Chikungunya and dengue

Preventive medicine:
General principles of prevention and control of diseases
CHIKUNGUNYA and DENGUE

1. Mr Ashish R. Chaudhari ASST. PROFESSOR, M.PHARM (QA ) P.R.PATIL, INSTITUTE OF PHARMACY, TALEGAON (SP), DIST- WARDHA Presented by : Preventive medicine: General principles of prevention and control of diseases CHIKUNGUNYA and DENGUE

2. Chicken Guinea

3. What is Chikungunya An arboviral disease (genus Alphavirus ) Transmitted 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

4. Aedes aegypti Aedes albopictus

5. 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

6. 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

7. S ym p t oms High fever (40°C/ 104°F) Joint pain (lower back, ankle, knees, wrists or phalanges) Joint swelling Rash Headache Muscle pain Nausea Fatigue

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

9. 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.

10. 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.

11. Pathogenesis Complem e n t activated immune complex mediated arthritis

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. T r e a tme n t 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. Management of chronic arthritis NSAIDS Short course of steroid ( In case of refractory to NSAID after 2-3 weeks) Hydroxychloroquine ( During sub-acute stage) Physiotherapy Surgery

17. P r e v e n tion Personal protection(Full sleeve clothing) Integrated Vector Management Source Reduction Larvicidal agents (Temephos) Adult mosquito control(Pyrethrum extract) Biological Control Legislative measures Operational research Capacity building

18. Dengue fever (also known as breakbone fever, is an infectious tropical disease

19. Family: Flaviviridae d e n gu e v i r u s . (DENV) showing dengue virus virions (the cluster of dark dots near the center

20. include fever , headache , muscle and joint pains , a characteristic skin rash common cold gastroenteritis (vomiting and diarrhea)

21. transmitted by Aedes mosquitoes An infection can be acquired via a single bite

22. A female mosquito that takes a blood meal from a person infected with dengue fever becomes itself infected with the virus in the cells lining its gut. About 8–10 days later, the virus spreads to other tissues including the mosquito's salivary glands subsequently released into its saliva.

23. Dengue can also be transmitted via infected blood products and through organ donation Vertical transmission (from mother to child) during pregnancy

24. mosquito carrying dengue virus bites a person the virus enters the skin enters white blood cells reproduces inside the cells while they move throughout the body

25. Warning signs Abdominal pain Ongoing vomiting Liver enlargement Mucosal bleeding High hematocrit with low platelets

26. cell cultures , nucleic acid detection antibodies (serology) Tests for dengue virus-specific antibodies, types IgG and IgM , can be useful in confirming a diagnosis

27. o ra l r e hy d ra t i o n t h e r a py administration of intravenous fluids intramuscular injections Paracetamol (acetaminophen) is used for fever

28. A ding insecticides or biological control agents wearing clothing that fully covers the skin using mosquito netting

29. Thanks……