CHIKUNGUNYA

Dr.T.V.Rao MD
 What is Chikungunya

Manifest with Crippling Arthritic disease of

sudden onset.
Name is derived from Swahili –
Chikungunya meaning that which bends
up
Virus isolated in 1953 from serum and
Aedes mosquitoes and Culex spp
 Chikungunya Virus

Family – Togaviridae
Genus - Alpha virus
Chikungunya viral infection manifests with
febrile illness
Epidemics of Chikungunya

Large epidemics were recognized

in Transvaal of South Africa,
Zambia, India and South east
Asia, Philippines.
Update - Chikungunya
Out Breaks of Chikungunya

Out breaks occur during rainy season with

increasing densities of Aedes aegypti
mosquito
Mosquitos bites infect the Humans
Laboratory acquired infection can also
occur
 Chikungunya a Mosquito
transmitted viral infection
Cycle of Infection
 History

Isolated in Aedes aegypti mosquitoes and

man in 1952 in Tanzania
Appeared in India in 1963
Major epidemic outbreaks in Calcutta,
madras and other areas
Manifested with Major epidemics till 1973
 Clinical features

Incubation 3 – 12 days
Fever may rise to 1030c to 1040c with
rigors
Viremia lead to fever.
Fever leads to release of large amount of
Interferons
 Clinical manifestations

Fever,
Crippling Joint pains
Lymphadenopathy
Conjunctivitis
A Maculopapular rash
May lead to hemorrhagic manifestations,
Fever is biphasic with remission after 1 - 6 days
of fever.
 How some Indian patients
presented

In India but not in Africa, patients

presented with Inguinal lymphadenopathy
and red swollen ears, and are observed as
part of clinical picture.
 Morbidity and Mortality

Fatalities are rare and when they occur

are associated with either with young age
or with Thrombocytopenia
Hemorrhagic version of illness, that can
lead to shock
 Diagnosis
The primary differential diagnosis of
Chikungunya, should be made from
Dengue, and O’Nyong nyong fevers
Chikungunya manifest with Myalgia rather
than Arthritis.
 Microbiological Diagnosis
Isolation of Virus
Amplification of Nucleic acid
Routine Diagnosis with serology
Detection of IgM antibody provides a
specific and reliable means for early
diagnosis
ELISA and Dot blotting methods are used
 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
Vaccines for Chikungunya

An experimental – live attenuated vaccine

( TSI – GSD – 218 ) enveloped by
passage of an isolate from Thailand in
MRC – 5 cell.
At present used in some laboratory
workers who can be protected,
Vaccine produces neutralizing
antibodies
 How Chikungunya can 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.
 Control of breeding of Aedes
Mosquitos
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.
 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.
 Indian Epidemic

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.
Severity of Indian Epidemic

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%.
 Current Research on
Chikungunya
Researchers at the Institut Pasteur have managed to
retrace the origin and evolution of the Chikungunya
virus in the Indian Ocean through complete
sequencing of the genome of six viral strains
isolated from patients from Reunion Island and the
Seychelles, as well as through partial sequencing of
the viral protein E1 from 127 patients from the Indian
Ocean islands (Reunion,Madagascar, Seychelles,
Mauritius, Mayotte). Their study, published in PLoS
Medicine, opens up new research paths that should
help to explain the magnitude of the epidemic and
the occurrence of severe forms of the disease.
Created for Health Awareness
on Chikungunya

Dr.T.V.Rao MD.
Email
doctortvrao@gmail.com