NVBDCP, CHIKUNGUNYA, DIAGNOSIS, MANAGEMENT

1. Chikungunya
Dr.Shibasish Banerjee
MBBBS,MD(COMMUNITY MEDICINE)

2. What is Chikungunya
• An arboviral disease (genus Alphavirus)
• Transmitted to humans by infected
mosquitoes –Aedes aegypti and Aedes
albopictus.
• The name chikungunya originates from a verb
in the Kimakonde language, meaning 'to
become contorted'. This refers to the
'stooped' appearance of those suffering with
joint pain

3. Geographical distribution
• First isolated Tanzania 1952
• Caused periodic outbreak Asia and Africa since
1960
• 2006: Outbreak in India, more than 1 500 000
cases of chikungunya were reported with Ae.
aegypti implicated as the vector.
• Between 2001 and 2011, a number of
countries reported on chikungunya outbreaks.
• 2016 at Delhi

5. Clinical Manifestation
• Incubation period: 3-7 days(may be 2-12 days)
• Acute phase: < 3weeks
• Sub-Acute phase: 3wks to 3 month
• Chronic phase: > 3 months

6. Symptoms
• High fever (40°C/ 104°F)
• Joint pain (lower back, ankle, knees, wrists or
phalanges)
• Joint swelling
• Rash
• Headache
• Muscle pain
• Nausea
• Fatigue

7. Some others symptoms in children
• Retro-orbital pain
• Photophobia
• Vomiting
• Diarrhea
• Meningeal syndrome
• Acute encephalopathy

8. Course of disease
• Chikungunya is rarely fatal.
• Symptoms are generally self-limiting and last for 2–3
days.
• The virus remains in the human system for 5-7 days
and mosquitoes feeding on an infected person during
this period can also become infected.
• Chikungunya shares some clinical signs with dengue
and can be misdiagnosed in areas where dengue is
common.
• Chikungunya can be detected using serological tests
• Recovery from an infection will confer life-long
immunity.

9. Case Definition by NVBDCP
• Probable or suspected case: a patient meeting
the clinical criteria only
• Confirmed (definitive) case: a patient meeting
both the clinical and laboratory criteria

10. Continued….
• Clinical criteria:Acute onset of fever and severe arthralgia / arthritis with or
without skin rash and residing or having left an epidemic area 15 days prior to
onset of symptoms
• Laboratory criteria: At least one of the following tests done in the acute phase of
illness 1.Direct evidence Virus isolation / Presence of viral RNA by RT-PCR
2.Indirect evidence
• Presence of virus specific IgM antibodies in single serum sample collected in
acute or convalescent stage.
• Four-fold increase in IgG values in samples collected at least three weeks apart.

11. Pathogenesis
Complement
activated
immune
complex
mediated
arthritis

12. Differential Diagnosis
• Dengue Fever
• Malaria
• Leptospirosis
• Enteric Fever
• Rheumatic Fever
• Reactive arthritis
• Serum sickness illness
• Rickettsial disease

13. Laboratory diagnosis
• MAC-ELISA –IgM for CHIKV (AFTER 7 DAYS)
• Paired sera IgG(4 FOLD RISE)
• RT-PCR(POSITIVE ≤ 8DAYS): E1 and C genome
from serum,CSF
• VIRAL ISOLATION( TAKE LONG TIME)

14. Outbreak criteria:
• One or more cases in an area where no case was
reported before.
• For the Public Health action, it is not necessary to
confirm the diagnosis of each and everysuspected
Chikungunya case.
• Remedial measures for containment of the diseases,
• symptomatic treatment of the suspected Chikungunya
fever cases should be started immediately on the basis
of Epidemiological diagnosis of the disease

15. Treatment
• SUPPORTIVE
• Rest in Acute phase
• Paracetamol and NSAIDS
• Avoid Aspirin
• Plenty of water and adequate hydration
• Protection against mosquito bites
• Timely referral if indicated
• Cold compress to inflamed joint and physiotherapy

16. Indications for Referral to PHC
• Fever more than 5 days
• Hemorrhagic manifestation
• Reduced urine output
• Severe vomiting
• Altered sensorium
• Jaundice
• Postural dizziness ,cold extremities

17. Continued….
• Refer sooner at extreme of age, pregnancy
and significant comorbid illness

18. Management of chronic arthritis
• NSAIDS
• Short course of steroid ( In case of refractory
to NSAID after 2-3 weeks)
• HCQS ( During sub-acute stage)
• Physiotherapy
• Surgery

19. Prevention
• Personal protection(ITN,DEET,Full sleeve clothing)
• Integrated Vector Management
• Source Reduction
• Larvicidal agents (Temephos)
• Adult mosquito control(Pyrethrum extract)
• Biological Control
• Legislative measures
• Operational research
• Capacity building

20. Thanks……