Chandipura Virus vector born disease ppt

Chandipura virus is a zoonotic and sporadic disease and causes acute encephalitis syndrome in humans, especially children below 15 years young- once.

1. Presented by Dr. Nikhita M. Pendam MVSc (VPE) IVRI RE-EMERGENCE OF C HANDIPURA VIRUS : AN EPIDEMIOLOGICAL PERSPECTIVE  

2. OUTLINE Introduction Aetiology History Transmission Epidemiology Pathogenesis Clinical signs Diagnosis and Treatment Case studies Disease Impact Prevention and Control Conclusion

3. INTRODUCTION The virus was named "Chandipura" after the location of its discovery . (Jacob, 2010 ) Primarily transmitted by arthropods such as mosquitoes, and sandflies. (Padhi et al ., 2024) It caused Acute encephalitis , affecting pediatric populations. Sporadic, Vector born and Zoonotic disease . (WHO, 2024) Chandipura virus (CHPV), a newly identified Arbovirus. Family -Rhabdoviridae (Bhatt and Rodriguez, 1967)

4. ETIOLOGY Order - Mononegavirales Family - Rhabdoviridae Genus – Vesiculovirus Species - Chandipura virus   (Shanmugaraj , 2024)

5. CONT… Viruses belonging to this family, its name   rhabdo , meaning rod-shaped in Greek , to the typical bullet shaped (Knipe,  2001 ) Non-segmented, Enveloped,   negative-sense single-stranded RNA molecule of approximately 11 kb long  (Banerjee, 1987 )

6. CLASSIFICATION ( Bisen and Raghuvanshi, 2013) Mononegavirales Borna disease virus Filoviridae Rabdoviridae Paramyxoviridae Cytorhabdovirus nonclassified Nuchorhabdovirus Vesiculovirus Lyssavirus Ephemerovirus Vesicular stomatitis virus(New jersey) Chandipura virus Vesicular stomatitis virus(Indiana)

7. (Clewley et al .,  1977 ) HISTORY (Bhatt and Rodrigues,  1967 ) (CHPV) was first isolated in 1965 from a patient suffering from febrile illness in a village called Chandipura , Maharashtra, India . 1975 The virus was isolated in human beings in 1980 , in Madhya Pradesh , India , from a patient with acute encephalitis.

8. (Shanmugaraj , 2024) (Chadha et al ., 2005) CONT… (WHO, 2024) 2004 2003 1990-96,1993 (Fontenille D, 1994;Sapkal et al. , 2018)

9. TRANSMISSION Primarily transmitted by arthropods such as mosquitoes, and sandflies. (Padhi et al ., 2024) CHPV is transmitted mainly by the bite of sand flies ( Phlebotomus &   Sergentomyia  spp. (   A.B et al ., 2014) The sandfly vectors are abundant in the South-East Asia Region . No human-to-human transmission has been reported. (WHO, 2024)

10. CONT… Small mammals (Rodent) Maintenance host Human Animal Sand flies/ Mosquitos through bite Sand fly

11. CONT… Primary vector : Phlebotomus spp Sergentomyia spp. After the virus enter the sand fly through a blood meal, it replicated within the cells of the salivary glands (4-5 days) Transmission to a new host when the sand fly bites and feeds again. Sand flies are usually active at twilight, evening and night- time hours. Geographical Range : Sandflies are commonly found in rural and semi-rural areas, in regions with warm and humid climates. Aedes aegypti Mosquito vector: : (Bhatt and Rodriguez, 1967) Phlebotomus spp

12. CONT… RISK FACTORS Poor housing and domestic sanitary conditions (lack of waste management) I ncrease sandfly breeding and resting sites , as well as vector access to humans .  Climate change : T emperature, rainfall, and altitude may influence vector abundance and virus transmission dynamics. S easonal , with higher rates during the warmer months. Hot summer following early monsoon .   Open sewerage, stagnated water . (Ghosh, 2017) Proximity to animal habitats Population mobility

13. EPIDEMIOLOGY  CHPV is endemic in India , with outbreaks occurring periodically . The 2003 outbreak was the largest in the past 20 years till the latest outbreak of 2024. CHPV cause of AES in western, central and southern parts of India , during the monsoon season . (Sapkal et al. , 2018 )

14. Region Study objective Study design and data source No. of confirmed CHPV cases Reference Andhra Pradesh (2003) " brain attacks " (strokes) in epidemics in 10 districts of AP. Hospital-based, case-control study among admitted cases at government hospitals. 28 out of 55 cases (50.91%) ( Rao et al.,2004) Eastern districts Nagpur (Vadodara and Panchamahal- Gujarat(2004) To investigate and confirm the etiology and to describe clinic-epidemiological features of an outbreak of AES among children from Nagpur Retrospective case series and outbreak investigation (clinical and laboratory data from patients) 9 out of 20 cases (45%) (Chadha et al., 2004) Nagpur, Maharashtra (2007) To investigate an outbreak of AES among children, confirm the etiology, and describe clinic-epidemiological features Retrospective observational study and outbreak investigation (clinical and laboratory data from hospitalized patients) 39 out of 78 cases (50%) ( Gurav et al.,2010)

15. CONT… North Telangana, Andhra Pradesh 2007 CHPV to AES cases in children , seroconversion in recovered cases and to compare the seroprevalences of anti-CHPV IgM and N antibodies in areas of reporting cases Hospital-based, surveillance study, clinical and laboratory data 25 out of 52 cases (48.1%) ( Tandale et al., 2008) Gudrigaon, Odisha To identify CHPV infection causing encephalitis among sudden death of 10 children in a tribal village Field investigation (door-to-door survey to identify cases) and hospital-based, surveillance study 4 out of 21 tested samples (19.04%) ( Dwibedi et al.  ,2015) Gaya district, Bihar 2018 To investigate an outbreak of ( AES) and identify the causative agent Outbreak investigation of patient records from hospital, and field investigation (door-to-door survey) in affected areas laboratory testing of blood and CSF samples 1 case out of 24 cases (4.1%)  (Singh et al . ,2018)

16. CONT… (Sapkal et al. , 2018 ) Warangal , Andhra Pradesh investigations suggested its wide circulation in the country 1997 & 2002 2005-2006 Andhra Pradesh Hospital-based surveillance, about 54.4% CFR 2007-2008 Investigation in Nagpur Maharashtra, CDR 43.6%, viral RNA detected in sandflies from affected areas. CHPV activity in Maharashtra RNA was detected in two pools of sandflies 2012 Encephalitis cases from Maharashtra and Gujarat state anti-CHPV IgM ELISA and RT-PCR confirmed 4.7% sera.

17. CONT… EPIDEMIOLOGY CHPV can cause a high case fatality , ranging from 56% to 75%. The disease affects mostly children under 15 years caused febrile illness that may progress to convulsions, coma, and in some cases, death. In children , it can lead to high mortality within 48 to 72 hours of symptoms onset, typically presenting with AES. (WHO, 2024)

18. CONT… Studies during Andhra Pradesh in 2003 and 2007, Gujarat in 2004, Maharashtra in 2007 and 2009, and Odisha in 2015 . ( Gaurav et al ., 2010) The presence of anti-CHPV neutralizing antibodies in the blood collected from pigs, buffalos, cattle, goats and sheep suggests continuous circulation of the virus in this region. (Joshi et al ., 2005) Anti-CHPV have been found in frogs, lizards, and rodents , indicating the wide range of hosts for multiplication and maintenance in nature. ( Kanbhar et al ., 2024)

19. Gender (male: female ratio): This inconsistency suggests that gender may not be a significant risk factor for CHPV infection. Age : (most studies reporting cases in children under 15 years ) The highest incidence is typically observed in the 2-9-year age group. CONT… ( Rao et al ., 2004) H igher incidence in boys H igher incidence in female cases  (Tandale et al ., 2008) DEMOGRAPHIC CHARACTERISTIC ( Tandale et al ., 2008)

20. GLOBAL SCENARIOS (CHPV) can infect many mammalian species , in different places throughout the world , but human cases have only been reported in India . (Peiris et al., 1993 ) Virus is highly prevalent in India, Sri Lanka, Africa in Nigeria and Senegal ( Fontenille et al ., 1994; Traore- Lamizana et al., 2001) (Sapkal et al. , 2018 )

21. INDIAN SCENARIO NIV in Pune investigated CHPV associated with a large encephalitis outbreak in children in many districts of Andhra Pradesh and Maharashtra, India. (Rao et al ., 2004) (Kanbar et al. , 2024 )

22. OUTBREAKS (Ghosh, 2017) The endemic zones of CHPV in India. (Menghani et al., 2012) MH , GJ , AP, TN, BIHAR

23. PATHOGENESIS The virus enters humans through the bite Encephalitis Spreads into the person’s bloodstream Infects immune cells where it replicates

24. CLINICAL SIGN ANIMAL Asymptomatic or I haven’t found any report related to clinical cases in animals.

25. (Shanmugaraj , 2024) Acute encephalitis-encephalopathy (Ab et al. , 2016) CONT… HUMAN ( Death 48-72 hr after onset of symptom) ( Whitley and Gnann , 2002) The right side of the brain (orange portion) shows abnormal dilation of the ventricles

26. DIAGNOSIS CHPV R everse transcription polymerase chain reaction (RT-PCR) S erology blood or cerebrospinal fluid (CSF) samples.( EARLY DIAGNOSIS) Virus Isolation IgM Capture ELISA : Detects IgM antibodies - indicating a recent infection. IgG ELISA : Measures IgG antibodies to assess past exposure and immunity status. Detective viral RNA Imaging Techniques :  MRI or CT scans to detect brain inflammation. Vero cell, RD cells

27. As of now,   no treatment/vaccine for CHPV is available. Only supportive treatments can be provided to neuroinvasive CHPV patients. Often involving hospitalization, Antipyretics   , intravenous fluids, Anticonvulsant and Antibiotics (prevent secondary bacterial infections) . TREATMENT (NOTE) Two candidate vaccines, viz . a recombinant vaccine and a killed vaccine and siRNAs targeting P and M proteins have been developed and are awaiting clinical trials (Ab et al. , 2016)

28. CASE STUDIES 2003 outbreak Andhra Pradesh 329 cases of encephalitis between June and September, 2003, with 183 deaths. (case fatality rate 55·6%). The male to female ratio was 1 to 0·77 .

29. CONT… 2004 outbreak Gujarat (CFR) during the 2004 Gujarat outbreak reached 78.3% . 26 probable encephalitis cases (6 Death) Reported in children between 9 June and 14 July, 2004. 22- Vadodra district 4- Panchmahal district Map of Gujarat, India showing areas with cases of encephalitis The male to female ratio was 1 to 1.

30. CONT… 2024 outbreak

31. CONT… https://pib.gov.in/PressReleasePage.aspx?PRID=2039050 Early June 2024 (AES) Reported cases in children under 15 years of age in Gujarat . Situation overview (as of 1 August 2024 ) 1 August 2024 148 AES cases including 59 deaths as of 31 July . 24 districts in Gujarat, 4 in Madhya Pradesh, 3 in Rajasthan, and 1 in Maharashtra. confirmed in 51 cases 48 were reported in Gujarat, 2 in Rajasthan, and 1 in Maharashtra .

32. CONT… Between early June and 15 August 2024 India reported 245 cases of AES, 82 deaths (CFR 33%) Among these , 64 cases were confirmed as Chandipura virus infection. A total of 43 districts in India are currently reporting AES cases – (GJ, MH, RJ, AP & MP) CHPV has been confirmed in 64 cases through (IgM ELISA) or (RT-PCR). Of the 64 confirmed cases , 61 cases have been reported from Gujarat and 3 from Rajasthan . A declining trend in the number of new cases of AES has been observed daily since 19 July 2024

33. CONT… PH Response Gujarat state has implemented several public health measures including insecticidal spray for vector control, information, education , and communication activities, sensitization of medical personnel and timely referral of cases to designated facilities. A National Joint Outbreak Response Team (NJORT) has been deployed to assist the Gujarat State Government. A joint advisory from National Center for Disease Control (NCDC) and National Center for Vector-borne Disease Control (NCVBDC) is being issued to guide the neighboring States reporting AES cases. (WHO, 2024)

34. Economic Burden :   Social Consequences :   Health Systems :   DISEASE IMPACT E conomic losses due to medical costs and lost productivity. High mortality rates. S ignificant impact on affected families and communities. Health system deteriorated. Outbreaks can strain healthcare resources.

35. PREVENTION & CONTROL Controlling the vectors : by reducing the vector populations in specific geographic areas. Individual protective measures: Insect repellents and insecticide-treated bed nets. (Alkan et al ., 2013) (Balaska S et al ., 2021) T hrough insecticide spraying P revent sandfly bites during sleep. Protective Clothing: Wearing long-sleeved shirts and pants, especially during peak sandfly activity times (dawn and dusk). Reducing the risk of infection in people

36. CONT… (WHO, 2024) Environmental Management : Clearing vegetation and debris around living areas to reduce sandfly habitats. S anitation : Remove stagnated water, and domestic sanitary conditions. Fogging ( Pre-monsoon and post-monsoon should be done against sand flies covering the area) .

37. CONT… CHPV continues to pose a threat , a multidisciplinary approach involving entomologists, virologists, clinicians, public health authorities, researchers, and the community is crucial for effective control and prevention. Effective surveillance is important to monitor and act effectively during an outbreak. Early diagnosis and treatment reduced prevalence especially in children. Education of the community with effective behavioural change intervention must be carried out in endemic regions.

38. CONT… Veterinary public health Surveillance :- Coordinated surveillance of human and animal populations to detect and monitor CHPV outbreak early. This helps in identifying the virus in animal hosts or vectors before it spreads widely among humans. Vector control :- By understanding the environmental factors that support the breeding of sandflies and other vectors, one health initiative can implement effective vector control measures. Used insecticides and public education on reducing exposure Public health measure :- campaign, education, information & knowledge

39. CONCLUSION Re-e merging threat to public health in India. A ffect children , rapid disease progression, and high mortality rates. Outbreaks are spreading geographically, necessitating enhanced surveillance, targeted vector control, and improved clinical management protocols . Communities at risk need better awareness of potential risks, prevention methods, symptoms, and when to seek testing and treatment.

40. The lack of effective vaccines or antiviral treatments for CHPV emphasises the urgent need for research into preventive measures. Need of systematic study to know the status of CHPV infection in human Enhanced surveillance is needed in high-risk areas , particularly focusing on children under 15 years old. WAY FORWARD Future research should focus on understanding transmission dynamics, developing rapid diagnostics and vaccines, and exploring potential therapies.

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