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Outline

 Introduction  Epidemiology  transmission  Clinical manifestation  Treatment  Prevention 2

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. 3

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. 4

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 5

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 person to-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 10

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. 12

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 14

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. 17

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 19

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

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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 21

Prevention

 Use mosquito coils and electric vaporization mats both day and night  Use mosquito nets  Use door and window screens (mesh) 22

Prevention

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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 23

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 24

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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 29

Potential Breeding Grounds 30

Potential Breeding Grounds

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Potential Breeding Grounds 32

Potential Breeding Grounds

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Potential Breeding Grounds 34

Potential Breeding Grounds

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Potential Breeding Grounds

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Potential Breeding Grounds 37

Chikungunya Prevention & Control is in your hands – Do Something

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