Focus on Chikungunya

March 2014

FOCUS ON: CHIKUNGUNYA

KEY FACTS

Chikungunya fever is an arboviral disease caused by a RNA Alphavirus of the Togaviridae family
The virus is transmitted to humans by the bite of infected female mosquitoes of the species Aedes aegypti and Aedes albopictus
Onset of symptoms occurs usually between four and eight days (range 2- 12) after the bite of an infected mosquito
Chikungunya is characterized by fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash
Treatment is focused on relieving the symptoms
The disease resembles dengue fever in terms of transmission, geographical spread, seasonality, and prevention methods. However, unlike
dengue, chikungunya fever is usually not fatal

EPIDEMIOLOGY AND BURDEN OF CHIKUNGUNYA

Chikungunya is a mosquito-borne viral disease, first described

Countries with reported human Chikungunya virus infections, as of May 2012
during an outbreak in southern Tanzania in 1952
Chikungunya has been identified in nearly 40 countries in Asia,
Africa, Europe and also in the Americas
In the Philippines, Chikungunya fever is now considered endemic in
all regions. Since the last case reported in 1996, the desease has
re-emerged in 2011 affecting initially few provinces and spreading
all throughout the country over the last 3 years. In 2012 and 2013,
cases of Chikungunya fever have been confirmed in 43 of the
countrys 80 provinces and outbreaks have have been reported in
the urban centres of Davao and Manila. Since 2012, several
outbreaks have led to an increase in awareness and reporting of
cases, supported by expanded laboratory testing capacity
The Philippine Event-based Surveillance and Response (ESR)
system of the DOH verified 79 Chikungunya fever events in 14
regions from January to December 2013. A total of 8,370 suspect
and 593 laboratory confirmed chikungunya cases were reported among all age groups (range 5 days 84 years). No deaths were recorded
From 1 January to 4 March 2014, 4 Chikungunya fever ESR events with 116 suspect and 6 laboratory confirmed cases were verified in
Region VII and XII.

TRANSMISSION

Aedes aegypti and Aedes albopictus are the two species of mosquitoes most commonly involved in the
transmission of chikungunya virus
These mosquitoes can be found biting throughout daylight hours, though there may be peaks of activity
in the early morning and late afternoon. Aedes albopictus is found biting outdoor, while Aedes
aegyptiboth outdoor and indoor
In the Philippines, Chikungunya fever occurs throughout the year, with a high peak following the onset of
the rainy season ( July-August), and a smaller peak around December/January (i.e. as for dengue fever).
Adults are affected most often with women affected slightly more frequently

SIGNS AND SYMPTOMS

An abrupt onset of fever accompanied by joint pain, frequently debilitating, lasting usually a few days; other common signs and
symptoms include muscle pain, headache, nausea, fatigue and rash
Symptoms are mainly mild and the infection may go unrecognized, or misdiagnosed in areas where dengue occurs
Most patients fully recover, however joint pain may persist for weeks or months (years in some cases)
Occasional cases of eye, neurological, heart and gastrointestinal complications have been reported. Serious complications are rare, but in
elderly the disease can contribute to the cause of death

DIAGNOSIS AND TREATMENT

Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya
antibodies. IgM antibody levels are highest three to five weeks after the onset of illness and persist for about two months
The virus may be isolated from the blood during the first few days of infection. Samples collected during the first week after the onset of
symptoms should be tested by both serological and virological methods (RT-PCR)
There is no specific antiviral drug treatment for Chikungunya. Treatment is directed primarily at relieving the symptoms, including the
joint pain using anti-pyretics, optimal analgesics and fluids
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EWARN weekly summary| 23 February to 1 March 2014

PREVENTION AND CONTR OL

There is no vaccine to prevent chikungunya infection or disease

Measures to reduce the human-vector contact include the use of:
o clothes that minimize skin exposure to the day-biting vectors
o repellents to exposed skin or to clothing (in strict accordance with product label instructions)
o insecticide treated mosquito nets for those who sleep during the daytime (young children or sick or older people)
o mosquito coils or other insecticide vaporizers to reduce indoor biting
o window/door screens
Measures for the vector control include:
o preventing mosquitoes from accessing egg-laying habitats by environmental management and modification
o disposing of solid waste properly and removing artificial man-made breeding sites
o covering, emptying and cleaning of domestic water storage containers on a routine basis
o applying insecticides to water storage containers
o improving community participation and mobilization for sustained vector control
o active monitoring and surveillance of vectors to determine their distribution and key breeding sites for planning of effective
control interventions
Being the two species of mosquitoes involved in the transmission of both Chikungunya virus and dengue virus, the 4-S against dengue
(Search and destroy; Self-protection measure; Seek early consultaions; Say no to indiscriminate fogging) and the practice of the four
oclock stop look and listen habit are also recommended to prevent Chikungunya fever
Health workers need to be aware and ready to provide appropriate care and information to patients, always considering the differential
diagnosis of chikungunya versus dengue, which can be fatal

CHIKUNGUNYA IN TYPHOON YOLANDA AFFECTED AREAS

In 2013, Region VI of the Philippines experienced two outbreaks of Chikungunya fever in the provinces of Antique and Negros Occidental.
Antique reported through ESR a total of 1113 suspect and 83 laboratory confirmed cases; among the 13 reporting municipalities, 50%
(593) of the cases were from the municipality of Patnongon. The Province of Negros Occidental reported a total of 250 suspect and 83
laboratory confirmed cases; among the 13 reporting municipalities, 50% (167) of the cases were from the municipality Kabankalan City
In 2012 and 2013, Region VIII of the Philippines reported Chikungunya fever suspect cases through ESR in the province of Western Samar
(499 Villareal; 25 Zumaraga; 366 Daram), Samar (51 Sta. Rita; 15 Jabong; 8 - Borongan) and Leyte (26- Tacloban city; 12 Barugo)
In the current post-typhoon situation, the number of chikungunya cases is likely to increase due to an increase in the density of
mosquitoes in affected areas, where mosquito breeding conditions are ideal among debris with stagnant rainwater. Since Chikungunya
fever is not a notifiable disease to SPEED and PIDSR surveillance systems there might have been cases that were not reported or were
misclassified as supect dengue or measles cases

More information at: http://www.who.int/mediacentre/factsheets/fs327/en/

This weekly EWARN Summary is published by the World Health Organization (WHO), Philippines. It is based on preliminary surveillance data from
multiple sources, including the Surveillance in Post-Extreme Emergencies and Disasters (SPEED) system, the Philippines Integrated Disease
Surveillance and Response System (PIDSR), and event-based reporting system.
WHO surveillance contact: haiyanops@wpro.who.int
Weekly Summaries are available at:http://www.wpro.who.int/philippines/typhoon_haiyan/en/index.html

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