Preventing Chikungunya

in Low Resource Practice

Settings

Michelle D Kelly

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 Agenda
 Overview
 Who
 What
 Where
 How
 Summary

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 Who?
 Sub Saharan Africans

 1 to 1.4 million new cases

 French territory
 India
 Sri Lanka
 Italy

Adults
Children and infants
Health workers

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 What

 Arbovirus
 Chikungunya

 Aedes mosquitos

 Human to Human

 New strains

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 Where

Geographical distribution of Chikungunya

cases 2001-2007

Weekly epidemiological record (WER) No. 47, 2007, 82, 409�416.

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10/17/09 6
 How
 Global warming
 Travel

 Exported goods
 Evolving Genome

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 Summarize
What is known
Vaccines not in pipeline
Lab testing - PCR not credible
Populations at risk
Evidence of higher AR & CFR
Maternal-child transmission
Health workers at risk

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 Guidelines
World Health Organization
Clinical Management of Chikungunya

Malaria Epidemics: Forecasting, Prevention

Early Detection

Malaria Control in Complex Emergencies

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 Gap in Guidelines

 Based on mosquito borne

principles in WHO
guidelines

 Educate and empower

village health workers on
chikungunya

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 Recommendation

Prevent Chikungunya at
the Village level

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 INTERVENTIONS AND PRACTICES
CONSIDERED

 1. Risk Assessment

 2. Primary Prevention

 3. Secondary Prevention

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 MAJOR OUTCOMES CONSIDERED

u Prevent Morbidity

u Empower community level health workers

u Reduce chikungunya DALYs

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 Risk Assessment
 assessment
 environment
 vector
 occupations and activities
that expose persons
 migration/ market
movement patterns

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 Primary Prevention

 mosquito habitat- standing

water
 barriers to mosquito bites
 vaccination
 establishing surveillance
 case definition
 community awareness

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 Secondary Prevention

Screen

 surveillance data and

mapping
 PCR testing

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 Next Steps

 Assess for stakeholders

 MOH, non-governmental, WHO, Eurosurveillance

Current prevention activities

 ｷ assess level of knowledge & traditional
positive prevention behaviors

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 Evaluation and Monitoring
Examples of prevention metrics:

 Number of:
communities informed of chikungunya risk

prevention activities carried out before rainy season

health workers attending prevention workshop

households visited without mosquito breeding areas

presumed chikungunya cases identified

bed nets distributed to households at risk

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Prevent Morbidity

Empower health workers

Reduce impact of chikungunya