planning, implementation, and evaluation of strategies for chikungunya virus disease on community and national basis for its prevention, awareness, and planning

1. PLANNING,
IMPLEMENTATION AND
EVALUATION FOR
CHIKUNGUNYA VIRUS
DISEASE
FARHAT NAZ
MPHIL PUBLIC HEALTH

2. THE PLANNING, IMPLEMENTATION AND
EVALUATION OF CHIKUNGUNYA (CHIK)
IN PUBLIC HEALTH
OBJECTIVES:
General objectives are the prevention, detection, and timely responseto outbreaks
of Chikungunya through planning, implementation, casedetection, investigation,
and the evaluation of public health actions.
BACKGROUND:
Epidemics of fever, rash, and arthritis resembling CHIK were reported as early as the 1770s.
There was an epidemic in Tanzania in 1952−1953. CHIKV strains were isolated during large
urban outbreaks in Bangkok, Thailand, in the 1960s and in Calcutta and Vellore, India, during
the 1960s and 1970s. The
epidemic spread from the Indian Ocean islands to India, where large outbreaks occurred in 2006
THE PLANNING
Develop institutional plans to address disease surveillance, hospital communications, education
and training, triage and clinical evaluation, facility access, occupational health, surge capacity
(beds and access to care), supply chain, and access to critical inventory needs.
Following the introduction of CHIKV into an area, health care facilities should:
• Activate institutional plans with assistance from the Ministry of Health.
• Ensure rapid and frequent communication within health care facilities and between health care
facilities and health departments.
• Implement surge-capacity plans that address staffing, bed capacity, consumable and durable
supplies, and continuation of essential medical services.
Effective triage systems at various levels of health care may help to decrease the potential burden
of a CHIK outbreak on the health care system. Regardless of the level of medical care available
at the triage location, there must be appropriate mosquito control measures in the immediate
area. If this is not done, patients acutely ill with CHIK can serve as a source of subsequent
infections for other patients and for health care workers via mosquito transmission
Finally, consideration should be given to the safety of health care workers
HEALTH EDUCATION

3. This include News paper, Pamphlets, Exhibitions, TV, Radio, making short films
and animations which the people can remember easily. Short message service
(SMS), text messages, inter-personal communication through group meetings,
schools, and utilization of traditional or folk media.
Working with partners to develop strategies to guide care seeking, travel (national
and international), and prevention/risk reduction.
To ensure every household keeps there surrounding clean and maintains basic
hygiene making of ‘HouseSanitizer Kit’ which includes hand sanitizer, mosquito
repellent cream, eucalyptus oil and insect sprays.
Start a ‘Clean Neighborhood’ drive where everyone cleans their own surroundings.
Organize ‘ResourcePooling’ where people can join together and clean the stagnant
water.
Triage systems should be considered at various levels of health care to facilitate the
flow of patients during an outbreak.
Prior to the introduction of CHIKV, the following should be considered (adapted
from PAHO and U. S. Department of Health and Human Services (HHS).
Develop and implement methods for identifying and investigating potential
introduction of CHIKV within existing surveillance systems (e.g., surveillance
system for dengue).
Inform health care providers and public health officials about the potential threat
of CHIKV, and educate them about the clinical presentation, diagnosis, and
management of cases at health care facilities.
AWARENESS ON CHIKUNGUNYA VIRUS DISEASE
What is chikungunya?
Chikungunya is an emerging, epidemic-prone, vector-borne disease.Although it’s
not a killer disease, high morbidity rates and prolonged polyarthritis leading to
considerable disability in affected population.
The term is derived from the Kimakonde language of the Makonde people
which means "to become contorted” or “to bends up” for its stooped
posture which develop in result of severe arthralgia. The fever locally also
named as ‘LangraJor’.
 Causative agent is RNA VIRUS

4.  Genus – Alpha Virus
 Family – Togaviridae
 Class – Arbor Virus (Arthropod Borne)
 Species – Chikungunya Virus
SYMPTOMS OF CHIKUNGUNYA
Most people infected with chikungunya virus will develop some symptoms.
Symptoms usually begin 3–7 days after being bitten by an infected
mosquito.
 Chikungunya causes sudden onset of high fever, severe joint pain,
muscle pain and headache, Lymphadenopathy, Conjunctivitis,
Maculopapular rash
May lead to hemorrhagic manifestations,
 It has three main presentations
• Acute:
– Suddenonset,
– Severe, incapacitating polyarthralgia
– Maculopapular rash on trunk & extremities
• Sub acute:
– Relapse of symptoms 2 to 3 months following initial infection
– Exacerbated pain in previously affected joints
• Chronic:
– Persistent arthralgia & fatigue for > 3 months
– Prevalence in 12 to 50%
Most patients feel better within weeks. In some people, the joint pain may persist
for years.
Once a personhas been infected, he or she is likely to be protected from future
infections.
Who should seek medical care immidiately?
• Anyone with neurologic signs or symptoms including irritability, drowsiness,
severe headaches, or photophobia.
• Anyone with chest pain, shortness of breath, or persistent vomiting.

5. • Anyone with a fever persisting for more than five days (indicative of another
illness like dengue).
• who develops any of the following, especially once the fever subsides:intractable
severe pain, dizziness, extreme weakness, or irritability, cold extremities,
cyanosis,decreased urine output, and any bleeding under the skin or through any
orifice. Triage at the secondarylevel (district or local hospital)
• Women in the last trimester of pregnancy, newborns, and persons with chronic
underlying disease, as they or their offsprings are at risk for more severe disease.
Triage at point of first contact(Primary or ambulatory/urgent care).
DIAGNOSIS
 The symptoms of chikungunya are similar to those
of dengue and Zika, diseases spread by the same mosquitoes. But in
chickungunya there is persistent joints pain.
 Diagnostic tests include virus isolation, reverse transcriptase-polymerase
chain reaction (RT-PCR), and serology.
 Samples collected during the first week after onset of symptoms should be
tested by bothserological (immunoglobulin M [IgM] and G [IgG] ELISA) and
virological (RT-PCR and isolation) methods. Specimens are usually blood or
serum, but in neurological cases with meningoencephalitic features, cerebrospinal
fluid (CSF)may also be obtained.
TREATMENT AND CASE MANAGEMENT(CDC
Guidelines)
There is no vaccine to prevent or medicine to treat chikungunya virus.
Only symptomatic or supportive treatment is available:
Take good care and proper rest.
Take fluids to prevent dehydration because of heavy sweating and vomiting.
Take medicine such as acetaminophen (Tylenol®) or ibuprofen and naproxen to
reduce fever and pain.

6. Avoid aspirin until dengue can be ruled out to reduce the risk of bleeding and
the risk of developing Reye’s syndrome in children less than 12 years of age
Patients with persistent or chronic phase of arthritis who fail to respond to
NSAID may show some responseto chloroquine phosphatei.e. being used for
rheumatoid arthritis.
If person already taking medications should concern with health care provider for
any co-morbidity and complication and drug-interaction as well.
If person has chikungunya, prevent mosquito bites for the first week of his/her
illness.
During the first week of infection, chikungunya virus can be found in the blood
and passed from an infected person to a mosquito through mosquito bites.
An infected mosquito can then spread the virus to other people.
TRANSMISSION: Aedes mosquito
The main two types include;
Aedes aegypti Aedes albopictus: Asian tiger
mosquito
Urban mosquito Urban, peri-urban, rural habitats
Needs standing water for larvae Invasive- spreading
Prefers cool, dark areas for resting
Feeds through the day, most active
at dawn/dusk
Feeds through the day, most active
dawn/afternoon
Eggs do not survive winter in
temperate climates
Eggs survive winter in temperate climates
COMPLICATIONS
Neurological complications suchas meningoencephalitis have reported in few
patients.
Mother to child transmission of chikungunya virus was recorded between 3 to 4.5
months of gestation during the recent French Reunion islands outbreak. This
passes through placenta.
Maternal IgG develops in 2 weeks after CHIKV
Neonatal infections are very mild; fully recover
No miscarriages or congenital malformations occurred.

7. IMPLEMENTATION
Socioeconomic factors and inadequacies in public health that facilitated the spread
of this infection in the pastcontinue to exist. Environmental factors and
community behaviors play a significant role in the outbreak and spread of
chikungunya .There is an urgent need to strengthen national surveillance and
implementation strategies for prevention and controlof Chikungunya fever
responsecapacity by securing multi sectoral supportand active participation of the
communities to prevent and controlthis emerging infectious disease.
Launch the whole mission in Phases.
1st Phase should be targeted towards the area which has already seen the outbreak
of this Epidemic the program will help them to prevent from further morbidity.
2nd Phase should be towards the High-risk zones where the surroundings are
unclean, inhumane conditions of living. Once the plan is activated there, it will see
improve the overall conditions and have a clean neighborhood .
PERSONAL PROPHYLATIC MEASURES
 Avoiding contact with disease carrying mosquitoes. Use of mosquito repellent
creams, liquids, like DEET, Icaridin and PMD coils mats etc.
 Using Eucalyptus Oil.
 Wearing of bite-proof full sleeve shirts and full pants
with socks. Garments can be treated with pyrethroids, an
insecticide having the qualities of repellents.
 Always follow instructions when applying insect repellent
to children.
 Do not use insect repellent on babies younger than 2 months old.
 Instead, dress the child that covers arms and legs.
 Use of bed nets for sleeping children during day time to prevent mosquitoes bite.
 Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated
skin.

8.  Adults: Spray insect repellent onto your hands and then apply to a child’s face.
BIOLOGICAL CONTROL
 Use of larvivorous fishes Gambusia and Guppyin ornamental
tanks, fountains, etc.
 Use of biocides.
CHEMICAL CONTROL
• Use of chemical organophosphorous larvicides like Abate in
big breeding containers.
• Aerosol spacespray of ultra low volume [ULV] of MALATHION or
SUMITHION 250 ml/hectare is effective in interrupting transmission and stopping
epidemics during day time. It does not affect man or the taste of water.
ENVIRONMENTAL MANAGEMENT & SOURCE REDUCTION
METHODS
• Detection & elimination of mosquito breeding sources.
• Management of rooftops, porticos and sunshades.
• Proper covering of stored water.
• Reliable water supply.
3rd phase is to promotethe individual hygiene and moving towards communities by
coordination of government and other non-government organizations.
 Sensitilizing and involving the community for detection of Aedes breeding places
and their elimination
 To ensure every household keeps their surrounding clean and maintains basic
hygiene
 Joining hands with various NGOs to ensure that everyone has access to basic
housing facilities Making of ‘HouseSanitizer Kit’ which includes Hand Sanitizer,
mosquito repellent cream, eucalyptus oil and Insect sprays.
 Promote communities to keep their surroundings clean and dumps free.
 Organize ‘ResourcePooling’ where people can join together and clean the
stagnant water.

9. EVALUATION:
WHO encourages countries to develop and maintain the capacity to detect and
confirm cases.
Manage patients and implement social communication strategies to reduce the
presence of the mosquito vectors.
Reportcases and to check the management and controlled programs for CHIKV.
REFERENCES:
https://www.ecdc.europa.eu/en/chikungunya-virus-disease
www.drjayeshpatidar.blogspot.com
Dr Lipilekha Patnaik, National Vector Borne Disease Control Program,Jul 24, 2018