CHICKEN GUNIYA

Recent breakout of CHICKEN GUNIYA in some southern states of India, Kerala in particular, is alarming. I therefore present some facts which could be helpful to common people.

(This information has been republished from: I.M.A.G.S.B.NEWS
BULLETIN/September 2006)

What Is Chicken Guniya or (CHIK or CHIKU) ?

Chickenguniya is a debilitating disease caused by a virus of the
Togaviridae family(alphavirus genus). The incubation period
(time between contamination or infecting bite and the first clinical
signs) is usually 4-7 days.Chickenguniya is an arbovirosis : the
virus causing the disease is transmitted by a vector, an arthropod
(mosquito). This is a heat-sensitive RNA virus. The virus was first
isolated in Tanzania & Uganda in 1953. The name originates from
the posture of the patients : in Swahili, Chickenguniya means:
waiting bent over.

How Is The Virus Of CHIK Transmitted ?

The virus is transmitted by mosquito only. The main virus reservoirs
are monkey, but other species (including humans) can also be
affected. The mosquito picks up the virus by biting a person
suffering from the disease during the viremia phase and in turn
infects other people.The virus is contained in the blood during the
viremic period or viremia.This period starts on the first day of
symptoms(D0) and lasts until about D+5. The virus is therefore
transmitted from human to the mosquito when a human is bitten
by a mosquito during the viremic period.
An infected mosquito will remain infected all its life and can
therefore transmit the virus each time it bites.

Can The Virus Be Transmited From One Person To Another?

No. Transmission takes place uniquely through vector mosquitos. This
vector is a daytime vector with highest activity at the beginning and at
the end of the day.However,artificial transmission through blood-
transfusion and graft surgery is possible in theory.Hence as the
precautionary measure the patient should be prevented from donating
the blood.

SYMPTOMS OF CHICKENGUNIYA

The symptoms of Chickenguniya( Chicken Guinea) include fever which can
reach 39 C i.e.,102.2 F, a petechial or maculopapular rash usually involving
the limbs and the trunk, and arthralgia or arthritis affecting multiple joints
which can be debilitating.There can also be headache,conjunctival infection
and slight photophobia.In the present epidemic in the state of Andhra Pradesh
in India, high fever and crippling joint pain was the prevalent complaint.
Fever typically lasts for two days and abruptly comes down,however joint
pain,intense headache,insomnia and an extreme degree of prostration lasts
for a variable period,usually for about 5-7 days.

Dermatological manifestations observed in a recent outbreak of Chickenguniya
in Southern India includes the following:

1. Maculopapular rash
2. Nasal blotchy erythema
3. Freckle-like pigmentation over centro-facial area
4. Flagellate pigmentation on face and extremities
5. Lichenoid eruption and hyperpigmentation in photodistributed areas
6. Multiple aphthous-like ulcers over scrotum,curual areas and axilla
7. Lympoedema in acral distribution (bilateral/unilateral)
8. Multiple ecchymotic spots (Children)
9. Vesiculobullous lesions (Infants)
10.Subungual haemorrhage

VACCINES & IMMUNIZATION

Since the beginning of the outbreak in La Reunion, 243 deaths directly
or indirectly related to Chickenguniya have been reported-most of them
occurring among elderly patients with underlying medical condition. About
755 of the deaths occured in persons over the age of 70 years.There are
273 patients(older than 10 days of age) who presented with a severe form
of Chickenguniya,246 of whom were confirmed. Of these,67 patients have
died. The signs of severity include respiratory failure, cardio-vascular
decompensation, or meningo-encephalitis. As for infants less than 10 days
old, 40 tnfections have been confirmed, one of whom has died. Chikungunya
infection was confirmed in the mothers of 39 of these infants.
Like in other arboviruses,Chickenguniya infection can either go totally
unnoticed(i.e. the person is symptom-free; infection is then said to be
asymptomatic) or cause painful and persisting symptoms.

WHAT SHOULD YOU DO WHEN FIRST SYMPTOMS APPEAR ?

You should immediately see a doctor who will prescribe a suitable treatment
for your particular symptoms. You must also avoid contact with mosquitos
so as not to transmit the disease to people around you.

CAN YOU BE INFECTED AGAIN?

No. Any person infected once acquires durable immunity naturally.However,
some joint pain(arthralgia) may persist or reappear over variable periods of
time.This is a reaction of the joints and is not due to any re-infection by the
virus.

ARE CERTAIN POPULATION GROUPS MORE LIKELY
TO DEVELOP CHICKENGUNIYA ?

No single catagory of population ( age, sex, occupation, ethnic group, etc. )
is more immune from Chickenguniya than others.

IS THERE A HUMAN VACCINE? CAN IT BE DEVELOPED
IN SHORT TERM?

No. There is currently no marketed vaccine available for humans.It takes
several years to complete a vaccine research, development and marketing
campaign.

IS THERE AN EFFICIENT THERAPY FOR PEOPLE?

Treatment is symptomatic-rest, fluids,and ibuprofen, naproxen,acetamenophen, or paracetamol may relieve symptoms of fever and aching. Aspirin should be avoided.
There is possible role for chloroquine in the treatment of Chikenguniya.There is an interesting dialogue, mostly in French(on Internet), about the possible use of chloroquine in the treatment of the arthralgia associated with Chikenguniya.
Supportive care with rest is indicated during the acute joint symptoms.Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbate rheumatic symptoms.
Use of steroids for the control of joint npains and inflammation is dangerous and completely unwarranted.
Following a recent outbreak (2006) of the disease in Southern India, several homeopathy practitioners in the region have been handing out medicine that is supposed to prevent the disease. However, there have been no scientific studies to confirm the effectiveness of homeopathy against the Chikenguniya.

HOW TO AVOID BEING INFECTED ?

Because there is no vaccine or preventive treatment, the only way not to be infected is to reduce exposure tu mosquito-bite as far as possible. This entails destroying larva-breeding grounds in order to reduce vector density, and protecting oneself against insect-bite.

WHERE DOES THE FEMALE Aedes albopictus LAY EGGS?

The female Aedes albopictus lays its eggs in a breeding ground or "nest" consisting of standing waterpools.Females lay their eggs in fresh water containing little organic matter(clean water).There are different types of these nests:

*Household Nests: rain barrels, flowerpot saucers,cut-in pots,etc.
*Quasi-household Nests: rain-exposed containers, cluttered rain gutters that do not drain completely, unmaintained swimming-pools and basins, old tyres, refuse abandoned in gardens, cut bamboo stalks, plants with sheathing leaves, etc.
*Natural Pockets:ravines,holes in boulders, holes or nooks of trees, swamps, ruts,etc. About 80% of nests are man-made(household and quasi-household). The aedes mosquito is sedentary: it will not fly more than 100 metre from itd original shelter.

AT WHICH TIME OF THE DAY IS THE Aedes albopictus MORE LIKELY TO BITE?

The adult(female) is active during the day, with two major periods of activity: one in the morning at sunrise, the other in late afternoon at sunset(when the mosquito is often more aggrassive).Aedes albopictus generally bites outdoors( it is "exophagic") but it can also fly into the house and bite people inside.

IS A VIRUS-INFECTED MOSQUITO ITSELF AFFECTED BY THE DISEASE?

No.Mosquitos do not seem to be affected by the virus in their bodies.Once a female is infected( and infecting), it remains so throughout its life. There is no evidence of the female transmitting the Chikenguniya virus to its eggs(however, transmission of the dengue fever virus to eggs has been evidenced.

HOW TO REDUCE RISK?

Short of an available vaccine or preventive drugs, the only way to reduce the risk of catching the disease is to reduce exposure to infected mosquitos. You must therefore(i) protect your body against bites and(ii) reduce the number of mosquitos around your home by destroying larva nests(discussed above).

HOW TO PROTECT ONESELF FROM MOSQUITO-BITES ?

Several options are available to you:
-Ventilation with fans or air conditioners.
-Electric insecticide diffusers or coils for outside use.
-Repellant creams and sprays.Mosquito repellant based on a 30% DEFT concentration is recommended.Aphysician should be consulted before using repellants if there are children under 12 years or/and a pregnant woman.Repellants are not advisible for children under three months.Insecticide-treated bed-nets are recommended for them.
-In the evening, long-sleeved clothes and long trousers should be worn to reduce direct skin exposure(especially legs and ankles).
-Mosquito screens should be placed on windows; mosquito nets over baby-cots and prams and over the beds of people confined to bed.

RECENT OUTBREAKS:

In February 2005, an outbreak was recorded on the French Island of Reunion in the Indian Ocean. As on May 18,2006, some 258,000 residents have been hit by the virus in the past year(out of about 777,000). 219 official deaths have been associated with Chikenguniya.

Mauritius-3500 islanders have been hit in 2005.

In 2006,there was a big outbreak in Andhra Pradesh(India). The initial cases were reported from Hyderabad and Secunderabad as well as from Anantpur district as early as in Nov and Dec,2005 and it is continuing unabated. In Hyderabad alone an average practitioner sees and treats somewhere between 10 to 20 cases every day.

On average there are around 5300 cases being treated daily. This figure is only from public-sector. The figures combined with the private sector (clinics) would be much higher.

There have been reports of large scale outbreak of this virus in Southern India.At least 80000 people in Gulbarga, Tumkur, Bidar, Raichur, Bellary, Chitradurga, Davangere, Kolar and Bijapur districts in Karnataka State are known to have been affected since Dec 2005.

In Bangalore,the capital of Karnataka State(India), there seems to be an outbreak of Chikenguniya now(May 2006) with arthralgia /arthritis and rashes. So also in the neighbouring State of Andhra Pradesh. In the third week of May 2006 the outbreak of Chikenguniya in North Karnataka was severe.

As of July 2006, nearly 50000 people were affected in Salem, Tamilnadu.

On 24 August 2006,"The Hindu" daily reported that the Indian States of Tamilnadu,Karnataka,Andhra Pradesh, Maharashtra, Madhya Pradesh, Gujarat and Kerala had reported 1.1 million cases.

Analysis of the rcent outbreak has suggested that the increased severity of the disease may be due to a change in the genetic sequence, altering the virus' coat protien, which potentially allows it to multiply more in mosquito cell.

PLENTY OF ORAL FLUIDS

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

NO ASPIRIN

NO STEROIDS