UChicago CMSC 23320 - The Best Commit Messages of 2024
Chikungunya-Brief-DCS-29Jul2014.ppt
1. Announcements
Register for the Monthly Disease Surveillance Trainings to receive CMEs/CNEs:
– Log-on or Request log-on ID/password: https://tiny.army.mil/r/zB8A/CME
– Register for Epi-Tech Surveillance Training: https://tiny.army.mil/r/dVrGO/EpiTechFY14
Communicate with your Service surveillance hub to ensure you get information on future
trainings: POC info in chat box
Confirm attendance for today’s training:
– Enter your name/service into chat box or email your Service hub
– You will receive a confirmation email within the next 48 hours; If you do not receive this
email, please contact us
PLEASE put your phones on mute when not speaking
3. Navy and Marine Corps Public Health Center 2
Chikungunya
Objectives:
1. Chikungunya (CHIK) mosquito vectors: behavior, vector competence and
other relevant factors for CHIK surveillance and control.
2. Installation pest and vector management program requirements
and how to enhance those programs for CHIK response.
3. Enhanced clinical surveillance and reporting recommendations (AFHSC
and Service recommendations).
4. Navy and Marine Corps Public Health Center 3
Chikungunya
Mosquito Vectors:
• Aedes aegypti (yellow fever mosquito).
• Aedes albopictus (Asian tiger mosquito).
• Vector identification:
5. Navy and Marine Corps Public Health Center 4
Chikungunya
CONUS Mosquito Vector Distribution:
Aedes aegypti (yellow fever mosquito) Aedes albopictus (Asian tiger mosquito)
6. Navy and Marine Corps Public Health Center 5
Chikungunya
Disease vector competence:
• Three described genotypes of CHIKV
• West African
• East/Central/South African (ECSA)
• Asian
• Ae. aegypti & Ae. albopictus are competent for all genotypes of CHIKV.
• Caribbean/Americas have experienced local transmission of Asian strain.
• Although Ae. aegypti more competent, Ae. albopictus is a competent vector
for the Asian strain.
• The spread of CHIK and threat to CONUS US is real
7. Navy and Marine Corps Public Health Center 6
Chikungunya
Disease vector surveillance:
• Both vectors are active during daylight hours
• Particularly morning and late afternoon
• Surveillance must be tailored to vector
• Biogents Sentinel Trap (BGS) or CDC light trap during daylight hours
• BGS superior in terms of attraction/capturing Ae. aegypti and Ae. albopictus
8. Navy and Marine Corps Public Health Center 7
Chikungunya
Disease vector surveillance:
• Per DoD Instruction, all installations are required to have Integrated Pest
Management Plans (IPMPs).
• DODI 4150.07
• Navy: OPNAV 6250.4C; Air Force: AFI 32-1053; Army: AR 40-5
• Service specific guidance/relationships
• IPMPs ideally incorporate emergency vector control plans (EVCPs).
• Military entomologists available to assist with creation & implementation.
• Relationship b/t Medical Departments and Facilities (ie NAVFAC/Public Works) for
surveillance of pests and vectors of public health importance.
• Bottomline: Installation Medical Depts must be familiar with and ensure
disease vector surveillance is conducted.
9. Navy and Marine Corps Public Health Center 8
Chikungunya
Disease vector surveillance and control:
• Common means of assessing Ae. aegypti and Ae. albopictus populations are egg,
larval, adult, or container surveys (i.e. Breteau index).
• See the Navy Entomology Center of Excellence CHIK Vector Surveillance and
Control Plan for more complete details at:
- http://www.med.navy.mil/sites/nmcphc/Documents/program-and-policy-
support/Chik-Vector-Surv.pdf
• NOTE: Source reduction of breeding habitat for these two vectors is of utmost
importance and first line of defense.
• If CHIK cases present near or on installation, larval and adult control should be
implemented, to include chemical control. Contact your POCs for guidance.
10. Navy and Marine Corps Public Health Center 9
Chikungunya
Disease surveillance and control resources:
• Armed Forces Health Surveillance Center recommendations:
- http://www.afhsc.mil/home
• Navy and Marine Corps Public Health Center Chikungunya webpage:
- http://www.med.navy.mil/sites/nmcphc/program-and-policy-
support/Pages/Chikungunya.aspx
• Army: U.S. Army Public Health Command, Chikungunya Fact Sheet:
http://phc.amedd.army.mil/PHC%20Resource%20Library/Chikungunya_FS_18-029-
0714.pdf
• USPHC Army Vector-borne Disease Report:
http://phc.amedd.army.mil/whatsnew/Pages/PublicationDetails.aspx?type=Army%20Ve
ctor-borne%20Disease%20Report
11. Navy and Marine Corps Public Health Center 10
Chikungunya
Disease surveillance and control resources:
• Armed Forces Pest Management Board:
- Chikungunya Preparation:
- http://www.afpmb.org/content/chikungunya-preparation
- Dengue and Chikungunya Vector Control Pocket Guide:
- http://www.afpmb.org/sites/default/files/pubs/techguides/tg47.pdf
• Navy and Marine Corps Public Health Center Chikungunya webpage:
– http://www.med.navy.mil/sites/nmcphc/program-and-policy-
support/Pages/Chikungunya.aspx
• Rutgers-USDAAsian Tiger Mosquito Area Wide Management Project:
- http://www.rci.rutgers.edu/~AWATM/index.html
12. Navy and Marine Corps Public Health Center 11
Chikungunya
Disease surveillance and control:
• Diagnostic considerations: travel, differential diagnoses, dengue considerations
• Suspicious symptoms: acute onset of fever and polyarthralgia, especially travelers
who returned within two weeks from areas with virus transmission
• Can be lab confirmed via:
• Viral isolation
• Detection of viral RNA by RT-PCR.
• Detection of IgM in a single serum sample (collected during acute or
convalescent phase).
• Four-fold increase in chikungunya-specific antibody titers (samples collected at
least two weeks apart).
• Note: Since clinical presentations of chikungunya and dengue are very similar,
dengue must be ruled out. Send blood for serology and/or RT-PCR
13. Navy and Marine Corps Public Health Center 12
Chikungunya
Disease surveillance and control:
• Clinical Diagnostic Testing
• USAMRIID Special Pathogens Laboratory
• NMRC Navy Infectious Disease Diagnostic Laboratory
• If using a non-DoD lab, recommend saving an aliquot of refrigerated serum
• Mosquito surveillance and testing:
• Army: USAPHC regional commands
• Air Force: USAFSAM Epidemiology Consult Service Entomology Program
Information https://gumbo2.wpafb.af.mil/epi-consult/entomology/ Also,
Contact your MAJCOM Entomologist
• Navy: regional NEPMUs and Navy Entomology Center for Excellence
14. Navy and Marine Corps Public Health Center 13
Chikungunya
Disease surveillance and control:
• Report Chikungunya cases via Disease Reporting System internet as “Any Other
Unusual Event” or “Arboviral Encephalitis” depending on Service-specific guidance
• Include in the report: clinical presentation, travel history, hospital admission
status/dates, deployment information
• Report in a timely manner to enable rapid implementation of control measures
• If you suspect a case, call your service surveillance hub
• Can advise on and assist with case investigation, lab testing and vector control
measures
• Know your local civilian reporting requirements as well as what mosquito control
measures localities have in place.
• ***Situation is fluid: expect reporting guidance to evolve ***
15. Navy and Marine Corps Public Health Center 14
Chikungunya
US Navy Points of Contact:
US Navy Entomology Center of Excellence
Jacksonville, FL, USA
E-mail: NECE-FleetSupport@med.navy.mil
(904) 542-2424, DSN: (312) 942-2424
Navy Environmental Preventive Medicine Unit 2
Norfolk, VA, USA
(757) 953-6600; DSN: (312) 377-6600
Navy Environmental Preventive Medicine Unit 5
San Diego, CA, USA
(619) 556-7070, DSN: (312) 526-7070
16. Navy and Marine Corps Public Health Center 15
Chikungunya
US Navy Points of Contact:
Navy Environmental Preventive Medicine Unit 6
Pearl Harbor, HI, USA
(808) 471-0237, DSN: (315) 471-0237
Navy Environmental Preventive Medicine Unit 7
Rota, Spain
DSN: (314) 727-2230
US Naval Facilities Engineering Command ATLANTIC
Norfolk, VA
(757) 322-8000, DSN: (312) 262-8000
17. Navy and Marine Corps Public Health Center 16
Chikungunya
Army Points of Contact:
US Army Public Health Command; Army Institute of Public Health; Entomological Sciences
Program
(410) 436-3613, DSN 584-3613
Email: usarmy.apg.medcom-phc.mbx.pesticide-hotline@mail.mil
Mr. Thomas Burroughs, Manager, Entomological Sciences Program email:
thomas.m.burroughs.civ@mail.mil
US Army Public Health Command PHCR-North Entomological Sciences Division
Fort George G. Meade, MD 20755
Email: PHCR-NorthESD@amedd.army.mil
(301) 677-3932, DSN: 622-3932
Mr. Ben Pagac, Chief, Entomological Sciences Division email: benedict.pagac.civ@mail.mil
US Army Public Health Command PHCR-South Entomological Sciences Division Joint Base
San Antonio, Texas 78234
(210) 221-4942, DSN: 471-4942
CPT Travis Gilchriest , Chief, Entomological Sciences Division email:
travis.r.gilchriest.mil@mail.mil
18. Navy and Marine Corps Public Health Center 17
Chikungunya
Air Force Points of Contact:
USAF School of Aerospace Medicine/PHR Wright-Patterson AFB, OH
Email: will.reeves@us.af.mil
(937) 938-2716, DSN: (312) 798-2716
USAFSAM - Epidemiology Consult Service
Email: episervices@wpafb.af.mil
Website (CAC-required): https://gumbo2.wpafb.af.mil/epi-consult/
(937) 938-3207; DSN: 798-3207
19. Navy and Marine Corps Public Health Center 18
Chikungunya
Questions:
Additional references consulted listed in notes below.
Editor's Notes
WHO: Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae. The name ‘chikungunya’ derives from a word in the Kimakonde language (language of the Makonde people on the eastern border between Mozambique and Tanzania) meaning "to become contorted" and describes the stooped appearance of sufferers with joint pain (arthralgia).
Note the wider distribution of Ae. albopictus in the US. It appears that in some parts of the world, introduced Ae. albopictus have outcompeted Ae. aegypti. This is not to imply that Ae. aegypti are completely displaced where the two cohabitate. For example, in the US, parts of Arizona, California, Florida, and Texas have witnessed re-emergences of Ae. aegypti. Many factors influence the prevalence of each species, such as climate, urban landscape, and mosquito control measures. Scientists are still studying the complex vector-ecology of these two species and interaction.
Ae. aegypti are considered to have the closer relationship with human geography in both native and introduced habitats. She will feed indoors and out, and oviposit in such manner as well. Ae. albopictus is domestic but more peri-domestic, preferring outdoor natural and artificial containers. Ae. albopictus is also considered to be the more aggressive biter.
References:
High vector competence of Aedes aegypti and Aedes albopictus from ten American countries as a crucial factor of the spread of Chikungunya; Mar 2014; http://jvi.asm.org/content/early/2014/03/20/JVI.00370-14.full.pdf+html?ijkey=r15WuAincAeuw&keytype=ref&siteid=asmjournals
Chikungunya in the Americas; Isabelle Leparc-Goffart a, Antoine Nougairede b, Sylvie Cassadou c, Christine Prat a, Xavier de Lamballerie; Feb 2014; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60185-9/fulltext
The Biogents Sentinel mosquito trap (BGS) utilizes an attractive visual cue (black cup) which attracts gravid female Ae. aegypti and Ae. albopictus. A required and scented lure is placed inside the trap which emanates out as signified by red arrows. Mosquitoes are sucked into trap bag as indicated by yellow arrows. This trap is very effective for capturing Ae. aegypti and Ae. albopictus, and may be employed without CO2 for aforementioned vectors.
As an alternate, the CDC light trap may be used during daylight hours. The addition of the Biogents lure and CO2 will attract Ae. aegypti and Ae. albopictus.
NSNs adult mosquito surveillance traps and required accessories:
BG Sentinel Trap - 3740-01-628-9326
BG-Lure® for BG Sentinel Trap (Note: trap will not work without lure) - 3740-01-628-9325
Catch Bag for BG Sentinel Trap - 3740-01-628-9327
Wall charger for BG Sentinel Trap - 3740-01-628-9324
CDC Light Trap - 3740-00-134-9229
Per DODI 4150.07: IPM programs must be reviewed annually, and on-site every 3 years.
In the Navy, NAVFAC is responsible for tech assistance, tech review, and preparing IPMPs. In the route of establishing these plans, all plans are routed to NECE for input. This is important in particular for those sections pertaining to medical entomology.
Removing and emptying containers plus sanitation are first. Continuing surveillance is key to determine if these efforts suffice. If abundant Ae. aegypti and Ae. albopictus are found, ie >5 adults per BGS traps, then additional efforts and larval/adult control are warranted.
For larvae in containers, the Breteau Index is the number of positive containers per 100 sites surveyed. One site can defined as a structure or an area where containers are present. For example, a site can be a house with containers surrounding it, or it can be a yard with a pile of tires. The Breteau Index establishes a relationship between positive containers and surveyed sites. It is possible to use these data to profile the relative abundance of various container types in the surveillance area (e.g. the number of infested containers per 100 sites). The Breteau Index has also been used to estimate the risk of disease transmission. There is some risk of disease transmission when BI > 5. Emergency vector control should be implemented when BI > 50.
More??? Ento POCs? Army regional commands?
References:
Navy and Marine Corps Public Health Center webpage for CHIKUNGUNYA, DENGUE, AND OTHER ARBOVIRAL INFECTIONS; http://www.med.navy.mil/sites/nmcphc/program-and-policy-support/Pages/Chikungunya.aspx
Armed Forces Pest Management Board; http://www.afpmb.org/
Vector competence of Florida mosquitoes for chikungunya virus; Dec 2010; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076135/
A Single Mutation in Chikungunya Virus Affects Vector Specificity and Epidemic Potential; Dec 2007; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2134949/
CDC; Transcontinental Movement of Asian Genotype Chikungunya Virus; http://wwwnc.cdc.gov/eid/article/20/8/14-0268_article
CID 2009:49 (15 September) • EMERGING INFECTIONS; May 2009. Chikungunya Fever: An Epidemiological Review
of a Re-Emerging Infectious Disease; J. Erin Staples,1 Robert F. Breiman,2 and Ann M. Powers1
Monitoring of dengue and chikungunya viruses in field-caught Aedes aegypti (Diptera: Culicidae) in Surat city, India
Mandar S. Paingankar, Mangesh D. Gokhale, Keshav G. Vaishnav and Paresh S. Shah; April 2014
Genetic divergence of Chikungunya viruses in India (1963–2006) with special reference to the 2005–2006 explosive epidemic
Vidya A. Arankalle, Shubham Shrivastava, Sarah Cherian, Rashmi S. Gunjikar, Atul M. Walimbe, Santosh M. Jadhav, A. B. Sudeep
and Akhilesh C. Mishra; 2007.