Chikungunya Fever
exp date isn't null, but text field is
Chikungunya Virus Disease is the arthropod-borne virus caused by Chikungunya Virus (CHIKV), transmitted by the Aedes aegypti and Aedes albopictus mosquitos, the same which transmit Dengue virus, West Nile and Yellow Fever viruses. Chikungunya disease (Seroprevalence 7.7% to 26.9% in Tanzania) does not often result in death, but the symptoms can be severe and disabling. People at risk for more severe disease include newborns, older adults (≥65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease. The word "Chikungunya" is Makonde for "that which bends up," in reference to the stooped posture of patients afflicted with the severe joint pain associated with the disease. Epidemics of fever, rash and arthritis, resembling Chikungunya fever were recorded as early as 1779. However, the virus was first isolated between 1952-1953 from both man and mosquitoes during an epidemic in Tanzania.
Case Definition Acute clinical case
- Clinical criterion: Fever >38.50 C (101.30F) and joint paina (usually incapacitatingb) with acute onseta AND
- Epidemiological criterion: resident or visitor in areas with local transmission of Chikungunya on the last 15 days (suspected case for epidemiological surveillance)b OR
- Laboratory criterion: confirmation by laboratory: PCR, serology or viral culture (confirmed case for epidemiological surveillance)
- Usually accompanied by exanthema, myalgia, back pain, headache and occasionally, vomiting and diarrhoea (pediatric age group)
- In children aged <3 years, joint pain is expressed as inconsolable crying, irritability, rejection to mobilization and/or walking
Atypical case
Clinical case of laboratory confirmed Chikungunya accompanied by other manifestations: neurological, cardiological, dermatological, ophthalmological, hepatic, renal, respiratory, or haematological, among others.
Severe acute case
Clinical case of laboratory-confirmed Chikungunya presenting dysfunction of at least one organ or system that threatens life and requires hospitalization
Suspected and confirmed chronic cases
Suspect chronic case: Person with previous clinical diagnosis of chikungunya after 12 weeks of the onset of the symptoms presenting with at least one of the following articular manifestations: pain, rigidity, or edema, continuously or recurrently.
Confirmed chronic case: Every chronic case with a positive chikungunya laboratory test.
Laboratory Investigations
Chikungunya is a biosafety level-3 (BSL-3)
- Detection of Chikungunya virus (CHIKV) viral culture of blood in the first 3 days
- RT-PCR for Viral RNA from the serum collected <6 days after onset of illness
Serological tests show a four-fold rise in antibody titer to Chikungunya virus.
Management
Non-Pharmacological Treatment:
The mainstay treatment for Chikungunya is the supportive symptomatic treatment.
A: Assure plenty of rest to patients
Pharmacological Treatment
A: Maintain body fluids Sodium Lactate Compound (Ringers Lactate) intravenously
A: Control Fever and Pain by giving paracetamol (PO/IV) 15mg/kg 8hourly for 3days
Note:
- No antibiotics are of proven value.
- Steroids should not be used.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and aspirin should be avoided. These anti-inflammatory drugs act by thinning the blood, and in a disease with risk of hemorrhage, blood thinners may exacerbate the prognosis.
- Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under 3 years old.
- Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated skin.
PreventionThe most effective way to prevent infection from Chikungunya virus is to prevent mosquito bites during the day and night.
- Use insect repellent (DEET, Picaridin (known as KBR 3023 and icaridin IR3535, Oil of lemon eucalyptus (OLE), Para-menthane-diol (PMD), 2-undecanone)
- Modification of the mosquito bleeding sites
- Wear long-sleeved shirts and pants
- Treat clothing and gears with permethrin
- Take steps to control mosquitoes indoors and outdoors
Public Health Control Measures
- Symptomatic treatment for mitigating pain and fever using non-steroidal anti-inflammatory drugs along with rest usually suffices. Persistent joint pain may require analgesic and long-term anti-inflammatory therapy.
- Prevention is entirely dependent upon taking steps to avoid mosquito bites and elimination of mosquito breeding sites.
- To avoid mosquito bites:
- Wear full sleeve clothes and long dresses to cover the limbs
- Use mosquito repellents
- Use mosquito nets – to protect babies, old people and others, who may rest during the day
- The effectiveness of such nets can be improved by treating them with permethrin (pyrethroid insecticide). Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes