Chikungunya Fever

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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