What is Chikungunya? Chikungunya is a relatively rare form of viral fever
caused by an alphavirus that is spread by mosquito bites from the
Aedes aegypti mosquito. The name is derived from the African word
meaning ‘that which bends up’ in reference to the stooped posture
developed as a result of the arthritic symptoms of the disease.
The disease was first described by Marion Robinson and W.H.R.
Lumsden in 1955, following an outbreak on the Makonde Plateau,
along the border between Tanganyika and Mozambique, in 1952.
Chikungunya is not considered to be fatal. Chikungunya virus is
highly infective and disabling but is not transmissible between
people.
Epidemiology
Chikungunya was first described in Tanganyika, Africa in 1955. An
outbreak of chikungunya was discovered in Port Klang in Malaysia
in 1999 affecting 27 people. In February 2005, an outbreak was
recorded on the French island of Réunion in the Indian Ocean. As
of 18 May 2006, 258,000 residents have been hit by the virus in
the past year (out of a population of about 777,000). 219 official
deaths have been associated with chikungunya). In Mauritius, 3,500
islanders have been hit in 2005.
There have also been cases in Madagascar, Mayotte and the
Seychelles. In 2006, there was a big outbreak in the Andhra
Pradesh state in India. Nearly 200,000 people were affected by
this disease in the districts of Praksham and Nellore in this
state. Some deaths have been reported but it was thought to be due
mainly to the inappropriate use of antibiotics and anti
inflammatory tablets. As this virus can cause thrombocytopenia,
injudicious use of these drugs can cause erosions in the gastric
epithelium leading to exsangunating upper GI bleed (due to
thrombocytopenia).
A separate outbreak of chikungunya fever was reported from
Malegaon town in Nasik district, Maharashtra state, in the first
two weeks of March 2006, resulting in over 2000 cases. In Orissa
state, almost 5000 cases of fever with muscle aches and headache
were reported between February 27 and March 5, 2006. In Bangalore,
there was an outbreak of Chikungunya in May 2006 with arthralgia/arthritis,
rashes. So also in the neighbouring state of Andhra Pradesh. The
latest outbreak in Tamilnadu, India, 20,000 cases were reported in
June 2006. Earlier it was found spreading mostly in outskirts of
Bangalore, but now it has started spreading in the city also.
Analysis of the recent outbreak has suggested that the increased
severity of the disease may be due to a change in the genetic
sequence, altering the virus' coat protein, which potentially
allows it to multiply more easily in mosquito cells.
How do humans become infected with
chikungunya virus?
The chikungunya virus is spread by the bite of an infected
mosquito. Mosquitoes become infected when they feed on a person
infected with the chikungunya virus. Monkeys, and possibly other
wild animals, may also serve as reservoirs of the virus. Infected
mosquitoes can then spread the virus to other humans when they
bite.
Aedes aegypti (the yellow fever mosquito), a household container
breeder and aggressive daytime biter which is attracted to humans,
is the primary vector of chikungunya virus to humans. Aedes
albopictus (the Asian tiger mosquito) may also play a role in
human transmission is Asia, and various forest-dwelling mosquito
species in Africa have been found to be infected with the virus.
What are the symptoms? After an incubation period of 3-12 days there is a
sudden onset of flu-like symptoms including a severe headache,
chills, fever (>40°C, 104°F), joint pain, nausea, vomiting and a
rash involving the limbs and trunk. The joints of the extremities
in particular become swollen and painful to the touch. Haemorrhage
is rare and all but a few patients recover within 3-5 days. There
can also be headache, conjunctival injection and slight
photophobia. Some can suffer for joint pain for months. Children
may display neurological symptoms.
How is it diagnosed?
Sudden severe headache, chills, fever, joint and muscle pain are
the commonest symptoms. The diagnostic tests include detection of
antigens or antibodies in the blood, using ELISA (or EIA - enzyme
immunoassay) or molecular techniques like polymerase chain
reaction (PCR). The antibodies detected by serological assays like
ELISA require an IgM capture assay to distinguish it from dengue
fever.
How is it treated?
While supportive or palliative medical care with anti-inflammatory
drugs and analgesics is available, there is no specific treatment
for chikungunya. The illness is usually self-limiting and resolves
with time. Symptomatic treatment is recommended after excluding
other more dangerous diseases. Analgesics, antipyretics and fluid
supplementation are important aspects in managing this infection.
There is no vaccine currently available.
The virus can be killed by common disinfectants, moist heat and
drying. The vector (a mosquito) also needs to be controlled with
insecticides.
How to prevent Chikungunya?
Prevention is possible by controlling proliferation of mosquitoes
in stagnant water. Water collection should be avoided by:
* Eliminating any still water found on roofs
* Seeing to it that water pipes are not clogged
* 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, garbage, saucers
under flower pots, etc)
* Renew water in flower vases at least once a week
Other precautions:
* Wear clothes that suitably cover arms and legs
* Use mosquito nets and mosquito repellent products (coils,
sprays, topical lotions and creams)
* Have secure screens on windows and doors to keep mosquitoes out.
* A person with chikungunya fever should limit their exposure to
mosquito bites in order to avoid further spreading the infection,
and should stay indoors or under a mosquito net.
Treatment for Chikungunya
Chikungunya
Virus
Prevention for Chikungunya
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