Far Eastern University

Nicanor Reyes Street

Sampaloc, Manila

Laboratory Exercise 4: Virology

Viruses and The Public Health Nurse: A One Health Approach for Epidemiology
Management of Diseases

Submitted by:

Maomay, Micah Joyce

Pagsanjan, Rohn Raymund L.

Santiago, Prancheska Abigail P.

Serrano, Sofia Andrei O.

_________________________________________________________________________
INTRODUCTION

Viruses are microscopic disease-causing agents that contain either DNA or

RNA and are surrounded by a protein coat that prevents them from replicating
without the help coming from a host cell. They are usually connected to the
outside layer of specific cells of a host cell. In order to replicate, viruses must
infect cells with the use of components from the host cell. They frequently kill
the host cell and harm the host organism during the process. However, viral
transmission is the process where a virus transmits from one host to another.
In the case of viruses that can cross species barriers, It involves spreading to
members of the same host species as well as spreading to members of
different host species. Furthermore, epidemiology and the epidemiologic
triad/triangle are important in the transmission of viruses. There are three
components of the triad which are the host, agent, and environment wherein
these components interact with each other in different ways in order for us to
understand viral transmission and its nature even more.

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In this activity, there are three objectives accomplished by the group:

1. To determine the proper sequence and key epidemiologic steps in an
outbreak investigation into the epidemic.
2. To show how the topic can make you grasp and understand a possible
pandemic or epidemic.
3. To establish a field investigation of their own with the help of the
epidemiologic steps of an outbreak investigation.

METHODOLOGY

In order to achieve such results, Our group used reading materials from various
studies such as past research and web articles regarding the said topic. We must be
able to identify and assess the structure and core contents of the viruses based on their
capsids and genetics in order to classify and verify them. As a result, the experiment will
be able to distinguish the numerous viruses.

RESULTS AND DISCUSSIONS

STEPS OF AN OUTBREAK INVESTIGATION

● Establish the Existence of an Outbreak

Chikungunya has rapidly spread throughout the years and it also has been
identified across Asia, Africa, Europe, and the Americas. The virus started
spreading around 2004. Chikungunya virus was discovered in Tanzania
around 1952 and was isolated and caused outbreaks in Africa and Asia for
the next 50 years. According to WHO(2019), Beginning in 2004, an
outbreak in Kenya spread to other parts of the Indian Ocean. Over the
next two years, approximately 500 000 cases were reported; on La
Réunion Island, more than one-third of the population became infected.
The epidemic then spread from the Indian Ocean to India, where it lasted
several years and infected nearly 1.5 million people. Viremic travelers saw
the virus spread to Indonesia, the Maldives, Sri Lanka, Myanmar, and
Thailand. Local transmission was reported in Europe for the first time in
2007, in a localized outbreak in north-eastern Italy, with 197 cases
recorded. This outbreak proved that mosquito-borne outbreaks caused by
Aedes albopictus are a real possibility in Europe. In 2010, the virus
continued to cause illness in South East Asia, and another outbreak was
observed in the Indian Ocean on the island of La Reunion. Viremic

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travelers brought the virus back into Europe, as well as the United States
and Taiwan.

● Verify the Diagnosis

When it comes to verifying CHIKUNGUNYA(CHIK) Fever, in order to
search for suspected Chikungunya fever cases they conducted a house to
house survey. Between March to June 1996, anyone will be considered a
Chikungunya (CHIK) Fever suspect if they show a history of fever, rash or
joint pain/swelling. Respondents were interviewed using standard
questionnaires in order to collect data. Respondents were required to
undergo this interview whether they are symptomatic or not. They were
bled at that time where they will be reborn after two weeks if they are
febrile. The collected sera that was collected will then be sent to the
Vector-Borne Disease Laboratory.

In order to confirm the diagnosis of Chikungunya (CHIK) fever, all sera

collected from all respondents will be tested for anti-CHIK IgM and IgG
antibodies using the ELISA method. A confirmed CHIK fever case had IgM
or IgG antibody titers of 2 or higher. And an elevated IgM antibody titer
indicates a recent infection. In contrast, an elevated IgG antibody titer with
an IgM antibody titer of 2 indicates a previous infection. Furthermore,
according to (WHO, 2020), the levels of IgM antibodies are highest 3 to 5
weeks after the onset of illness and last for about 2 months.

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● Construct a Working case definition

Components of an Descriptive Features Chikungunya Outbreak

Outbreak

Person Age group A person with a history

of fever, rash,
joint/swelling.

Sex Newborns during

delivery and adults age
65 and above.

Race Asian

Place Geographic Location Laguna, Philippines

Time Illness Onset Mid 2012

Clinical Features Chikungunya Virus The most common

features are fever and
joint pain. Other features
include headaches,
muscle pain, joint
swelling and rash.

Laboratory Criteria Cultures;serology Serological tests, such

as enzyme-linked
immunosorbent assays
(ELISA), can confirm the
presence of IgM and IgG
anti-chikungunya
antibodies. IgM antibody
levels are highest 3 to 5
weeks after illness onset
and last about 2 months.

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● Find cases systematically and record information

A case was defined as any resident of San Pablo City's Concepcion Village who
experienced a two-day fever, joint pains, or a rash between June 23 and August
6, 2012. House-to-house canvassing and medical record review were used to
identify cases. A multivariate logistic regression was used to analyze the data
from an unmatched case-control study. A water and sanitation investigation was
conducted, and 100 households were surveyed to determine the House and
Breteau Indices. An enzyme-linked immunosorbent assay was used to confirm
the presence of chikungunya IgM in human serum samples.

Fig.1 CHIK cases by date of onset in Concepcion Village, San Pablo City,
Laguna June 23 - August 6 2012

Cases ranged in age from five months to 83 years (median: 27 years), with 54 (55
percent ) being females. With 26 cases, the 11–20 year old age group was the most
affected. All cases were from Concepcion Village's subvillages 3 and 4, with a
Concepcion Village attack rate of 1.2 percent overall (population: 7881). Aside from
fever, cases were also characterized by rash (88%), joint pains (85%), headache (61%),
and cough (61%). (23 percent ).

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Table. 1 Factors associated with chikungunya fever in Concepcion Village, San

Pablo City, Laguna Province, Philippines, June 23-August 6 2012.

● Develop Hypothesis
After being bitten by a contaminated mosquito, people become infected with
Chikungunya. Fever and joint pain are two of the most well-known disease side
effects. Migraine, muscle pain, joint swelling, and a rash are all possible
symptoms. Incidents have occurred in Africa, Asia, Europe, and the Indian and
Pacific Oceans. For the first time in the Americas, Chikungunya infection was
discovered on Caribbean islands in late 2013. Contaminated travelers pose a risk
of spreading the infection to new areas. As a result, if you are bitten by a
Chikungunya-infected mosquito, you are very likely to contract the virus.

● As necessary, reconsider, refine, and re-evaluate hypotheses

With the spread of the CHIKV virus millions of people will be exposed to massive
complications, including CHIKV disability. As we know, the immune response of
CHIKV is protective and pathogenic, with many kinds of immune cells
contributing to the rheumatic disorder of CHIKV according to our understanding
of pathobiology in current cases. CHIKV immunopathology has multiple
symptoms and presents challenges in developing effective treatment. Although
recent research has led to a better understanding of basic biology for CHIKV
replication and diseases, the development of therapeutic interventions, viral
molecular mechanisms, carefully deconstructed CHIKV-induced immune
responses and therapeutic intervention will require further work to combat CHIKV
transmission and disease.

● Compare and reconcile with laboratory and environmental studies

Dengue and Chikungunya are caused by different viruses, despite being
transmitted by the same mosquito species. Dengue is caused by a Flavirideae
flavivirus, whereas Chikungunya is caused by a Togaviridae alphavirus.

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Chikungunya's initial symptoms include fever, joint and muscle pain, eye
infection, and rashes, whereas dengue's initial symptoms include fever, joint pain,
eye pain, and rashes. Rashes appear on the torso and arms in chikungunya,
while they appear on the arms and face in dengue.Chikungunya fevers are
diagnosed through three main laboratory procedures: Isolation of the virus,
serological testing and molecular polymerase chain reaction technique (PCR).
Blood or serum is typically supplied as specimens; CSF may also be transmitted
in neurological diseases with meningoencephalitis.

● Implement control and prevention measures

Since there is no known vaccines yet to prevent CHIKV, the best way to prevent
CHIKV is, Insecticides may be sprayed to kill flying mosquitoes, applied to
surfaces in and around containers where mosquitoes settle, and used to treat
water to kill immature larvae during epidemics. This could also be done as an
emergency measure by health officials to control the mosquito population
.Clothing that limits skin exposure to day-biting vectors is recommended for
protection during chikungunya outbreaks. Repellents should be applied to
exposed skin or clothing according to product label instructions. DEET (N,
N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid
ethyl ester), or icaridin (1-piperidinecarboxylic acid,
2-(2-hydroxyethyl)-1-methylpropyl ester) should all be present in repellents.

● Initiate or maintain surveillance

The proximity of mosquito vector breeding grounds to human settlement
increases the risk of chikungunya and other infections spread by Aedes mosquito
species. Combating mosquito vectors is currently the most effective way to limit
or prevent the spread of the chikungunya virus. The quantity of natural and
artificial water-filled container habitats that promote mosquito development is
substantially reduced in the prevention and control of the disease. To prevent
mosquito breeding and subsequent adult generation, afflicted and at-risk
communities must be mobilized to empty and clean water containers on a weekly
basis. Community-wide measures to prevent mosquito reproduction can be a
useful technique for reducing vector populations if they are sustained.

● Communicate findings
Chikungunya is a mosquito-borne viral disease that was first identified in 1952
during an outbreak in southern Tanzania. It is an RNA virus in the alphavirus
genus of the Togaviridae family. The term "chikungunya" is derived from a word
in the Kimakonde language that means "to become contorted," and refers to the
hunched appearance of people suffering from joint pain (arthralgia). The

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beginning of sickness usually comes 4-8 days after being bitten by an infected
mosquito (but can range from 2-12 days). Chikungunya is marked by a sudden
onset of fever, which is commonly accompanied by joint pain. Joint pain can be
incredibly painful; it normally lasts a few days, but it can last weeks, months, or
even years. As a result, the virus has the potential to cause acute, subacute, or
chronic illness. Muscle soreness, joint swelling, headache, nausea, exhaustion,
and rash are all frequent indications and symptoms. The majority of people
recover completely from the illness, but joint pain can last for months or even
years in some situations. Individuals who have recovered are likely to be immune
to future infections. CHIKV is found in Africa's tropical and subtropical regions, as
well as Southeast Asia. In Africa, CHIKV is predominantly spread through a
sylvatic, enzootic cycle, which might result in human illnesses, including local
outbreaks in rural regions

CONCLUSIONS AND RECOMMENDATIONS

In conclusion,viruses are organisms that are capable of causing fatal

implications to humans. They also contain either DNA or RNA and are coated
with a protein coat that does not allow them to replicate without any help from
the host cell. Viruses replicate through the process in which they kill the host
cell and harm the host organism during the process with the use of
components coming from the host cell. Viruses transfer from one host to
another through the process of viral transmission. VIruses also undergo a
species barrier where they only cross to a different host of the same variety.
The Chikungunya virus is a common disease in Southeastern Asia and Africa
and belongs to the Alphavirus family. Bites of the Aedes mosquitoes is how
the virus can be transmitted to humans. The symptoms include fever,
headache, arthralgia, myalgia and conjunctivitis and are similar to dengue.
Those symptoms will diminish and a maculopapular rash will appear after two
or three days. The fever can come back. Over weeks and even months,
arthralgia can persist. The diagnosis may be negative in the early stages of
the condition, although it is usually determined by tests on an antibody. If
PCR is possible for the diagnosis. Treatment with pain relievers and
antipyretics is symptomatic.

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REFERENCES

Centers for Disease Control and Prevention. (2016). Epidemiologic Steps of an Outbreak
Investigation. Principles of Epidemiology in Public Health Practice, Third Edition: An Introduction
to Applied Epidemiology and Biostatistics. Retrieved from
https://www.cdc.gov/csels/dsepd/ss1978/lesson6/section2.html

World Health Organization. (2019). Distribution and outbreak of chikungunya.

https://www.who.int/news-room/fact-sheets/detail/chikungunya

Ballera JE, Zapanta MJ, de los Reyes VC, Sucaldito MN, Tayag E. Investigation of
chikungunya fever outbreak in Laguna, Philippines, 2012. Western Pac Surveill
Response J. 2015 Aug
https://pubmed.ncbi.nlm.nih.gov/26668759/

Investigation of chikungunya fever outbreak in Laguna, Philippines, 2012.

https://www.semanticscholar.org/paper/Investigation-of-chikungunya-fever-outbreak-in-
Ballera-Zapanta/05df7eb020a8512deb2bde83eb3709391e06dff5

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