Chikungunya is an arboviral disease transmitted by Aedes mosquitoes that causes fever and severe joint pain. It was first identified in Tanzania in 1952 and has since caused outbreaks in Asia and Africa. India saw a major outbreak in 2006 with over 1.5 million cases reported. Clinical symptoms include high fever, joint pain and swelling, rash, and fatigue. While rarely fatal, the joint pain can last for months in some cases. Diagnosis is confirmed through serological tests showing IgM or IgG antibodies. There is no vaccine or antiviral treatment, so care is supportive with rest, hydration, and pain medication. Prevention relies on controlling mosquito populations and avoiding bites.

1. Chikungunya
Dr.Shibasish Banerjee
MBBBS,MD(COMMUNITY MEDICINE)

2. 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

3. 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

5. 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

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

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

8. 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.

9. Case Definition by NVBDCP
• Probable or suspected case: a patient meeting
the clinical criteria only
• Confirmed (definitive) case: a patient meeting
both the clinical and laboratory criteria

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. Differential Diagnosis
• Dengue Fever
• Malaria
• Leptospirosis
• Enteric Fever
• Rheumatic Fever
• Reactive arthritis
• Serum sickness illness
• Rickettsial disease

13. 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)

14. 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

15. 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

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

17. Continued….
• Refer sooner at extreme of age, pregnancy
and significant comorbid illness

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

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

20. Thanks……