CHIKUNGUNYA (Article From Nammude Arogyam)

Chikungunya is a “viral” disease which spread exclusively by the bite of infected

mosquitoes. Aedes aegypti is the major vector and also Aedes albopictus. It was first

isolated in 1953 in Tanzania; it affects hundreds of thousands of people there. It is rarely a

life threatening disease. The disease resembles dengue fever or it can be a combination of

both since the vector is same for Chikungunya and Dengue fever.

Virus—

Chikungunya virus, belong to family Togaviridae, Alpha Virus. Man is the reservoir of

this virus for mosquitoes. An infected person cannot transmit the disease to another but

only through mosquito by biting infected person and then biting someone else. Incubation

Period:-1-12 days after the bite of the infected mosquito—Aedes aegypti and Aedes

albopictus

Prevalence: -

First reported cases in Africa (1953), India and Southeast Asia.

In India the first outbreak was at Calcutta in 1963, cases were in Lakhs. In 1964

epidemic occurred in lakhs. Since 1973 there was no cases reported till now. In 2005-2006

periods there were more than 8 lakhs cases reported. In 2005 epidemics in Andrapradesh

and Maharashtra at Sholapur nearly 37% people were affected with Chikungunya but death

was not reported. It is disease found primarily in Urban Area.

Symptoms:-

1. The disease starts suddenly with fever, chills, headache, nausea, vomiting,

2. Low back ache, joint pain, and Maculo-papular rashes after 5th

day is noticed.

3. The affected patient is in stooped posture which is the most common feature of the

disease.

4. The out come of the disease is the persistent arthritis which may need long term

anti-inflammatory therapy.

5. Children may be asymptomatic –can present as head ache, pharyngitis, loose stools

and vomiting 6. Almost always self-limiting,

Epidemic in Kerala 2007:-

� Total number reported cases in 2007 were 2, 40,052. Non reported cases may be

more .In Kottayam alone the reported cases were 10662

� Following Pre-monsoon showers epidemic of Chikungunya started in

Pathanamthitta and Palakkad– Walayar check post, affected more in hilly areas.

� Pathanamthitta, Kottayam, Alleppey, Part of Ernakulam were severely affected.

Idukki Palghat and Trissur were less affected; similarly reported cases in northern

part of Kerala were low. So we should be very careful about the less affected area

because next attack will be severe in the less affected areas. Unless we are very

agile in containing the mosquito breed the epidemic out break will be very severe in

non affected and less affected areas.

Virological Investigations:-

� National Institute of Virology, Pune

� Rajiv Gandhi Institute for Biotechnology, Trivandrum

� Kerala State Institute of Virology & Infectious Diseases, Alleppey, .not

strengthened properly so far

Diagnostic facilities at:-

� Kerala State Institute of Virology & Infectious Diseases, Alleppey. So far

this institute has not strengthened in spite of the repeated epidemics. There

is no full fledged facility for research & study available, but still depending

on National institute at Pune

� Medical College – Trivandrum

� Medical College – Kottayam

� State Public Health Laboratory – Trivandrum

� Rajiv Gandhi Institute for Biotechnology (Genetic Methods) so not useful

for routine investigation

Spread by – Bite of infected Aedes aegypti and Aedes albopictus, in daylight hours.

If no water, the eggs can remain alive up to 1 year

Prevention:- ONLY WAY OF CONTROLLING THE DISEASE IS ERRADICATION of

MOSQUITO & MOSQUITO BREEDING SOURCES.

“There is no preventive Treatment available in the World so far” Avoid mosquito bites and eliminate mosquito breeding sites,Use mosquito nets to

prevent mosquito bite and repellents help to drive mosquito away.

IMA Action Plan for Prevention and Control of Chikungunya/Dengue in Kerala

IMA is very much concerned about the Emerging disease –Chikungunya, and Re-

Emerging of Dengue, Leptospirosis, and Malaria. We cannot afford one more epidemic, So

IMA has set up a state level epidemic cell and Action-Plan to contain these diseases

especially Chikungunya on war footing. State President has appointed Dr.C.V.Pratapan Rtd

DHS as the Chairman and Dr. C.V Prasanth as Convener of the IMA State Epidemic Cell

.The first state level meeting of the cell was held on 16/01/2008 at 8.30 PM in the IMA

Head Quarters and evolved an IMA Action Plan.

First outbreak of Chikungunya in India was at Calcutta in1963. Since 1973

there was no cases reported till now. In 2005-2006 period there were more than 8 lakhs

cases reported.. In Maharashtra at Sholapur nearly 37% people were affected with

Chikungunya but only one death reported. As on 4/10/2006 in Kerala 71 death due to

suspected Chikungunya is reported by the news media, majority are old people, few

newborn cases also among the list but no scientific evidence. So in our case the death due

to Chikungunya is doubtful unless clear evidence is available.

State Level Office Bearers of State Level, Regional Level, District Level and Local Branch

level Committees were formed under the Chairman Dr..C.V Pratapan Rtd. DHS and

Convener Dr.C.V Prasanth to coordinate them. Action Plan formulated as shown below

Phase I - Preparedness (Inter epidemic) - Jan to March 2008

Phase II - Apprehensive (Pre-epidemic) – April to June2008

Phase III - Attack/ Response (Epidemic) - June to Dec 2008

• Slate level meetings / sittings of state leaders concerned Epidemic Control Cell,

Research Cell combined meeting periodically and as and when required. Review

meetings off and to evaluate the then present scenario.

• Liaison with the Governmental set up, Media, etc.

• To detail Medical teams to epidemic threat areas.

• Special T.V. Program in India Vision.

• Special issue of IMA. ‘Nammude Arogyam’ – on Epidemic diseases. –

Chikungunya. Dengue, Leptospirosis.

• Press conferences and interview to /with visual media.

Prevention on avoiding mosquito bites and eliminating mosquito breeding sites

Aim;-

1. Contain the disease first in epidemic areas

2. Create task force in District Level and Branch level

3. Mosquito source reduction

4. Vector control is the only solution to contain the disease—can be done with the

cooperation of Residential associations, local body involvement and other voluntary

associations

Suggestions:-

1. Bring out facts sheets for recording and

2. Advice to Government on control measures to contain the disease time to time

3. There should be short term planning and long term policy: - It is advisable to start a

State Level separate wing for the control of epidemics. Disease surveillance system

for early identification and rapid control of epidemics

4. Set up well equipped Virology lab for Kerala

5. Mobilization of Doctors and Paramedical staff

6. There should be a protocol for the management of cases - Fever protocol

Decisions:-

1. Curative and preventive action has to start immediate

2. Uniform guide line for the management of Chikungunya

3. Preventive measures-Urgent measures to reduce mosquito population

4. Health education to the public

5. Individual isolation of infected cases for 4 to 5 days to prevent mosquito bite

6. Promote mosquito Nets use and Mosquito repellants.

7. Formation of District level Crisis Management team 2. Integrated Vector Management with the cooperation of local bodies and other

Voluntary Organisations about:-

� Entomological Surveillance including larval surveys ( in inter-epidemic period)

� At ward level, block level and district level

� Vector Control Measures –educating School children, residential Associations

and local body leaders its importance of eradicating.

� Transmission Risk Reduction through identification of region specific

potential sources & source reduction larvivorous fish, chemical larvicides,

environmental management

� IMA Meetings for Implementation of the action plan Ward level. Discuss with

The Ward Health & Sanitation Committee

� Identification and reporting of fever syndromes, Vector surveillance

� Management protocol

Zonal Level

• IMA State Vice President will take initiative to organize District level CME in each

District under the area involving IMA leaders at District Level.

• Various topics: Prevention Control and containment of epidemic diseases with

relevance to C.G. & D.F, high lighting the threat of C.G. epidemic. Action to be

initiated for opening as many fever clinics attached to private hospitals / Clinics.

FUNCTION OF DISTRICT LEVEL BODY

DTF Chairman and Convenor will take initiative to organize CME / Seminar in the

District. Ensure involvement of the Zonal vice president, Joint Secretary and Senior IMA

leaders and subject experts.

Subjects: As mentioned for branches

It was decided to set up district level act force on epidemic of Chikungunya.

All the local branches in the district have to be mobilized and set up an Action Plan to

contain the disease. All the District Task force Chairmen should take up the challenge.

Suggestions:-

1. Set-up a district level Action Body to face the threat of Chikungunya epidemics

2. All the branch presidents and secretaries should meet regularly under the chairman

and the convener should coordinate the meetings and prepare a programme

3. Concerned branch officials should prepare fact sheets for doctors and public

4. Regularly report to the district cell and in turn to state cell

5. Measures to contain the disease immediately

6. Make the Voluntary associations and local bodies to come into action for vector

control.

7. Health awareness classes for school children and students of the locality and make

them also participate in the campaign of vector control

8. Update the doctors with latest information about the disease and treatment

guidelines

Branch level Action: - In the months of February / March

• Fever Clinics to be started in all hospitals – IMA Branch President and Secretary

will take initiative to high light the threat of Viral Fever Epidemic in the state

during the coming months – February, March, April, May, June.

• At least one CME/Seminar/Workshop to be organized in each branch. IMA leaders

of State level/District level / Regional Level residing in the jurisdiction of the

branch if any will be involved. Subject experts may be exploited.

• Subjects, General talk about epidemic, viral diseases especially Chikungunya,

Dengue and Leptospirosis.

• Mosquito Control measures

• Importance of observation of the patient for 5 to 7 days after the onset of fever.

Protect the patient from mosquito bite.

• Importance of proper reports of the fever under the classification of C.G; DF; and

other viral fevers.

• Should Co-operate with Government Epidemic Control activities involving

actively.

• Conduct as many CMEs and special classes for Nurses, Paramedical & Public

(including teachers, Politicians, voluntary organizations)

• Have Liaison with Press and Media people.