Review of control efforts for Chikungunya in New Delhi

1. Review of
Control Efforts for
Chikungunya
in New Delhi
Presenter: Dr Des K. Raj
Moderator: Dr Dinesh Kumar
Dated: 21st October 2016

2. Introduction
• RNA virus Disease: Alpha virus, an arbovirus of
Togaviridae family
• Transmitted from human to human
• Vector : Aedes aegypti and A. albopictus
• Causes: High grade fever, petechial/ maculopapular
rash, severe joint and muscle pain and headache
• High morbidity but minimal mortality
• Usually provides lifelong immunity, self limiting
• Endemic in Africa, Asia

3. Epidemiology: Global
• First outbreak reported in Makonde Plateau
in 1952
• Bangkok(1960s),Sri Lanka(1969),Vietnam and
Myanmar(1975), Indonesia( 1982)
• India: Calcutta(1963), Madras(1964),
Maharashtra(1973)

7. Definition of an outbreak
• Rural area
– If no. of fever cases is 5 or more in a village during a
period of 7 days
• Urban area
– 5 or more in a locality with a population of 10,000 to
15,000 during 7 days

8. Current epidemic: India
• 2015: 99913 cases with 220 deaths (2.2%)
• 2016: 27879 cases with 60 deaths (2.1%)
• Spurt due to cyclical trend, may be at peak of
7-8 year cycle
• May cause encephalitis

10. Epidemic: New Delhi
148
202
57
0
50
100
150
200
250
North Delhi South Delhi East Delhi
CasesinNumbers

11. Re-emergence
• Susceptible population
• Viral mutation
• Increased air travel, tourism
• Cyclical peak
• Population explosion
• Global warming
• Unplanned urbanisation
• Inadequate sanitation

12. Reporting of an outbreak
• NVBDCP: Community based fever surveillance
• IDSP: Community based reporting
• New Delhi:
– Hospital based
– Media reporting
– Community based surveillance and reporting as a
passive effort

13. Vector : Aedes mosquito
• A. aegypti, A. albopictus, A. africanus, A.furcifur-
taylori, A. luteocephalus
• Climate tropical: 27*c
• Life span of adult mosquito: 15 days
• Habitat: Indoor-living rooms, offices, business
places, in isolated containers
• Flying capacity: 100 meters
• Bite: Only the female mosquito bites
– Powerful bites / fearless bites/ day time
– Bites 3 to 4 times for a satisfactory meal

14. Breeding habits
Artificial accumulation
of water in:
• Discarded tins
• Fire brackets
• Flower pots
• Coconut shells
• Earthen pots
• Tree holes
• Rubber containers
• Broken bottles
• Plastic containers

15. Symptoms
• Fever upto 104
• Petechial/maculopapular rash
• Arthropathy
• Headache
• conjuctival infection
• Mild photophobia, iridocyclitis, retinal lesions
• Poedal oedema unrelated to cardio-hepato-
renal abnormalities

16. Case Definition
 Suspected case
An acute illness characterized by sudden onset of fever with:
myalgia, headache, backache, photophobia, arthralgia, rash
 Probable case
As above and Occurrence at same location and time as other
serologicaly confirmed cases of chikungunya
 Confirmed case
A probable case with any of the following:
o Four fold IgG antibody difference in paired serum
samples
o Detection of IgM antibodies
o Virus isolation from serum
o Detection of Chikungunya virus nucleic acid in sera by
RT-PCR

17. A. Management
• Early Case reporting
Fever alert surveillance:
• all fever cases to be reported
• Fever clinic in 262 dispensories, 106 mohalla clinics and
26 Delhi Government hospitals
Sentinel Surveillance sites with laboratory support :
• 33 sentinel surveillance sites using CHIKV specific IgM
ELISA test kits for diagnosis and RT-PCR and line listing
of cases
• NIV Pune is Apex laboratory

18. Strengthening of referral services:
• AIIMS and NCDC as Apex referral centers
• All hospital to remain open till 30 October
• Free diagnosis and treatment
Involvement of Private sector in sentinel surveillance:
private hospital and nursing homes permitted to increase bed
capacity
All institutes to send report to Government
• Case management : Guidelines issued
• Bed strength increased: 10% beds for fever cases and
1000 additional beds
Epidemic preparedness and rapid response: 12 RRT
constituted

19. B. Integrated vector management
• Entomological Surveillance including larval surveys:
Zonal entomological teams
3500 domestic breeding checkers, checks 60-70 houses/day
• Anti-larval measures
– Biolarvicide power sprays
– fish in 120 water bodies

20. B. Integrated vector management
• Anti- adult measures
– Indoor Space Spraying with Pyrethrum extract (2%)
– Fogging during outbreaks: once in 10 days for 2 hours
twice a day, since August
– Personal protection measures
– Protective clothing
– Insecticide treated bed nets and repellents: in July

21. C. Supporting Interventions
• Human Resource Development through capacity
building
• Behaviour Change Communication (BCC)
• Activities during anti dengue/ Chikungunya months
• Inter-sectoral coordination
• Supervision and Monitoring
• Coordination Committees
• Legislative support: Challans of civic bodies for having
mosquito breeding places: MTNL office, Hindu Rao Hospital,
Delhi Jal Board

22. Thank you