Chikungunya

NVBDCP, CHIKUNGUNYA, DIAGNOSIS, MANAGEMENT

1. Chikungunya Dr.Shibasish Banerjee MBBBS,MD(COMMUNITY MEDICINE)

2. What is Chikungunya An arboviral disease (genus Alphavirus ) T ransmitted to humans by infected mosquitoes – Aedes aegypti and Aedes albopictus . The name chikungunya originates from a verb in the Kimakonde language, meaning 'to become contorted'. This refers to the 'stooped' appearance of those suffering with joint pain

3. Geographical distribution First isolated Tanzania 1952 Caused periodic outbreak Asia and Africa since 1960 2006: Outbreak in India, more than 1 500 000 cases of chikungunya were reported with Ae . aegypti implicated as the vector. Between 2001 and 2011, a number of countries reported on chikungunya outbreaks. 2016 at Delhi

4. Clinical Manifestation Incubation period: 3-7 days(may be 2-12 days) Acute phase: < 3weeks Sub-Acute phase: 3wks to 3 month Chronic phase: > 3 months

5. Symptoms High fever (40°C/ 104°F) Joint pain (lower back, ankle, knees, wrists or phalanges) Joint swelling Rash Headache Muscle pain Nausea Fatigue

6. Some others symptoms in children Retro-orbital pain Photophobia Vomiting Diarrhea Meningeal syndrome Acute encephalopathy

7. Course of disease Chikungunya is rarely fatal. Symptoms are generally self-limiting and last for 2–3 days. The virus remains in the human system for 5-7 days and mosquitoes feeding on an infected person during this period can also become infected. Chikungunya shares some clinical signs with dengue and can be misdiagnosed in areas where dengue is common. Chikungunya can be detected using serological tests Recovery from an infection will confer life-long immunity.

8. Case Definition by NVBDCP Probable or suspected case: a patient meeting the clinical criteria only Confirmed (definitive) case: a patient meeting both the clinical and laboratory criteria

9. Continued…. Clinical criteria:Acute onset of fever and severe arthralgia / arthritis with or without skin rash and residing or having left an epidemic area 15 days prior to onset of symptoms Laboratory criteria : At least one of the following tests done in the acute phase of illness 1.Direct evidence Virus isolation / Presence of viral RNA by RT-PCR 2.Indirect evidence • Presence of virus specific IgM antibodies in single serum sample collected in acute or convalescent stage. • Four-fold increase in IgG values in samples collected at least three weeks apart.

10. Pathogenesis Complement activated immune complex mediated arthritis

11. Differential Diagnosis Dengue Fever Malaria Leptospirosis Enteric Fever Rheumatic Fever Reactive arthritis Serum sickness illness Rickettsial disease

12. Laboratory diagnosis MAC-ELISA – IgM for CHIKV (AFTER 7 DAYS) Paired sera IgG (4 FOLD RISE) RT-PCR(POSITIVE ≤ 8DAYS): E1 and C genome from serum,CSF VIRAL ISOLATION( TAKE LONG TIME)

13. Outbreak criteria: One or more cases in an area where no case was reported before. For the Public Health action, it is not necessary to confirm the diagnosis of each and everysuspected Chikungunya case. Remedial measures for containment of the diseases, symptomatic treatment of the suspected Chikungunya fever cases should be started immediately on the basis of Epidemiological diagnosis of the disease

14. Treatment SUPPORTIVE Rest in Acute phase Paracetamol and NSAIDS Avoid Aspirin Plenty of water and adequate hydration Protection against mosquito bites Timely referral if indicated Cold compress to inflamed joint and physiotherapy

15. Indications for Referral to PHC Fever more than 5 days Hemorrhagic manifestation Reduced urine output Severe vomiting Altered sensorium Jaundice Postural dizziness ,cold extremities

16. Continued…. Refer sooner at extreme of age, pregnancy and significant comorbid illness

17. Management of chronic arthritis NSAIDS Short course of steroid ( In case of refractory to NSAID after 2-3 weeks ) HCQS ( During sub-acute stage) Physiotherapy Surgery

18. Prevention Personal protection( ITN,DEET,Full sleeve clothing) Integrated Vector Management Source Reduction Larvicidal agents ( Temephos ) Adult mosquito control(Pyrethrum extract) Biological Control Legislative measures Operational research Capacity building

19. Thanks……