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Chikungunya

Introduction

Chikungunya is a virus that is spread by mosquitoes and can cause fever, edema, and joint discomfort, among other symptoms. The term “Chikungunya” is derived from the Makonde language and signifies “that which bends up,” referring to the bent position of individuals afflicted with the illness. In tropical and subtropical areas, chikungunya poses a serious threat to public health. Outbreaks have been documented in Africa, Asia, the Americas, and the Pacific Islands.

Epidemiology

Epidemics of Chikungunya have been documented across the globe, posing a serious threat to public health. The illness has a high attack rate during epidemics and affects both urban and rural areas. The World Health Organization (WHO) states that epidemics of chikungunya have been documented in:

  • Africa: Angola, Burkina Faso, Cameroon, Central African Republic, Congo, Democratic Republic of the Congo, Guinea, Kenya, Madagascar, Mali, Mauritius, Mozambique, Rwanda, Senegal, South Africa, Tanzania, and Uganda.
  • Asia: Bangladesh, Cambodia, India, Indonesia, Malaysia, Maldives, Pakistan, Philippines, Singapore, Sri Lanka, Thailand, and Vietnam.
  • Americas: Brazil, Caribbean islands, Colombia, Costa Rica, Dominican Republic, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, and the United States.
  • Pacific Islands: French Polynesia, New Caledonia, and Papua New Guinea.

Causative Agent

Chikungunya virus (CHIKV) is an RNA virus belonging to the alphavirus genus, family Togaviridae. It is a single-stranded, positive-sense RNA virus with a genome of approximately 11.8 kilobases. CHIKV is closely related to other alphaviruses, such as Ross River virus, O’nyong-nyong virus, and Semliki Forest virus.

Incubation Period

The incubation period of Chikungunya ranges from 2-12 days, typically 3-7 days. During this period, an infected person may not exhibit any symptoms, but they can still transmit the virus to mosquitoes.

Reservoir

Monkeys and other primates serve as natural reservoirs of CHIKV, while humans are the primary hosts during outbreaks. The virus is maintained in the ecosystem through a cycle involving mosquitoes and primates.

Reservoir Infection

CHIKV infects primates through the bite of infected mosquitoes. Once infected, primates can transmit the virus to other mosquitoes, which can then transmit it to humans.

Mode of Transmission

Transmission of CHIKV occurs through the bite of infected female mosquitoes, primarily Aedes aegypti and Aedes albopictus. These mosquitoes are also responsible for transmitting other diseases like dengue fever and Zika virus.

Period of Communicability

Viremia typically lasts 2-5 days, during which an infected person can transmit the virus to mosquitoes. This period may be shorter in some cases, depending on individual factors.

Susceptibility and Resistance

Although anybody can contract CHIKV, people with compromised immune systems or underlying medical disorders are more prone to serious illness. Individuals who have never been vaccinated or infected with CHIKV are susceptible to infection, while those who have had past infections are immune to the virus for life.

Standard Case Definition

A suspected case of Chikungunya is defined as:

  • Acute onset of fever (>38.5°C)
  • Severe joint pain or swelling (arthralgia and arthritis)

A confirmed case requires laboratory confirmation through:

  • Reverse transcription-polymerase chain reaction (RT-PCR)
  • Serology (IgM and IgG antibodies)

Susceptibility Case

A person with no immunity, having not been previously infected or vaccinated, is considered susceptible to CHIKV infection.

Confirmed Case

A person with laboratory-confirmed CHIKV infection is considered a confirmed case.

Clinical Manifestation/symptoms

  • High fever (>38.5°C)
  • Severe joint pain and swelling (arthralgia and arthritis)
  • Muscle pain
  • Headache
  • Rash
  • Fatigue

In severe cases, Chikungunya can cause:

  • Hemorrhagic fever
  • Neurological symptoms (meningitis, encephalitis)
  • Eye inflammation (uveitis)

Control

  • Vector control: larval control, adult mosquito control
  • Elimination of breeding sites
  • Personal protection: insect repellents, clothing

Prevention

  • Using insect repellents
  • Wearing protective clothing
  • Eliminating standing water
  • Using mosquito nets

Treatment

There is no specific treatment for Chikungunya, Supportive care includes:

  • Rest
  • Fluid intake
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