CHIKUNGUNYA : recap

EPIDEMIOLOGY Epidemics of fever, rash and arthritis, resembling Chikungunya fever

have been recorded as early as 1824 in India . Chikungunya fever displays interesting epidemiological profiles: major

epidemics appear and disappear cyclically. CHIK fevers have appeared in Indonesia in 1999. Chikungunya in Asia and Africa (1960-1982) Recent occurrences of chikungunya fever

After an interval of more than 20 years, chikungunya fever has been reported from several countries including India, Indonesia, Maldives, Thailand 

Chikungunya fever in IndiaTill 10 October 2006, 151 districts of eight states/provinces of India have been affected by chikungunya fever. More than 1.25 million cases have been reported from the country with 752,245 cases from Karnataka and 258,998 from Maharashtra provinces.

Chikungunya and dengue feversThe clinical manifestations of chikungunya fever have to be distinguished from dengue fever. Co-occurrence of both fevers has been recently observed in Maharashtra state of India thus highlighting the importance of strong clinical suspicion and efficient laboratory support.  

CHIKUNGUNYA in Malaysia – the little known virus

SITI WAN ARIFAH BINTI WAN ABU HANIPAHSITI ZULAIHA ABU BAKAR

SPECIFICATION OF PROBLEMWhile most of us were distracted by events of the

world, this disease has steadily made its impact, not only in tropical regions but also in far-flung countries like Italy.

In Malaysia alone, in 2008, more than 3700 cases have occurred. It used to have an incidence of 100 cases per year but this has now risen to 100  cases per week.

Strangely enough, mainstream media has been deafeningly quiet and the health authorities have not done enough to educate the public on this relatively unknown condition. – press

History of Chikungunya ‘development’ reported in malaysia 1998 -1999 : first clinical disease outbreak in

suburb of Klang , more than 51 persons infected 2006 : Bagan Panchor , Perak ; outbreak after 7

years , at least 200 cases reported, coincided with reports of ongoing epidemics in India and almost all the island nations of the Indian Ocean, with >200,000 cases in the French island of Reunion alone since February 2005

2008 : reemerging of endemic in Johor Bahru, more than 1000 suspected cases coincided with cases reported in Singapore

2009 : 3988 cases reported positive (until October )

2010 : 787 cases reported positive (until October) after government launched the ‘War Against Dengue and Chikungunya’ like campaign

Quick facts on Chikungunya

What is Chikungunya ? :

Chikungunya (in the Makonde language "that which bends up") virus (CHIKV) is an insect-borne virus, of the genus Alphavirus, that is transmitted to humans by virus-carrying Aedes mosquitoes.[

Signs & Symptoms –

Sudden onset of high fever Redness with rashes appearing on the hand, leg and body Headache Severe joint pains Nausea and vomiting Redness of the eyes Fever can occur for a period from 1 - 7 days (usually 5 days) (Commonly mistaken for dengue fever)

Quick facts on chikungunya Incubation Period : Ranging from 3 - 12 days, usually

3 - 7 days Care & Treatment : No specific treatment

treated symptomatically (treating for specific symptoms)

Majority need only outpatient treatment Vaccine : No vaccine Immunity : Most patients who have been infected will

be immune for life. Is it Contagious? - It is not contagious, in other words

one human can't directly pass to another human. However an aedes mosquito after biting an infected person can transmit the disease by biting someone else

PATHOGENESIS The virus is transmitted from human to human by the bites of

infected female mosquitoes. Aedes aegypti and Aedes albopictus.

After the bite of an infected mosquito, onset of illness occurs usually between four and eight days but can range from two to 12 days.

Both Ae. aegypti and Ae. albopictus have been implicated in large outbreaks of chikungunya. Whereas Ae. aegypti is confined within the tropics and sub-tropics, Ae. albopictus also occurs in temperate and even cold temperate regions. In recent decades Ae. albopictus has spread from Asia to become established in areas of Africa, Europe and the Americas.

The species Ae. albopictus thrives in a wider range of water-filled breeding sites than Ae. Aegypti.

This diversity of habitats explains the abundance of Ae. albopictus in rural as well as peri-urban areas and shady city parks. Ae. aegypti is more closely associated with human habitation and uses indoor breeding sites.

both species are found

biting outdoors, but Ae.

aegypti will also readily feed indoors

Aedes aegypti and Aedes albopictus

peaks of activity in the early morning

and late afternoon

found biting throughout

daylight hours

the species Ae. albopictus thriv

es in a wider range of water-filled breeding sites than Ae.

aegypti

Water-filled breeding sites

coconut husks

cocoa pods

tree holesbamboo stumps

vehicle tyressaucers beneath

plant pots

Dengue and Chikungunya awareness campaign

Aedes mosquito clearing operation when there was a cluster infection in a particular area.

Fogging and cleanliness activities especially in residential areas .

1.2 million spent on mass media during first two weeks of campaign .

Flyers and pamplets distributions .Checking the cleanliness on potential spots such

as recreational spots, shopping malls, food courts, terminals for LRT, bus and taxi as well as tourists destinations .

Fines for ‘breeding’ aedes .

PREVENTION & CONTROLNo vaccine is available against this virus

infection.

To avoid mosquito bites:Wear full sleeve clothes and long dresses to cover the limbs;

Use mosquito coils, repellents

Use mosquito nets – to protect babies, old people and others, who may rest during the day.

To prevent mosquito breedingDraining water from coolers, tanks, barrels, drums and buckets, etc.;

Emptying coolers when not in use;

Removing from the house all objects, which have water collected in them

Cooperating with the public health authorities in anti-mosquito measures.

Role of public health authoritiesNational programme for prevention and control of vector borne diseases should be strengthened

Legislations for elimination of domestic/peridomestic mosquitogenic sites should be effectively enforced

Communities must be made aware of the disease and their active cooperation in prevention and control measures elicited

Minimizing Transmission of Infection: This can be done in the following ways:

1.      Risk Communication to the household members:      Educate the patient and other members in the household about the risk of transmission to others and

the ways to minimize the risk by minimizing vector population and minimizing the contact with vector. 2.      Minimizing vector population:      Intensify effort to reduce larval habitats in and around the houses: remove stagnant water from all junk

items lying around and in the household and in the peri-domestic areas      Stagnating water in flower pots or similar containers should be changed daily or at least twice weekly      Introduce larvivorous fish in aquaria, garden pools, etc      Weeds and tall grasses should be cut short to minimize shady spaces where the adult insects hide and

rest during hot daylight hours      Drain all water stagnating after rains      Fogging and street sanitation with proper waste management(fogging does not appear to be effective,

yet it is routinely implemented in epidemic situation   3.      Minimize the vector-patient contact (Aedes mosquitoes bite during the daytime, mostly in the

morning and late afternoon)       At household level: Have the patient and infants in the house rest under bed-nets, preferably permethrin-impregnated nets Insecticide sprays: bed rooms, closets and crevices, bathrooms, kitchens, nooks and corners; alternatively,

coils , mats, vapourizers, etc Have the patient as well as other members of the household wear full sleeves to cover extremities,

preferably bright coloured clothes Wire-mesh/nets on doors and windows   4.      Reporting to the nearest public health authority: Occurrence of the case in the community needs to be communicated immediately to the nearest public

health official for identification of clusters by person, place and time and for expansion of the control measures in the community and district levels.

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hikungunya