Chikungunya

ICD-10 A92.0
 Chikungunya

Derived from a local word meaning that

which bends up or doubling up in
reference to the stooped posture
developed as a result of excruciating joint
pain and arthritic symptoms of the
disease
Manifested by high fever and severe
articular pains in the limbs and spinal
column
 Problem statement

Global
Virus was isolated from patients &
mosquitoes during an epidemic in
Tanzania, Africa (1952-53)
2005 outbreak: French island of Reunion,
Mauritius, Madagascar and other islands
 Outbreaks of Chikungunya virus are seen
in:
sub-Saharan Africa
Southeast Asia (India & Indian
subcontinent)
islands in the Indian Ocean
SEAR
1963-64 outbreak: first reported in India
(Kolkata)
1965 outbreak: in India (Chennai)
1999 outbreak: Port Klang in Malaysia
2006 major outbreak: in 16 states of India
(Andhra Pradesh, Tamil Nadu, Kerala,
Karnataka, Goa, West Benagal & many
others)
Nepal
Despite reports of large outbreaks in
neighbouring India and indication of possible
local transmission , there are no published
national seroprevalence surveys for Nepal
and CHIKV cases are possibly
misdiagnosed as typhoid or other bacterial
or viral fevers
Three cases of CHIKV infection were
reported in Nepal in 2013
 Epidemiology
Agent
Chikungunya Virus (CHIKV)
+ve single-stranded RNA virus
Family: Togaviridae
Genus: Alphavirus
Vector
Aedes mosquito:
- Aedes aegypti
- Aedes albopictus
These mosquito types are characterised
by white stripes on their bodies and legs
Host
Man
Other reservoirs: Monkeys, Birds, Cattle,
Rodents can also be affected
Environment
Population explosion
Deforestation
Global warming
Unplanned urbanization
Inadequacy of sanitation
Improper disposal of garbage and pollution
of aquatic systems
Development of resistance in vectors to
insecticides
 Clinical Features
I.P. : 4-7 days
Onset: sudden
Fever with chills
Cephalalgia (pain in the region of head &
neck)
Anorexia
Lumbago (low back pain)
Conjunctivitis
Adenopathy (large or swollen lymph nodes)
 Morbilliform rash : occasionally with
purpura; on the trunk and limbs; cutaneous
eruption in every 3-7 days
Coffee-coloured vomiting
Epistaxis & petechiae
Arthropathy (pain, swelling & stiffness of
joints namely metacarpophalangeal, wrist,
elbow, shoulder, knee, ankle, metatarsal):
appear on 3rd & 5th day after onset of
symptoms, persist for months to years
 Diagnosis
Virus isolation from blood of febrile patients
by intracerebral inoculation in suckling
mice or on VERO cells
Serologic diagnosis:
- Haemagglutination inhibition, serum
neutralization or complement fixation test: to
demonstrate sero-conversion by comparing
acute- & convalescent-phase sera
- ELISA: to detect IgM
- RT-PCR: rapid diagnosis
 Management
No specific treatment
Usually self-limiting
Analgesics, antipyretics like paracetamol,
diclofenac sodium, chloroquine along
with fluid supplementation are
recommended to manage infection and
relieve fever, joint pains and swelling
Avoid steroids and drugs like aspirin
 Prevention & control
Elimination of stagnant water at home,
schools and work place; properly covering all
water tanks to avoid breeding of mosquitoes .
Using insect repellents over the exposed
parts of the body.
Using mosquito screens or nets in non air-
conditioned rooms.
Wearing the long sleeved clothes like long
trousers of a light shade for protection against
mosquitoes.
 Anti-mosquito 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 or Fumigation

ULV treatments 10 days apart has shown to

reduce mosquito densities more than 98%
Aerosol spray of ultra low volume [ULV] of
MALATHION or SUMITHION 250 ml/hectare
is effective in interrupting transmission and
stopping epidemics
 Biological control
Introduction of larvivorous fish, namely
Gambusia and Guppy in water tanks and
other water sources.
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