Chickungunya - dr

‘Chikungunya –A short
Chikungunya’
presentation with Salient
Features

Dr.G.C.Sahu/ROH&FW/GoI/Ahmedabad
Dr.G.C.Sahu/ROH&FW/GoI/Ahmedabad 1

Chikungunya is a relatively rare form of viral
fever caused b an alpha virus that i spread b bi
f d by l h i h is d by bites
of the Aedes aegypti mosquito.

The name i derived from the M k d word
Th is d i d f h Makonde d
meaning "that which bends up" in reference to the
stooped posture developed as a result of the arthritic
symptoms of the di
f h disease.

The disease was first described by Marion
R bi
Robinson and W H R L
d W.H.R. Lumsden i 1955, following an
d in 1955 f ll i
outbreak on the Makonde Plateau, along the border
between Tanganyika and Mozambique in 1952.

Chikungunya is closely related to O'nyong'nyong
virus

Chikungunya is not considered to be fatal…..but
can be debilitating.


Synonyms
CHIKV Fever
Buggy Creek virus infection
Knuckle fever
Me Tri virus infection
Semliki Forest virus infection


Chikungunya is spread by the bite of an Aedes mosquito,
p
primarily Aedes aegypti species.
y gyp p

Humans are thought to be the major source or reservoir of
chikungunya virus for mosquitoes.

Therefore, the mosquito usually transmits the disease by
biting an infected person and then biting someone else.
else

An infected person cannot spread the infection directly to other
Persons (i.e. it is not a contagious disease).

Aedes aegypti
gyp
mosquitoes bite during the day time.

4

Chikungunya occurs mainly in Africa, India, and Southeast
Asia.
Asia There have been a number of outbreaks (epidemics) in
the Philippines and on islands throughout the Indian Ocean.

Humans act as very efficient reservoirs for the virus.
chikungunya is most prevalent in urban areas. Currently the
d sease s being epo ted o
disease is be g reported from rural a eas a so due to t e
u a areas also the
proliferation of this vector as a result of life style change among
rural population. Epidemics are sustained by the human-mosquito-
human-mosquito-
human transmission cycle.
cycle

Anyone who is bitten by an infected mosquito can get
chikungunya.
hik

Widespread poverty, year-round tropical climate, environ-
year- environ-
mental disturbance due to war or natural disaster and lack of
public health infrastructure are some of the factors that promote
uncontrolled mosquito breeding and is condusive to
outbreaks of chikungunya,

Epidemiological Triangle

The Environment
The Vector

Interaction
I t ti

The Virus The Host

The Indian Epidemic
The last Indian epidemic started in Nov 2005.
Andhra Pradesh, Karnataka, Maharashtra,
Madhya Pradesh, Odisha, Gujarat, Tamilnadu,
j
Rajasthan, Kerala came under its onslaught.
The epidemic spread far and wide at a rapid
rate but northern states like Delhi, Haryana,
t b t th t t lik D lhi H
Punjab remained mostly unaffected.
There was not much cry from U.P. and Bihar
UP
either.

8

Symptoms
S t

The symptoms of chikungunya include:

•Fever which can reach 39 °C,
C

•A petechial or maculopapular rash
usually involving the limbs and trunk,

•Arthralgia or arthritis affecting multiple
g g p
joints which can be debilitating.

•There can also be headache,
headache
conjunctival suffusion and slight
photophobia.


Clinical Features
Incubation period is 2-12 days; usually 3-7
2- 3-
days.
Viremia last for 5 days (infective period).
Silent CHIKV – inapparent infections in children
Flu-
Flu-like symptoms, Severe headache and chills.
High grade fever (40°C or 104°F).
(40° 104°
Arthralgia or arthritis – lasting several weeks.
g g
Conjunctival suffusion and mild photophobia.
Nausea, vomiting, abdominal pain, severe
weakness.


The Arthralgia
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.


Course of illness
Fever typically lasts for 2 - 3 days and comes down.
Fever may reoccur after 3 days – ‘saddle back’ fever.
Some rare cases - fever lasts up to a couple of weeks.
weeks
Patients do have prolonged fatigue for several weeks.
High fever & crippling joint pain marked the last Indian
epidemic.
Joint pain, intense headache, insomnia and an extreme
deg ee of prostration ay as o
degree o p os a o may last for 5 to 7 days.
o days
Life long immunity, once one suffers this infection.


Who are at greater risk ?
Pregnant women
P t
Elderly people
Newborns
Women in general
Diabetics
Immuno-
Immuno-compromised patients
Patients with severe chronic
illnesses
ill


Differential Diagnosis
Dengue fever, DHF, DSS.
O nyong
O’nyong-nyong viral fever
O’nyong- fever.
Sindbis viral fever.
Other non specific viral fevers.
Any other acute fever like
malaria, UTI etc.


DIAGNOSIS

Chikungunya is diagnosed by blood tests.

Since the clinical appearance of both
Si th li i l f b th
chikungunya and dengue are similar, laboratory
confirmation is important, especially in areas where
p p y
dengue is present.

Key Diagnostic Tests.

Detection of antigens or antibody to the agent in
the blood (serology)

ELISA is available

An IgM capture ELISA is necessary to distinguish
the disease from dengue fever.
g
15

Treatment….
Treatment
There is no specific treatment for CHIK VV.
Symptomatic treatment only.
No vaccine or preventive pill is available .
The illness is usually self-limiting.
self-
It will resolve with time over a week to 10
days.
No relapses occur – no second attacks.
Convalescence may take longer.
Infected persons should be isolated from mosquitoes in as
much as possible in order to avoid transmission of infection to
other people.

16

Treatment….
Treatment
Rest to the patient and mild movements of joints.
Cold compresses to inflamed joints.
Liberal fluid intake or IV fluids.
Analgesics and NSAIDS:
Paraetamol ± Ibuprofen or aceclofenac or diclofenac .
Naproxen sodium (Naprasyn, Xenobid).
Aspirin should be avoided
Hydroxy chloroquine sulphate (HCQS) 200 mg/OD or
chloroquine p
q phosphate 250 mg/OD may supplement
p g/ y pp
alleviating the acute symptoms.
The role of steroidal preparations in easing the acute
symptoms is still debatable.
y p

17

What not to give ?
No indication for antibiotics.
Never use costly, large spectrum
drugs.
No indication for long acting steroids
No indication for short term steroids
also in the acute phase of illness.
Rarely, if the joint swelling persists –
we may consider use of steroids in
short burst.


Although it may feed at any time, the mosquito's periods
of peak biting activity are few hours after dawn and in the late
afternoon until a few hours after dark.
The mosquito's preferred breeding areas are in areas of
stagnant water, such as flower vases, uncovered barrels,
g , , ,
buckets, and discarded tires, but the most dangerous areas are
wet floors, underground tanks, cement tanks and also toilet
bowls, as they allow the mosquitos to breed right in the
residence.


…..THE VECTOR IS AN
AGGRESSIVE BITER…AND
MOSTLY BITES DURING DAY
TIME……. WITH A PAINFUL
STING.

……..JUST WATCH THE
JUST
FEROCITY OF THE STING


…… HER PARAPHRENALIA

THE
PLOT IS
HATCHED
MOSTLY
UNDER
WATER !!!


…AND THE CYCLE GOES ON

ONE GENERATION
IS BORN ROUGHLY EVERY
WEEK
EVERY THING IN A
PLATTER !!!


URBAN BREEDING
SITES
(Now a days also found in
rural settings)
23

PERSONAL PROPHYLACTIC MEASURES-
MEASURES-
PREVENTION OF MOSQUITO BITES

WEAR FULL SLEEVED CLOTHS, LONG DRESSES THAT COVER THE
CLOTHS
ARMS AND LEGS DURING THE OUTBREAKS.

USE INSECT REPELLENTS WHILE SLEEPING AT NIGHT
NIGHT.

TAKE ADDITIONAL CARE OF CHILDREN AND ELDERLY.

USE MOSQUITO COILS/ELECTRIC VAPOUR MATS.

USE MOSQUITO NETS ESPECIALLY TO PROTECT BABIES AND OLD
PEOPLE.

KEEP PATIENTS PROTECTED FROM MOSQUITO BITES IN ACUTE
PHASE WHICH WILL REDUCE NO.OF INFECTIVE MOSQUITO
POPULATION.


PREVENTION OF MULTIPLICATION OF MOSQUITO

DRAIN WATER FROM COOLERS.TANKS,BARRELS,DRUMS AND
BUCKETS ETC.

COOLERS SHOULD BE EMPTIED OF WATER WHEN NOT IN USE.

UNUSED WATER CONTAINING OBJECTS/HOLDING OBJECTS
SHOULD BE REMOVED FROM HOUSE HOLDS.

WATER SHOULD BE REMOVED FROM REFRIGERATER DRIP OPANS
EVERY OTHER DAY
DAY.

ALL USABLE AND STORED WATER COINTAINERS SHOULD BE
KEPT COVERED ALLTHE TIME.

CLEAN UP THE TERRACE, DISCARD SOLID WASTE FROM THE
SORROUNDINGS.


TAKE LONG TERM MEASURES

INITIATE RECOMMENDED VECTOR CONTROL
MEASURES.

IDENTIFY AND MAP OUT THE HIGH RISK AREAS FOR
PRIORITISATION OF AREA SPECIFIC STRATEGIES.

PATIENTS SHOULD BE TREATED IN NEARBY HEALTH
/HOSPITALS.

EFFECTIVE HEALTH EDUCATION CAMPAIGNS AND
FIELD SUPERVISION
SUPERVISION.


ELIMINATION OF AEDES
AEGYPTI
BREEDING SITES---
SITES---
THE INITIATIVE
MOSTLY LIES WITH
INDIVIDUALS/COMMUNITY


Is Bangalore in the grip of chikungunya?
[ Saturday, A il 08 2006 12 33 46 am TIMES NEWS
S t d April 08, 12:33:46
NETWORK ]

BANGALORE: The Aedes aegypti mosquito that causes chikungunya now seems to
have bitten Bangaloreans. At least 15 persons, suspected to be suffering from the viral
infection, have been admitted to the Epidemic Diseases (ED) Hospital ………. At least
80,000 people in Gulbarga, Tumkur, Bidar, Raichur, Bellary, Chitradurga,
Davanagere, Kolar and Bijapur are affected since December 2005.

Back after 32 yrs, dengue-like fever: chikungunya
Toufiq Rashid
Indian Express.. Thursday, April 27, 2006 at 0000 hrs
Mosquito carrier, not known to be fatal, cases sweep Andhra, Karnataka
NEW DELHI, APRIL 26: Thirty two years after its last outbreak in India, chikungunya is back. A relatively rare viral fever with dengue-like
symptoms, chikungunya has been sweeping Andhra Pradesh, Karnataka and Maharashtra.
In the last three months, the official count of the affected has climbed to a staggering 1.5 lakh people and Health officials concede that
figures on the ground may be higher.
Caused by an alphavirus spread through bites from the Aedes Aegypti mosquito—the same mosquito behind dengue—chikungunya is not
considered fatal. But 77 deaths since 2005 on the Indian Ocean island of Reunion have been linked to chikungunya.
Health officials in Delhi said the last outbreak in the country was reported in 1974. “The
virus must have been silent but it has made a comeback,”

28

Knowing is not enough; we must apply.
Willing is not enough; we must do
do.
(Goethe)

GOVT EFFORTS
COUPLED WITH
THE PUBLIC
PARTICIPATION….
PARTICIPATION….
IS THE KEY.
KEY.

Acknowledgements:
Acknowledgements:
g
• WHO
• CDC
• NVBDCP
• NCDC
• JD(NVBDCP),Gandhinagar.
( ), g
• Dy.Director(Epidemic),Gandhinagar
• Dr. R.V.S.N.Sarma. (Canada)

…….. THANKS

Chickungunya - dr

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