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B.Sc., M.B.B.S.,(M.D Community Medicine)., D.P.H., D.I.H., PGCH&FW(NIHFW,New Delhi)
Sr.D.M.O (SELECTION GRADE) INDIAN RAILWAYS
Chikungunya is a relatively rare form of viral fever ("debilitating
non-fatal viral illness." )
caused by an alphavirus that is spread by mosquito bites from the Aedes aegypti mosquito.
500 islanders have been hit in 2005. There have also been cases in Madagascar.000). 2006. In February 2005. An outbreak of chikungunya was discovered in Port Klang in Malaysia in 1999 affecting 27 people. Chikungunya was first described in Tanzania. Africa in 1952. an outbreak was recorded on the French island of Réunion in the Indian Ocean. In neighboring Mauritius. .000 residents have been hit by the virus in the past year (out of a population of about 777. 219 official deaths have been associated with chikungunya. As of May 18. Mayotte and the Seychelles. 3. 258.
in 2005-2006. The name is derived from the Makonde word meaning "that which bends up" in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. . Lumsden in 1955. Chikungunya is not considered to be fatal. along the border between Tanganyika and Mozambique. 200 deaths have been associated with chikungunya on Réunion island. following an outbreak on the Makonde Plateau.H. The disease was first described by Marion Robinson and W.R. However. Chikungunya is closely related to O'nyong'nyong virus. in 1952.
Dharwad are affected. . A separate outbreak of chikungunya fever was reported from Malegaon town in Nasik district. rashes. there seems to be an outbreak of CHIK now (May 2006) with arthralgia/arthritis. 992 tested positive.611 samples sent to laboratories. resulting in over 2000 cases. there was a big outbreak in the Andhra Pradesh state in India. Nearly 200. In the 3rd week of May 2006 the outbreak of Chikungunya in North Karnataka is severe. Of the 10. ² first reported in India in 1963 ² had returned after a three-decade dormancy and 121 districts across seven States were affected by it with a total of 9.000 people were affected by this disease in the districts of Praksham and Nellore in this state. Gadag. In Bangalore. Koppal.74. Maharashtra state. in the first two weeks of March 2006. In Orissa state. amost 5000 cases of fever with muscle achesand headache were reported between February 27 and March 5. All the North Karnataka districts specially Gulberga. 2006. the state capital of Karnataka (India). In 2006.541 suspected cases. Bellari.
Virus classification Group: Group IV ((+) ssRNA) Family: Togaviridae Genus: Alphavirus .
EPIDEMIOLOGICAL TRIAD AGENT VECTOR HOST ENVIRONMENT .
Aedes aegypti.CULEX and MANSONIA species Mosquitoes . Aedes albopictus .VECTOR It is transmitted by AEDES.
Aedes aegypti mosquito .
plastic cups. washing and bathing ± Rainwater collected in unused materials like coconut shells.AEDES MOSQUITOES Household container breeders Breeds in ± clean water ± In all stored water for drinking. mud pots. tyres etc .
BREEDING SOURCES .
HOST MAN The main virus reservoirs are monkeys. but other primates. mammals and birds can also be affected .
AEDES MOSQUITOES Aggressive day time Bite Major period of activity ± sunrise and sunset .
ENVIRONMENT Population explosion Deforestation Global warming Floods Competition for food fast movement of population .
Improper disposal of garbage and pollution of aquatic systems Development of resistance in vectors to insecticides .ENVIRONMENT Emergence of world as single village Unplanned urbanization Inadequacy of sanitation.
TRANSMISSION This virus is transmitted only by mosquitoes The mosquito picks up the virus from an infected person during the viraemic period ± within five days from the day of starting of symptoms An infected mosquito will remain infected all its life span and can transmit the virus each time it bites An infected person cannot spread the infection directly to other persons .
Headache. (102.2 °F) Petechial or Maculopapular Rash Usually Involving the Limbs and Trunk Arthralgia or Arthritis Affecting Multiple Joints Which Can Be Debilitating. .SYMPTOMS Fever Which Can Reach 39°C. Conjunctival Injection and Slight Photophobia.
enzyme immunoassay) polymerase chain reaction (PCR).DIAGNOSIS The diagnostic tests include detection of antigens or antibodies in the blood. . using ELISA (or EIA .
DIFFERENTIAL DIAGNOSIS DENGUE WEST NILE FEVER ONYONG NYANG FEVER .
neurological complications such as meningoencephalitis have been reported in a small proportion of patients Mother to child transmission of chikungunya virus was a new observation recorded during the recent French Reunion islands outbrea .COMPLICATIONS However.
In some patients.COMPLICATIONS Symptoms are generally self-limiting and last 1±10 days. minor hemorrhagic signs such as epistaxis or gingivorrhagia have also been described . Arthralgia may persist for months or years.
. antipyretics and fluid supplementation are important aspects in managing this infection.IS THERE ANY EFFECTIVE TREATMENT ? There is no active treatment against chikv Presently treatment is purely symptomatic supportive care and rest and nutrition Analgesics.
aspirin and nonsteroidal antiinflammatory drugs. Movement and mild exercise tend to improve stiffness and morning arthralgia. chloroquine phosphate (250 mg/day) has given promising results. No Specific Treatment for Chikungunya. the Project Was Discontinued and There Is No Vaccine Currently Available. Supportive care with rest is indicated during the acute joint symptoms." .TREATMENT Self-limiting and Will Resolve With Time. Supportive or Palliative Medical Care With Antiinflammatories Vaccine Trials Were Carried Out in 2000. but heavy exercise may exacerbate rheumatic symptoms.
Is there any vaccine? Currently there is no marketable vaccine available for man Chikungunya confers a life-long immunity on the infected person. .
which potentially allows it to multiply more easily in mosquito cells. . altering the virus' coat protein. Analysis of the recent outbreak has suggested that the increased severity of the disease may be due to a change in the genetic sequence.
. Using mosquito screens or nets in non ± Airconditioned rooms. Wearing the long sleeved clothes like long trousers of a light shade for protection against mosquitoes. Using insect repellents over the exposed parts of the body.PREVENTION Elimination of stagnant water at home. schools and work place to avoid breeding of mosquitoes.
Properly covering all water tanks so that mosquitoes cannot get in Getting rid of any container capable of retaining water in the outdoor surroundings (used tyres. food cans. saucers under flower pots. garbage. etc) Renew water in flower vases at least once a week .
CONTROL Aedes species is the main target of control Source reduction of breeding sites of mosquitoes Requires community involvement to keep the water storage containers free of mosquitoes Eliminate other breeding places in and around houses .
BIOLOGICAL CONTROL Introduction of larvivorous fish. namely Gambusia and Guppy in water tanks and other water sources. .
ANTI ² MOSQUITOE MEASURES The organophosphorous insecticide ABATE is being used in a large scale ABATE can prevent breeding upto 3 months when applied to sand granules It does not affect man or the taste of water .
THERMO FOGGING ULV treatments 10 days apart has shown to reduce mosquito densities more tham 98% Aerosol spray of ultra low volume [ULV] of MALATHION or SUMITHION 250 ml/hectare is effective in interrupting transmission and stopping epidemics .
YOUR ROLE? Educate community about the disease. mode of its transmission. Changes in practice of storage of water and personal protection should be encouraged They should also be reassured that this a preventable disease . availability of treatment and adoption of control measures.
rallies etc . Community should be advised to cooperate in fogging Take measures for eliminating breeding places Special campaigns may be carried out involving mass media including local vernacular newspapers/magazines. radio and TV as well outdoor publicity like hoardings. miking. drum beating.
pamphlets. Interpersonal communication through group meetings. Health education materials should be developed and widely disseminated in the form of posters. traditional/folk media particularly must be optimally utilized. . handbills.
repellents are not recommended . insecticide-treated bed nets should be used . pregnant women and children under the age of 12 years should consult a physician or pharmacist For newborn children under three months. Before using repellents. and should stay indoors or under a mosquito net.CAUTION A person with chikungunya fever should limit their exposure to mosquito bites in order to avoid further spreading the infection. instead.
0 .Inter National Classification of Diseases Code for Chikungunya ICD-10 A92.
M) .ARUNMURUGAN(M.P.D S.THANK YOU ACKNOWLEDGEMENT: DR.
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