Chikungunya

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Outline

 Introduction

 Epidemiology

 transmission

 Clinical manifestation

 Treatment

 Prevention

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Introduction

 Chikungunya is a virus that causes acute febrile polyarthralgia (inflammatory disorder. It results in muscle pain and stiffness in the body) and arthritis.

 The name is derived from a word in local language of

Tanzania meaning "that which bends up" or "stooped walk”

 Multiple outbreaks occur Africa and beyond.

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Epidemiology

 Endemic areas — Africa, Asia

 Chikungunya virus, 1 st indentified during an outbreak in Tanzania in the 1950s

 Then spread to countries of central, southern, and western Africa.

 Outside Africa, the first documented chikungunya fever outbreak was in Thailand in 1958.

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Epidemiology

• Other outbreaks occurred in other Asian countries:-

• India, Sri Lanka, Malaysia, Indonesia,

• Spread — mainly through infected travelers between regions where mosquitoes exist for perpetuation of local transmission.

• Imported cases in European countries, USA and

Australia.

• Since 2004 it has caused outbreaks in various parts of

Asia

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How serious is Chikungunya?

December 9, 2013

PAHO issues Epidemiological Alert

How serious is Chikungunya?

June 6, 2014

4,486 confirmed cases

17 Caribbean countries

TRANSMISSION

 Aedes Aegypti & Aedes Albopictus mosquitoes.

 The Reservoirs - Humans are the primary reservoir during epidemic periods.

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TRANSMISSION

 Mosquitoes acquire the virus from a viremic host.

 Following an average extrinsic incubation of 10 days, the mosquito transmits the virus to a naïve host.

 So far there is no evidence to indicate a personto-person transmission of the disease.

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Risk & Immunity

 All individuals not previously infected with

CHIKV are at risk of acquiring the infection

Once exposed, one will develop long term immunity

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Make No Mistake

Clinical Manifestation

 Most individuals will present with symptomatic disease after an incubation period of 3 – 7 days

(range: 1−12 days)

 Not all individuals infected with the CHIKV develop symptoms. (between 3% - 28% does)

 CHIKV can cause acute, sub acute, and chronic disease.

 Acute disease is characterized by an abrupt onset of high fever (usually≥ 102°F/39°C) and severe joint pain.

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Clinical Manifestation

 Fever typically may lasts from several days to a week.

 The fever may be continuous or intermittent

 A drop in temperature is not associated with worsening of symptoms.

 Fever may be associated with a relative bradycardia

(slowness of heart rate < 60 beats/minute)

.

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Main characteristics

 Fever

 Headache

 Fatigue

 Nausea, vomiting

 Muscle pain

 Rash

 Joint pain

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Other common symptoms

 Redness in eye

 Difficulty in looking at light

 Severe fever with headache and joint pain

 Rashes on limbs and trunks

 Rash usually appears 2 – 5 days after onset of illness and lasts 3 – 7 days in 50% of cases.

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High Risk Groups

 Infants and the elderly being at greatest risk for more severe disease.

(day sleepers, lower immune system)

 Co-morbidities have been identified as a risk factor for severe disease.

(chronic illnesses)

 Pregnancy – Most CHIKV infections that occur during pregnancy will not result in viral transmission to fetus.

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High Risk Group

 Rare reports of spontaneous abortions following

CHIKV infection in the mother.

 Neonates who had neurologic manifestations may develop long-term disabilities.

 There is no evidence of viral transmission through breast

Fatalities related to CHIKV infection are

uncommon.

 Fatalities related to CHIKV infection are uncommon.

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Chronic Presentation

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Treatment

-

 There is no specific antiviral drug treatment for

CHIKV.

 Symptomatic treatment.

Rest

Fluids

- Paracetamol

 Use of aspirin is not advised due to risk of bleeding

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Prevention

 Prevent Mosquito Bites

 Mosquitoes which spread Chikungunya bite during the daytime.

 Protect yourself from mosquito bites :

 Wear light coloured clothing and cover your body as much as possible

 Use mosquito repellents containing DEET on exposed skin

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Prevention

 Use mosquito coils and electric vaporization mats both day and night

 Use mosquito nets

 Use door and window screens (mesh)

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Prevention

 Eliminate Mosquito Breeding Sites

 Mosquitoes live and breed in standing water in and around the home.

 Do your part by preventing mosquito breeding:

 Cover all drums, tanks, barrels and buckets that are used to store water

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Prevention

 Get rid of all old tyres, tins, bottles, plastic containers, coconut shells and anything in which rain water settles

 Cover trash containers to keep out rain water

 Punch holes in the bottom of tins before placing them in the garbage

 Keep flower pot saucers dry

 Avoid over-watering potted plants

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Aedes Mosquito

 The Aedes mosquito needs only 2ml of water for breeding.

 After breeding the eggs can lay dormant up to one year.

 A carrier mosquito is capable of transmitting the virus to the next generation.

 The Chikungunya virus is sensitive to heat.

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Life Cycle of the Aedes aegypti

Lays egg 3 days after taking a blood meal

From eggs to

Larva - 1 – 3 days

From Pupa to

Adult- 2 days

From larva to pupa - 4 days

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Common Breeding Sites

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Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds

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Chikungunya Prevention & Control is in your hands – Do Something

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