CHIKUNGUNYA
Chikungunya fever is a viral disease transmitted to humans by the bite of infected Aedes Aegypti mosquitoes. Chikungunya virus (CHIKV) is a member of the genus Alphavirus, in the family Togaviridae.
CHIKV was first isolated from the blood of a febrile patient in Tanzania in 1953, and has since been identified repeatedly in west, central and southern Africa and many areas of Asia, and has been cited as the cause of numerous human epidemics in those areas since that time. The virus circulates throughout much of Africa, with transmission thought to occur mainly between mosquitoes and monkeys.
CHIKV was first isolated from the blood of a febrile patient in Tanzania in 1953, and has since been identified repeatedly in west, central and southern Africa and many areas of Asia, and has been cited as the cause of numerous human epidemics in those areas since that time. The virus circulates throughout much of Africa, with transmission thought to occur mainly between mosquitoes and monkeys.
1. What is chikungunya?
Chikungunya is a fever caused by Chikungunya virus transmitted by Aedes aegypti mosquitoes which breads in clean water stagnation in artificial containers.
2. What are the signs and symptoms of Chikungunya?
One to three days fever followed by headache, vomiting, photophobia, joint pain and swelling with or without rashes, If the fever lasts for more than 3 days, investigations are to be carried out to rule out the other causes
3. How to differentiate with other fevers?
The fever will not last long for more than 3 days. The joint swelling and pain will persist even after the recovery from the fever. The swelling and joint pain may persist 1- 3 weeks or even months depending on the age of the patient.
4. How chikungunya is transmitted?
There is no direct transmission from the infected person to healthy person. It is transmitted by the bite of the infected mosquito.
5. Will Chikungunya cause death?
No. Worldwide statistics and WHO reports clearly show that Chikungunya do not cause death. There may be deaths due to various other causes during Chikungunya outbreak. These deaths are often reported in the media as due to Chikungunya which is incorrect.
6. Is there a specific treatment for Chikungunya?
There is no specific treatment but drugs like paracetamol, diclofenac sodium, chloroquine are used to relieve fever, joint pains and swelling. Drugs like aspirin and steroids should be avoided.
7. Is there any treatment under Indian System of Medicine?
Yes, effective medicines are available. The following medicines are being used.
- Sudarsana sooranam
- Threethoda tablets
- Nilavembu Kudineer
- Pinda thailam - External use
- Karpoorathi thailam - External use
8. What is the situation in Tamil Nadu?
Now the disease is in the verge of total elimination.
9. Is there a vaccine for Chikungunya?
Yes.
10. Whether the person once recovered from the disease will he/ she get it again?
No. One attack of Chikungunya will give lifelong immunity.
11. Do we need a blood test for all Chikungunya cases?
No. There is no need to do blood test to confirm Chikungunya. Clinical diagnosis is enough. Fever with joint pain followed by swelling are the cardinal signs of Chikungunya.
12. How did Chikungunya occur after 42 years?
The first outbreak of Chikungunya reported during 1963 at Calcutta and in 1964 in Chennai. Due to the change in the structure of the virus the disease has re-emerged.
13. What is the status in Tamil Nadu India?
The first outbreak of Chikungunya reported in Vellore on 20th March 2006 and thereafter spread to other parts of Tamil Nadu. The worst affected districts are Vellore, Namakkal, Dharmapuri and Krishnagiri districts.
There is no direct human to human transmission. The infection is transmitted only through bite of infected mosquito. The best way of prevention is to eliminate domestic and peridomestic breeding of mosquitoes.
15. Where do the Aedes agypti mosquito breed?
The Aedes agypti mosquito breeds in clean water stored in artificial water containers within the house. These mosquito also breeds in discarded and unused containers like coconut shells, grinding stone, plastic cups, old tyres, mud pots etc.
16. How to eliminate the breeding of mosquitoes?
Remove all unwanted water containers around the houses
Inside the house, the easiest way is to cover all water containers with cloth including the cement tubs, drums and vessels. This will prevent mosquitoes laying of eggs and thereby prevent mosquito breeding.
17. What is ‘Operation Chikungunya 2006’?
Operation Chikungunya 2006 includes:
- Breeding source reduction measures
- Anti larval activities by application of
- Anti adult measures by fogging operations
- Intensified IEC activities
The PHC area is divided into 6 day blocks. Each day block is allotted to a group of health workers. Every day the team will go to their allotted areas, visit house to house and carry out all the above said activities. Nearly 35,000 health functionaries are involved in these activities.
19. How anti larval and anti adult measures are carried out?
Temephos is a chemical used to carry out anti larval activities. 2.5 ml in 10 litres of clean water will give a dilution less than 1 ppm. This stock solution is applied to the water containers based on the height of the water columns.
Pyrethrum extracts is used to carry out anti adult measures by fogging operation.
Pyrethrum extracts is used to carry out anti adult measures by fogging operation.
20. Are these chemicals hazardous to human beings and animals?
No. These chemicals are very safe for human beings and animals in the dilutions used for anti larval activities.
21. What are the other diseases transmitted by aedes agypti mosquitoes?
Dengue and Yellow fever
22. What are the other diseases transmitted by other types of mosquitoes?
Anopheline mosquito which breeds in clean water like wells, overhead tanks and sumps – transmits malaria Culex mosquito which breeds in sewage and sullage water, drains and septic tanks - transmits filariasis.
Another species of culex mosquito which breeds in paddy fields - transmits Japanese Encephalitis (Brain fever)
Another species of culex mosquito which breeds in paddy fields - transmits Japanese Encephalitis (Brain fever)
23. What are the personal protective measures against mosquito bites?
Mosquito nets and repellants
Chikungunya is a viral disease that is spread by mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.
The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.
There is no cure for the disease. Treatment is focused on relieving the symptoms.
The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.
The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in Europe, in a localized outbreak in north-eastern Italy.
Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an alphavirus of the family Togaviridae. The name ‘chikungunya’ derives from a root verb in the Kimakonde language, meaning "to become contorted" and describes the stooped appearance of sufferers with joint pain.
Signs and symptoms:
Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pain. Other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash. The joint pain is often very debilitating, but usually ends within a few days or weeks. Most patients recover fully, but in some cases joint pain may persist for several months, or even years.
Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints. Serious complications are not common, but in older people, the disease can contribute to the cause of death. Often symptoms in infected individuals are mild and the infection may go unrecognized, or be misdiagnosed in areas where dengue occurs.
Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints. Serious complications are not common, but in older people, the disease can contribute to the cause of death. Often symptoms in infected individuals are mild and the infection may go unrecognized, or be misdiagnosed in areas where dengue occurs.
Transmission:
The virus is transmitted from human to human by the bites of infected female mosquitoes. Most commonly, the mosquitoes involved are Aedes aegypti andAedes albopictus, two species which can also transmit other mosquito-borne viruses, including dengue.
These mosquitoes can be found biting throughout daylight hours, although there may be peaks of activity in the early morning and late afternoon. Both species are found biting outdoors, but Ae. aegypti will also readily feed indoors.
These mosquitoes can be found biting throughout daylight hours, although there may be peaks of activity in the early morning and late afternoon. Both species are found biting outdoors, but Ae. aegypti will also readily feed indoors.
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.
Diagnosis:
Several methods can be used for diagnosis. Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibody levels are highest three to five weeks after the onset of illness and persist for about two months.
The virus may be isolated from the blood during the first few days of infection. Various reverse transcriptase–polymerase chain reaction (RT–PCR) methods are available but are of variable sensitivity. Some are suited to clinical diagnosis. RT–PCR products from clinical samples may also be used for genotyping of the virus, allowing comparisons with virus samples from various geographical sources.
The virus may be isolated from the blood during the first few days of infection. Various reverse transcriptase–polymerase chain reaction (RT–PCR) methods are available but are of variable sensitivity. Some are suited to clinical diagnosis. RT–PCR products from clinical samples may also be used for genotyping of the virus, allowing comparisons with virus samples from various geographical sources.
Treatment:
There are no specific drugs to cure the disease. Treatment is directed primarily at relieving the symptoms, including the joint pain. There is no commercial chikungunya vaccine.
Prevention and control:
The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for chikungunya as well as for other diseases that these species transmit. Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes.
This requires mobilization of affected communities. During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.
For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the day-biting vectors is advised. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions.
Repellents should contain DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester) or icaridin (1-piperidinecarboxylic acid, 2-(2-hydroxyethyl)-1-methylpropyl ester). For those who sleep during the daytime, particularly young children, or sick or older people, insecticide treated mosquito nets afford good protection. Mosquito coils or other insecticide vaporizers may also reduce indoor biting.
This requires mobilization of affected communities. During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.
For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the day-biting vectors is advised. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions.
Repellents should contain DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester) or icaridin (1-piperidinecarboxylic acid, 2-(2-hydroxyethyl)-1-methylpropyl ester). For those who sleep during the daytime, particularly young children, or sick or older people, insecticide treated mosquito nets afford good protection. Mosquito coils or other insecticide vaporizers may also reduce indoor biting.
Disease outbreaks:
Chikungunya occurs in Africa, Asia and the Indian subcontinent. Human infections in Africa have been at relatively low levels for a number of years, but in 1999-2000 there was a large outbreak in the Democratic Republic of the Congo, and in 2007 there was an outbreak in Gabon.
Starting in February 2005, a major outbreak of chikungunya occurred in islands of the Indian Ocean. A large number of imported cases in Europe were associated with this outbreak, mostly in 2006 when the Indian Ocean epidemic was at its peak.
A large outbreak of chikungunya in India occurred in 2006 and 2007. Several other countries in South-East Asia were also affected. In 2007 transmission was reported for the first time in Europe, in a localized outbreak in north-eastern Italy.
A large outbreak of chikungunya in India occurred in 2006 and 2007. Several other countries in South-East Asia were also affected. In 2007 transmission was reported for the first time in Europe, in a localized outbreak in north-eastern Italy.
More about disease vectors:
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, including coconut husks, cocoa pods, bamboo stumps, tree holes and rock pools, in addition to artificial containers such as vehicle tyres and saucers beneath plant pots.
This diversity of habitats explains the abundance ofAe. 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, including flower vases, water storage vessels and concrete water tanks in bathrooms, as well as the same artificial outdoor habitats as Ae. albopictus.
This diversity of habitats explains the abundance ofAe. 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, including flower vases, water storage vessels and concrete water tanks in bathrooms, as well as the same artificial outdoor habitats as Ae. albopictus.
In Africa several other mosquito vectors have been implicated in disease transmission, including species of the A. furcifer-taylori group and A. luteocephalus. There is evidence that some animals, including non-primates, may act as reservoirs.
Symptoms of Chikungunya:
Symptoms of Chikungunya includes fever, debilitating arthralgia (joint pain), swelling of joints, stiffness of joints, myalgia (muscular pain), headache, fatigue (weakness), nausea, vomiting and rash.
The incubation period (time from infection to illness) can be 2-12 days, but is usually 3-7 days. "Silent" CHIKV infections (infections without illness) do occur; but how commonly this happens is not yet known.
Acute chikungunya fever typically lasts a few days to a couple of weeks, but some patients have prolonged fatigue lasting several weeks. Additionally, some patients have reported incapacitating joint pain, or arthritis which may last for weeks or months. No deaths, neuro-invasive cases, or hemorrhagic cases related to CHIKV infection have been conclusively documented in the scientific literature.
CHIKV infection (whether clinical or silent) is thought to confer life-long immunity.
Spread of Chikungunya:
CHIKV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on a person infected with CHIKV. 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 CHIKV to humans. Aedes albopictus (the Asian tiger mosquito) may also play a role in human transmission in Asia, and various forest-dwelling mosquito species in Africa have been found to be infected with the virus.
Treatment of Chikungunya:
Effective treatment for Chikungunya fever is available in homeopathy.
Homeopathy has very effective treatment for Chikungunya. After diagnosis of Chikungunya, homeopathic treatment should be started as early as possible. Homeopathic treatment can also be given along with conventional treatment (allopathy) if desired.
Conventional treatment consists of only symptomatic treatment of fever, stiffness, joint pain etc. of this viral illness, whereas homeopathic medicines give better and comparatively long lasting relief from the disease. Rhus Tox, Eupatorium Perf, Bryonia, Arnica are the few homeopathic remedies that help in Chikungunya but more accurate and effective remedy can be chosen by a homeopathic doctor according to clinical picture of that particular case. Homeopathy works effectively in all viral diseases.
Homeopathic pills are simply chewed (dissolved) on tongue and are sweet in taste. Homeopathic medicines do not cause gastric irritation, are safe on kidneys and liver even when taken for long duration.
Conventional treatment consists of only symptomatic treatment of fever, stiffness, joint pain etc. of this viral illness, whereas homeopathic medicines give better and comparatively long lasting relief from the disease. Rhus Tox, Eupatorium Perf, Bryonia, Arnica are the few homeopathic remedies that help in Chikungunya but more accurate and effective remedy can be chosen by a homeopathic doctor according to clinical picture of that particular case. Homeopathy works effectively in all viral diseases.
Homeopathic pills are simply chewed (dissolved) on tongue and are sweet in taste. Homeopathic medicines do not cause gastric irritation, are safe on kidneys and liver even when taken for long duration.
In epidemics, prevention of Chikungunya can be achieved by administering Homeopathic "Genus Epidemicus". Genus Epidemicus is a homeopathic remedy that is chosen as a preventive remedy for that particular epidemic in that particular locality. Homeopathic medicines are equally effective for post-chikungunya complaints like weakness, stiffness in joints, muscles pain etc.
Infected persons should be protected from further mosquito exposure (staying indoors and/or under a mosquito net during the first few days of illness) so that they can't contribute to the transmission cycle.
Infected persons should be protected from further mosquito exposure (staying indoors and/or under a mosquito net during the first few days of illness) so that they can't contribute to the transmission cycle.
Prevention tips:
• Use mosquito repellent on exposed skin.
• Wear long sleeves shirts and pants.
• Have secure screens on windows and doors to keep mosquitoes out.
• Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out.
• Additionally, a person with chikungunya fever should limit their exposure to mosquito bites in order to avoid further spreading the infection. The person should stay indoors or under a mosquito net.
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