public health concern

1. Dr. sayeed
MBBS(DMC)

2. AIM
To highlight
Chikungunya
virus,epidemiology,
clinical
feature,diagnosis,
treatment,
preventive
measurers and
recommendation.

3. SCOPE
 What is Chikungunya?
 Chikungunya virus.
 History
 Transmission
 Clinical feature
 Morbidity & mortality
 Diagnosis
 Diffential diagnosis
 Treatment
 Diffenence between chikungunya & dengue fever
 Prevention
 Recommendation
 Conclusion

4. What is Chikungunya ?
 Chikungunya name derived from Swahili word “that
which bends up. in reference to the stooped posture
Manifest with Crippling Arthritic disease of sudden
onset.
 Virus isolated in 1953 from serum and Aedes
mosquitoes and Culex spp

5. Chikungunya a Mosquito
transmitted viral infection

6. Chikungunya Virus
 Group-ssRNA
 Family – Togaviridae
 Genus - Alpha virus
 Species-
Chikungunya virus
 Chikungunya viral
infection manifests
with febrile illness

7. History
 The disease was first described by Marison Robinson
and W.W.R Lumsden in 1955,following an outbreak in
1952 in Tanzania(between Mozambique and
Tanganyika)
 Since its discovery in 1952, chikungunya virus outbreak
have occurred occasionally in Africa,South Asia and
Southeast Asia.

8. Transmission
 Chikungunya fever is primarily transmitted by bites of
mosquitoes of the genus Aedes,the same mosquito
that transmits Dengue fever.only female mosquitoes
are infective.
 Of two vectors in Asia,Aedes aegypti is believed to be
the principal vector .
 Human and non-human vertebrates serve as the
chikungunya virus reservoir.

9. Clinical Feature
 Fever : A period of fever may be
followed by an afebrile phase
and then recrudescence of fever
 Arthritis: Adults are susceptible
to arthritis which causes early
morning pain and swelling most
often in the small joints.
 Back pain
 Headache
 Maculopapular rash
 Anorexia, nausea and vomiting
 Myalgia

10. Who are at greater risk
 Elderly people
 Newborns
 Women in general
 Diabetics
 Immuno-comprommised patients
 Patients with severe chronic illness

11. Morbidity and Mortality
 Fatalities are rare and when they occur are associated
with either with young age or with Thrombocytopenia
 Hemorrhagic version of illness, that can lead to shock

12. Diagnosis
 Isolation of Virus
 Demonstrating of four fold or greater rise in antibody
titre.
 ELISA testing for IgM antibody.
 Diagnosis by RT-PCR Test
 The antibody titre will be positive after 5th day of
illness only.

13. Diffential diagnosis
 Dengue
 Group A streptoccus
 Leptospirosis
 Rubella
 Measles
 Post infectious arthritis
 Other alphavirus infections e.g. Sindbis viurs,O’nyong-
nyong virus,Ross river virus and Mayaro virus

14. Treatment
 Chikungunya fever is not a life threatening infection.
Symptomatic treatment for mitigating pain and fever
using anti-inflammatory drugs along with rest usually
suffices
 Rest to the patient and mild movements of joints
 Liberal fluid intake or iv fluids
 Analgesics and NSAIDS
 Antipyretic

15. Difference between Chikungunya & Dengue
Clinical signs chikungunya dengue
Fever Common Common
Rash Day 1- Day 4 Day 5-Day 7
Retroorbital pain rare common
Arthralgia Constant rare
Myalgia common common
Arthritis Common,edematous absent
Tenosynovitis common absent
Hypotension possible common
Minor blededing rare common
Thrombocytopenia Early and mild Delayed and moderate to
severe

16. How Chikungunya can be
Prevented
 There is neither Chikungunya virus vaccine nor drugs are
available to cure the infection. Prevention, therefore,
centers on avoiding mosquito bites. Eliminating mosquito
breeding sites is another key prevention measure. To
prevent mosquito bites, do the following:
 Use mosquito repellents on skin and clothing
 When indoors, stay in well-screened areas. Use bed nets if
sleeping in areas that are not screened or air-conditioned.
 When working outdoors during day times, wear long-
sleeved shirts and long pants to avoid mosquito bite.

17. Chikungunya case in Bangladesh
 First indentified outbreak of chikungunya in
Bangladesh,2008 (Health and Science Bulletin,volume
7.March 2009)
 39 case in Rajshahi and Chapainawabganj- confirmed
from laboratory at ICDDR,B. (Nov 23,2011)

18. Recommendation
 Preventive measures for vector control
 Awareness of CHIKV through mass media, TV, Radio,
News paper
 Involvement of NGOs in integrated systemic approch
 Special campaigns for public awareness
 Assurance to the public about the disease morbidity
and mortality
 Planned approach, besides knowledge and awareness
of early warning signs, for prevention.

19. Conclusion
 In recent years there have been explosive outbreak of
chikungunya fever in several parts of the sea
region.Although the disease is self-limiting, morbidity,
can be very high in major outbreaks resulting in heavy
social and economic toll.Integrated vector
management through the elemination of breeding
sites,use of anti-adult and anti-larval measures and
personal protection will contribute to prevent an
outbreak.