Communicable Diseases Chikungunya Fever

Chikungunya Fever, a re-emerging Disease in Asia Chikungunya fever, is a viral illness that is spread by the bite of infected mosquitoes. The disease resembles dengue fever, and is characterized by severe, sometimes persistent, joint pain (arthritis), as well as fever and rash. It is rarely life-threatening. Nevertheless widespread occurrence of diseases causes substantial morbidity and economic loss Epidemiology Epidemics of fever, rash and arthritis, resembling Chikungunya fever have been recorded as early as 1824 in India and elsewhere. However, the virus was first isolated between 1952-1953 from both man and mosquitoes during an epidemic of fever that was considered clinically indistinguishable from dengue, in the Tanzania. Chikungunya fever displays interesting epidemiological profiles: major epidemics appear and disappear cyclically, usually with an inter-epidemic period of 7-8 years and sometimes as long as 20 years. After a long period of absence, outbreaks of CHIK fevers have appeared in Indonesia in 1999. Chikungunya in Asia (1960-1982) Between 1960 and 1982, outbreaks of Chikungunya fever were reported from Africa and Asia. In Asia, virus strains have been isolated in Bangkok in 1960s; various parts of India including Vellore, Calcutta and Maharastha in 1964; in Sri Lanka in 1969; Vietnam in 1975; Myanmar in 1975 and Indonesia in 1982. Recent occurrences of chikungunya fever After an interval of more than 20 years, chikungunya fever has been reported from several countries including India, and various Indian Ocean islands including Comoros, Mauritius, Reunion and Seychelles. Chikungunya fever in India Till 10 October 2006, 151 districts of eight states/provinces of India have been affected by chikungunya fever. The affected states are Andhra Pradesh, Andaman & Nicobar Islands, Tamil Nadu, Karnataka, Maharashtra, Gujarat, Madhya Pradesh, Kerala and Delhi.

More than 1.25 million cases have been reported from the country with 752,245 cases from Karnataka and 258,998 from Maharashtra provinces. In some areas attack rates have reached up to 45%. Chikungunya and dengue fevers The clinical manifestations of chikungunya fever have to be distinguished from dengue fever. Co-occurrence of both fevers has been recently observed in Maharashtra state of India thus highlighting the importance of strong clinical suspicion and efficient laboratory support. Laboratory Diagnosis The clinical manifestations of chikungunya fever resemble those of dengue fever. Laboratory diagnosis is critical to establish the cause of diagnosis and initiate specific public health response. Treatment, prevention and control 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. While recovery from chikungunya is the expected outcome, convalescence can be prolonged (up to a year or more), and persistent joint pain may require analgesic (pain medication) and long-term anti-inflammatory therapy. Prevention and control No vaccine is available against this virus infection. Prevention is entirely dependent upon taking steps to avoid mosquito bites and elimination of mosquito breeding sites. To avoid mosquito bites: Wear full sleeve clothes and long dresses to cover the limbs; Use mosquito coils, repellents and electric vapour mats during the daytime; Use mosquito nets to protect babies, old people and others, who may rest during the day. The effectiveness of such nets can be improved by treating them with permethrin (pyrethroid insecticide). Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes. Mosquitoes become infected when they bite people who are sick with chikungunya. Mosquito nets and mosquito nets and mosquito coils will effectively prevent mosquitoes from biting sick people.

To prevent mosquito breeding The Aedes mosquitoes that transmit chikungunya breed in a wide variety of manmade containers which are common around human dwellings. These containers collect rainwater, and include discarded tires, flowerpots, old oil drums, animal water troughs, water storage vessels, and plastic food containers. These breeding sites can be eliminated by Draining water from coolers, tanks, barrels, drums and buckets, etc.; Emptying coolers when not in use; Removing from the house all objects, e.g. plant saucers, etc. which have water collected in them Cooperating with the public health authorities in anti-mosquito measures. Role of public health authorities National programme for prevention and control of vector borne diseases should be strengthened and efficiently implemented with multisectoral coordination Legislations for elimination of domestic/peridomestic mosquitogenic sites should be effectively enforced Communities must be made aware of the disease and their active cooperation in prevention and control measures elicited

Chikungunya Fever Fact Sheet What is chikungunya fever? Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes. Chikungunya virus (CHIKV) is a member of the genus Alphavirus, in the family Togaviridae. CHIKV was first isolated from the blood of a febrile patient in Tanzania in 1953, and has since been identified repeatedly in west, central and southern Africa and many areas of Asia, and has been cited as the cause of numerous human epidemics in those areas since that time. The virus circulates throughout much of Africa, with transmission thought to occur mainly between mosquitoes and monkeys. What type of illness does chikungunya virus cause? CHIKV infection can cause a debilitating illness, most often characterized by fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. The term chikungunya is thought to be derived from the word kungunyala in the Makonde language of southeastern Tanzania and northern Mozambique, which means to dry up or become contorted. The incubation period (time from infection to illness) can be 2-12 days, but is usually 3-7 days. Silent CHIKV infections (infections without illness) do occur; but how commonly this happens is not yet known. Acute chikungunya fever typically lasts a few days to a couple of weeks, but as with dengue, West Nile fever, o'nyong-nyong fever and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. Additionally, some patients have reported incapacitating joint pain, or arthritis which may last for weeks or months. The prolonged joint pain associated with CHIKV is not typical of dengue. Co-circulation of dengue fever in many areas may mean that chikungunya fever cases are sometimes clinically misdiagnosed as dengue infections, therefore the incidence of chikungunya fever could be much higher than what has been previously reported. No deaths, neuroinvasive cases, or hemorrhagic cases related to CHIKV infection have been conclusively documented in the scientific literature. CHIKV infection (whether clinical or silent) is thought to confer life-long immunity. How do humans become infected with chikungunya virus? CHIKV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on a person infected with CHIKV. Monkeys, and possibly other wild animals, may also serve as reservoirs of the virus. Infected mosquitoes can then spread the virus to other humans when they bite. Aedes aegypti (the yellow fever mosquito), a household container breeder and aggressive daytime biter which is attracted to humans, is the primary vector of CHIKV to humans. Aedes albopictus (the Asian tiger mosquito)may also play a role in human transmission is

Asia, and various forest-dwelling mosquito species in Africa have been found to be infected with the virus. Where does chikungunya virus occur? The geographic range of the virus is Africa and Asia. For information on current outbreaks, consult CDCs Travelers Health website (www.cdc.gov/travel). Given the current large CHIKV epidemics and the world wide distribution of Aedes aegypti, there is a risk of importation of CHIKV into new areas by infected travelers. How is chikungunya virus infection treated? No vaccine or specific antiviral treatment for chikungunya fever is available. Treatment is symptomatic--rest, fluids, and ibuprofen, naproxen, acetaminophen, or paracetamol may relieve symptoms of fever and aching. Aspirin should be avoided Infected persons should be protected from further mosquito exposure (staying indoors and/or under a mosquito net during the first few days of illness) so that they can't contribute to the transmission cycle. What can people do to prevent becoming infected with chikungunya virus? The best way to avoid CHIKV infection is to prevent mosquito bites. There is no vaccine or preventive drug. Prevention tips are similar to those for dengue or West Nile virus: Use insect repellent containing an DEET or another EPA-registered active ingredient on exposed skin. Always follow the directions on the package. Wear long sleeves and pants (ideally treat clothes with permethrin or another repellent). Have secure screens on windows and doors to keep mosquitoes out. Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used. Additionally, a person with chikungunya fever or dengue should limit their exposure to mosquito bites in order to avoid further spreading the infection. The person should stay indoors or under a mosquito net.

chikungunya Chikungunya (also known as chikungunya virus disease or chikungunya fever) is a debilitating, but non-fatal, viral illness that is spread by the bite of infected mosquitoes. It resembles dengue fever. 2. Which are the states affected by chikungunya?

The states affected by chikungunya are Andhra Pradesh, Karnataka, Maharasthra, Madhya Pradesh, Tamil Nadu, Gujarat & Kerala. In the year 2006, total number of 1390322 suspected Chikungunya fever cases were reported from the country. 3. When was chikungunya epidemic outbreak occurred in the past?

In India a major epidemic of Chikungunya fever was reported during the last millennium viz.; 1963 (Kolkata), 1965 ( Pondicherry and Chennai in Tamil Nadu, Rajahmundry , Vishakapatnam and Kakinada in Andhra Pradesh; Sagar in Madhya Pradesh; and Nagpur in Maharashtra) and 1973, (Barsi in Maharashtra ). Thereafter, sporadic cases also continued to be recorded especially in Maharasthra state during 1983 and 2000. 4. What is the infectious agent that causes chikungunya?

Chikungunya is caused by the chikungunya virus, which is classified in the family Togaviridae, genus Alphavirus. 5. How is chikungunya spread?

Chikungunya is spread by the bite of an Aedes mosquito, primarily Aedes aegypti. Humans are thought to be the major source, or reservoir, of chikungunya virus for mosquitoes. Therefore, the mosquito usually transmits the disease by biting an infected person and then biting someone else. An infected person cannot spread the infection directly to other persons (i.e. it is not a contagious disease). Aedes aegypti mosquitoes bite during the day time. TRANSMISSION CYCLE

6.

Where is chikungunya found?

Chikungunya occurs mainly in Africa, India , and Southeast Asia . There have been a number of outbreaks (epidemics) in the Philippines and on islands throughout the Indian Ocean . Epidemics are sustained by the human-mosquito-human transmission cycle. The Aedes mosquitoes that transmit chikungunya breed in a wide variety of manmade containers which are common around human dwellings. These containers collect water, and include discarded tyres, flowerpots, old oil drums, animal water troughs, water storage vessels, and plastic food containers. Lack of public health infrastructure and all factors that promote uncontrolled mosquito breeding are conducive to outbreaks of chikungunya, or other mosquito borne diseases. 7. What are the symptoms of chikungunya?

Chikungunya usually starts suddenly with fever, chills, headache, nausea, vomiting, joint pain, and rash. In Swahili, chikungunya means that which contorts or bends up. This refers to the contorted (or stooped) posture of patients who are afflicted with the severe joint pain (arthritis) which is the most common feature of the disease. Frequently, the infection causes no symptoms, especially in children. While recovery from chikungunya is the expected outcome, convalescence can be prolonged and persistent

joint pain may require analgesic (pain medication) and long-term anti-inflammatory therapy. Infection appears to confer lasting immunity. 8. How soon after exposure do symptoms appear?

The time between the bite of a mosquito carrying chikungunya virus and the start of symptoms ranges from 1 to 12 days.

9.

How is chikungunya diagnosed?

Chikungunya is diagnosed by blood tests (ELISA). Since the clinical appearance of both chikungunya and dengue are similar, laboratory confirmation is important especially in areas where dengue is present. Such facilities are, at present, available at National Institute of Virology (NIV), Pune & National Institute of Communicable Diseases (NICD), Delhi .

10.

Who is at risk for chikungunya?

Anyone who is bitten by an infected mosquito can get chikungunya. 11. What is the treatment for chikungunya?

There is no specific treatment for chikungunya. Supportive therapy that helps ease symptoms, such as administration of non-steroidal anti-inflammatory drugs, and getting plenty of rest, may be beneficial. Infected persons should be isolated from mosquitoes in as much as possible in order to avoid transmission of infection to other people. 12. How common is chikungunya globally?

The first recognized outbreak occurred in East Africa in 1952-1953. Soon thereafter epidemics were noted in the Philippines (1954,1956 & 1968), Thailand , Cambodia , Vietnam , India , Burma and Sri Lanka . Since 2003, there have been outbreaks in the islands of the Pacific Ocean, including Madagascar , Comoros , Mauritius , and Reunion Island . In January 2006, in an epidemic that is currently ongoing in Reunion Island , over ten thousand cases have been reported. It is suspected that many cases of chikungunya are either misdiagnosed or go unreported. 13. How can chikungunya 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.

14. (a)

How can Aedes mosquito breeding be controlled? Source reduction Method

(i) By elimination of all potential vector breeding places near the domestic or peri-domestic areas. (ii) Not allowing the storage of water for more than a week. This could be achieved by emptying and drying the water containers once in a week. (iii) Straining of the stored water by using a clean cloth once a week to remove the mosquito larvae from the water and the water can be reused. The sieved cloth should be dried in the sun to kill immature stages of mosquitoes. (b) Use of larvicides

(i) Where the water cannot be removed but used for cattle or other purposes, Temephos can be used once a week at a dose of 1 ppm (parts per million). (ii) Pyrethrum extract (0.1% ready-to-use emulsion) can be sprayed in rooms (not outside) to kill the adult mosquitoes hiding in the house. (c) Biological control

(i) Like introduction of larvivorous fish, namely Gambusia and Guppy in water tanks and other water sources.