13Kuldeep Vyas M.Sc. CHN

14. Transmission
 This virus is transmitted only by mosquitoes
 The mosquito picks up the virus from an
infected person during the viraemic period –
within five days from the day of starting of
symptoms
 An infected mosquito will remain infected all
its life span and can transmit the virus each
time it bites
 An infected person cannot spread the
infection directly to other persons
14Kuldeep Vyas M.Sc. CHN

15. Transmission
15Kuldeep Vyas M.Sc. CHN

16. CLINICALFEATURES
CHIKV Infection a disease of two phases
ACUTE :
o Incubation period: 3–7 days (range of
1‒12 days).
o Main symptoms: acute onset of fever and
polyarthralgia
CHRONIC :
o Early exacerbations, inflammatory
relapses, longstanding rheumatism and
loss in quality of life
16Kuldeep Vyas M.Sc. CHN

17. Fever and polyarthralgia
 Fever
 Acute onset
 ≥38.5°C
 Joint pain
 Sometimes serious and debilitating
 Multiple joints
 Bilateral and symmetric (usually)
 Most commonly in hands and feet
17Kuldeep Vyas M.Sc. CHN

18. 18Kuldeep Vyas M.Sc. CHN

19. Subacute stage, persisting distal inflamatory arthralgias
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20. Subacute stage, tenosynovitis
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21. Subacute stage, bursitis
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22. Subacute stage, associated rheumatic disorders
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23. Other signs and symptoms
 Headache
 Myalgia
 Arthritis
 Conjunctivitis
 Nausea and vomiting
 Maculopapular rash
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24. Skin Rash in CHIKV
.
24Kuldeep Vyas M.Sc. CHN

25. TheArthralgia
.
 The small joints of the lower and upper limbs
 Migratory poly arthralgia – not much effusions
 Larger joints may also be affected (knee, ankle)
 Pain worse in the morning – less by evening
 Joints may be swollen & painful to the touch
 Some patients have incapacitating joint pains
 Arthritis may last for weeks or months.
25Kuldeep Vyas M.Sc. CHN

26. .
The Contorted Posture
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27. Outcome
 Acute symptoms: resolved in 7-10 days
 Mortality: rare (elderly)
 Some patients have relapses of rheumatic
symptoms in the months following the acute
illness
 Chronic illness of varying degrees, with pain
persisting for months or years
 Life long immunity, once one suffers this infection
27Kuldeep Vyas M.Sc. CHN

28. Who are at greater risk ?
.
 Pregnant women
 Elderly people
 Newborns
 Women in general
 Diabetics
 Immuno-compromised patients
 Patients with severe chronic illnesses
28Kuldeep Vyas M.Sc. CHN

29. COMPLICATIONS
 However, neurological complications such as
meningoencephalitis have been reported in a
small proportion of patients
 Mother to child transmission of chikungunya
virus was a new observation recorded during the
recent French Reunion islands outbreak
29Kuldeep Vyas M.Sc. CHN

30. WHO case definitions
30Kuldeep Vyas M.Sc. CHN

31. DIAGNOSIS
The diagnostic tests include detection of
antigens or antibodies in the blood, using
 ELISA (or EIA - enzyme immunoassay)
 polymerase chain reaction (PCR).
31Kuldeep Vyas M.Sc. CHN

32. Pregnancy and CHIKV
.35
 Mother to fetus transmission can occur
 Reported between 3 to 4.5 months of gestation
 Maternal IgG develops in 2 weeks after CHIKV
 This passes through placenta – confers
protection
 Neonatal infections are very mild; fully recover
 No miscarriages or congenital malformations
32Kuldeep Vyas M.Sc. CHN

33. Differential Diagnosis
 (1) Dengue fever: Severe backpain with purpuras or
active bleeding might suggest dengue fever.
Confirmatory laboratory diagnosis is possible.
 (2) Reactive Arthritis: In general, any arthritis that
follows a febrile gastrointestinal or genitourinary
infection (triggering microbes) is considered a reactive
acute inflammatory arthritis if it lasts less than six
months. The hallmark feature is enthesitis Oral
mucosal ulcers are seen.
 (3) Serum sickness illness: Polyarthritis may be
associated with a serum sickness type reaction
caused by vaccine, medication or other viral infections
 (4) Rickettsial disease can present with fever, rash
and joint pains. Confirm by serology.
33Kuldeep Vyas M.Sc. CHN

34. Differential Diagnosis
 (5) Rheumatic fever: More common in the children and
presents with fleeting (migratory) polyarthritis
predominantly affecting the large joints. Modified Jones
criteria should be the basis for diagnosis. Raised ASO titre
and a history of recurrent sore throat are other points to be
noted.
 (6) Malaria: patient can present with high fevers and may
also complain of joint pains. Periodicity of fever and
alteration of consciousness / seizures should prompt a
diagnosis for malaria
 (7) Leptospirosis: Severe myalgia localized to calf
muscles with conjunctival congestion/ or subconjunctival
haemorrhage with or without oliguria or jaundice in a
person with history of skin contact to contaminated water
would suggest Leptospirosis 34Kuldeep Vyas M.Sc. CHN

35. Jaundice
Renal failure
Fever
Myalgia
Rash
Bleedings
DENGUE
FEVER
Retro-orbital pain
Transient arterial
hypotension
CHIKUNGUNYA FEVER
Acute polyarthritis
Tenosynovitis
MALARIA
Anemia
LEPTOSPIROSIS
BACTERIAL
SEPSIS
Myalgia
Myocarditis
ADRS
Chikungunya outbreak, high risk for misdiagnosis
35Kuldeep Vyas M.Sc. CHN

36. Dengue and CHIK
 Virus transmitted by the same mosquitos
 Similar clinical picture
 The viruses can circulate in the same
areas–- co-infection
 Discarding dengue is important, for an
adequate clinical care that improves the
prognosis of dengue
36Kuldeep Vyas M.Sc. CHN

37. 37Kuldeep Vyas M.Sc. CHN

38. Differential Diagnosis
41
Feature CHIKV DENGUE
Presentation A+F ± mild rash A+F+Rash
Arthralgia Moderate Severe
Arthritis Not common Frequent
Bone pains None Break bone fever
Thrombocytopenia Mild (Not < 1K) May be severe
Hemorrhage None May be present
Shock syndrome Never May occur
Immunity (IgG)
.
Life long 2nd attack fatality
38Kuldeep Vyas M.Sc. CHN

39. Treatment
39Kuldeep Vyas M.Sc. CHN

40. Treatment
.43
 There is no specific treatment for
CHIKV
 No vaccine or preventive pill is
available
 The illness is usually self-limiting
 Symptomatic treatment only
40Kuldeep Vyas M.Sc. CHN

41.  Mild movements of joints
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42.  Rest to the patient
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43.  Cold compresses to inflamed joints
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44.  Liberal fluid intake or IV fluids
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45.  Analgesics and NSAIDS
 Paraetamol ± Ibuprofen or aceclofenac or
diclofenac
 Naproxen sodium (Naprasyn, Xenobid)
 Aspirin should be avoided
45Kuldeep Vyas M.Sc. CHN

46. PREVENTION
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47. ANTI-LARVALMEASURES
 SOURCE REDUCTION OF BREEDING
PLACES
o Elimination of stagnant water at home, schools
and work place to avoid breeding of
mosquitoes.
47Kuldeep Vyas M.Sc. CHN

48. BREEDING SOURCES
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49. 49Kuldeep Vyas M.Sc. CHN

50. 50Kuldeep Vyas M.Sc. CHN

51. BIOLOGICAL CONTROL
 Introduction of larvivorous fish, namely
Gambusia and Guppy in water tanks and
other water sources.
51Kuldeep Vyas M.Sc. CHN

52. ANTI-ADULTMEASURE
 The organophosphorous insecticide ABATE is
being used in a large scale
 It does not affect man or the taste of water
 Aerosol spray of ultra low volume [ULV] of
MALATHION or SUMITHION 250 ml/hectare is
effective in interrupting transmission and
stopping epidemics
52Kuldeep Vyas M.Sc. CHN

53. • Wearing the long sleeved clothes like long
trousers of a light shade for protection against
mosquitoes.
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54.  Using insect repellents over the exposed parts of the
body.
• Using mosquito screens or nets in non – Air-
conditioned rooms
54Kuldeep Vyas M.Sc. CHN

55. CONCLUSION
 Chikungunya disease is expanding throuout
the world;
 The spread of the disease depends on the
distribution of its vectors;
 The disease is rarely fatal, but can impose a
heavy burden on the health systems.
 Prevention is the target as it has no specific
treatment.
 Vector reduction is the ultimate way to prevent
Chikungunya
55Kuldeep Vyas M.Sc. CHN

56. 56Kuldeep Vyas M.Sc. CHN