Chikungunya Disease

Chikungunya (pronounced chik'-A-GUN-yah) disease was first discovered in 1952 in Africa at a place called Makonde Plateau. This is a border area between Tanzania and Mozambique. The name "chikungunya" is from the Makonde language and its meaning is "that which bends up". This is a reference to the Chikungunya symptom where patients go into a stooped posture due to pain. Chikungunya is also known as Chicken Guinea, Chicken gunaya and Chickengunya. The similarity with the word "chicken" has also lead to a lot of misconceptions about the disease.

There were two medical reports were published in 1955, are identified and reported Chikungunya disease. "An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. II. General description and epidemiology" by WHR Lumsden and "An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. In . Clinical features. "M. Robinson looked at infections Makonde Plateau. In these papers, notes the similarity with the authors Chikungunya Dengue fever.

Since 1952, showed cyclical Chikungunya outbreak. Most number of Chikungunya cases were reported between 1960 and 1982 in Africa and Asia. The disease was reported in a long time and it reappeared in 1999. From 2003 onwards, were frequent outbreaks reported especially in southern India. The following is a brief overview of the reported outbreak of Chikungunya in the world.

Chikungunya cases reported:

1952 - Outbreak of Chikungunya detected in Makonde Plateau. 

1955 - Marion Robinson and W.H.R. Lumsden identifies and describes Chikungunya. 

1963/64 - Chikungunya discovered Indian cities, mainly Calcutta, Maharashtra and Vellore. The number of infections were in lakhs (100,000 +) and more than 200 deaths were reported. 

1969 - Chikungunya detected in Srilanka. 

1975 - Chikungunya detected in Vietnam and Myanmar. 

1982 - Chikungunya detected in Indonesia. 

2005/2006 - Chikungunya was reported in the Reunion Islands and about 200 people died. It was also reported from south Indian states namely Kerala, Karnataka, Tamil Nadu and Andhra Pradhesh. 

2007/2008 - Chikungunya infection were reported from different parts of India. It spread to other South Asian countries, including Maldives and Pakistan. By 2008, infection was reported from Italy, Singapore and Australia.

Chikungunya in India:

Most number of Chikungunya infections (which peaked in 2006) have been reported from India. Majority of infections are reported from the southern states (Kerala, Karnataka, Andhra Pradesh, Maharashtra and Tamil Nadu). The overall infection is over 1.3 million and in some areas around 50% of the population affected by this disease. Also a large number of infections are unreported or are misdiagnosed.

What causes Chikungunya fever?

 Chikungunya disease is a viral disease transmitted to humans by the bite of infected mosquitoes. Aedes aegypti mosquito (also called yellow fever mosquito) is the primary transmission agent Chikungunya virus (CHIKV). This is normally found in the tropics, and thus the reason for Chikungunya is predominantly found in Asian countries. In recent cases, named another mosquito species, Aedes albopictus is found to be a carrier. Aedes aegypti biting day time thus in the daytime mosquito bites is the main cause of transmission.

Over years Aedes mosquitoes have evolved and adapted to efficient human bite! They even reduce buzzing of wings, while approaching people. They attack from below, so there is minimal discovery. This mosquito is usually seen in urban areas, but has recently spread to many rural areas also. Aedes mosquitoes need only 2 milliliters of water for breeding and their eggs may rest up to 1 year! Carrier mosquitoes can even pass the infection to the next generation!

 Chikungunya virus is a heat-sensitive RNA virus (family Togaviridae and genus are alpha virus - Class IV +). There are three major groups of these viruses to Western Africa, Central Africa and Asia.

Chikungunya virus requires an agent of transmission and thus direct human to human transmission is not possible. So far, no such incidence has been reported. Normally, transmission, when a mosquito bites an infected person, and then subsequently bites an uninfected person. Chikungunya also affects monkeys, and there is suspicion that they are a major reservoir of the virus in Africa.

Global distribution of Aedes Aegypti mosquito that causes Chikungunya 

Yellow areas show the distribution of Aedes aegypti mosquito and the red area indicates dengue infection activity.

What are the symptoms of Chikungunya fever?

Chikungunya typically starts with one or more of the following symptoms - chills, fever, vomiting, nausea, headache and joint pain. The fever may reach up to 104 degrees Celsius. The attack is sudden and sometimes accompanied by rash. Severe pain is the main and the most problematic symptoms of Chikungunya. In some infections, no symptoms are seen, and this behavior is seen especially in children.

When the mosquito bites, it takes one to 12 days before symptoms are seen. In many cases the only differentiating factor for symptoms of acute pain.

 

Some of the physical symptoms of Chikungunya include:

Redness of the eye and hard to look at light. 

High fever with headache and joint pain. 

Rashes may also appear as a regular on the limbs and trunks.

Diagnosis of Chikungunya:

Chikungunya is diagnosed by the ELISA blood test. Blood test is the only reliable way to identify Chikungunya, because the symptoms resemble much more deadly dengue fever. Also co-occurance of these diseases seen in many places.

Chikungunya is confirmed when symptoms such as fever and joint pain seen with one of the following, Four times HI (haemagglutination inhibition) antibody difference in paired serum samples. This shows a positive within 5 to 8 days of infection. 

IgM antibodies. These antibodies persist up to 6 months after infection, but currently there are no commercial tests available.

Virus isolation from serum.

Detection of viral nucleic acid in serum by RT-PCR. This must be implemented within 5 days after infection.

Treatment of Chikungunya Disease:

There is no antiviral medication or medication specifically for Chikungunya. But as Chikungunya is cured of the immune system in almost all cases there is no reason to worry. The treatment usually have symptoms and includes taking sufficient rest, as more liquid food and medicine to relieve pain (paracetamol for example). Aspirin should be avoided.

Honey and lime mix proves to have soothing effect on the disease. Avoiding certain drugs is actually recommended for a quick recovery. Also very mild exercise to the joints can alleviate the pain.

Currently there is no vaccine against Chikungunya. Research is ongoing on the development of DNA vaccines against Chikungunya.

Usually the disease begins to decrease in intensity after 3 days and it may take up to 2 weeks for recovery. But in earlier recovery is very slow and can take up to 3 months. In some cases, pain can take as long as a year!

 

Ayurveda treatment for Chikungunya:

Since there is no medicine for Chikungunya in traditional medicine, people are increasingly targeted at traditional Indian medicine (Ayurveda). Ayurveda treatment for Chikungunya use herbal drugs. Some of the kashayams (concoction) is ordained Amrutharista, Mahasudarshana Churna, panchathiktha kashayam, Sudarshan Churnam, Dhanvantaram Gutika and Amruthotharam Kashayam. Ancient Ayurveda describes a similar condition called Sandhijwara similar to Chikungunya in its symptoms (joint pain). Therefore, some medicines sooth joint pain.

There are also reports of counterfeit medicines, as steroids are added. These can cause serious side effects in the long term. Therefore, the best advice is to find rest and drink plenty of fluids food!

Homeopathic treatment for Chikungunya:

According to homeopathic experts effective drugs available to prevent and to accelerate recovery from Chikungunya. In some of the southern Indian cities such treatment is tested. It is claimed that the medications Eupatorium perf prevent Chikungunya infection. Other drugs prescribed for the disease include Pyroginum, Rhus-tox, Cedron, Influenzinum, China and Arnica.

Prevention of Chikungunya fever:

Currently there is no vaccine against Chikungunya. There is only way to prevent Chikungunya fever - do not get bit by a mosquito! It is easier said than done in a tropical area like India. Some of these precautions can help reduce the risk of mosquito bites, 

Reduce the risk of mosquito bites

Use mosquito nets when sleeping in the daytime.

Wear dress that covers most of the body. Similar repellents available that can be used to coat materials.

Use mosquito coils or repellents (containing Picaridin, oil of lemon eucalyptus or DEET). But be aware that prolonged use of those not recommended. Also ensure adequate ventilation when used.

Use curtains or window nets to prevent entry of mosquitoes in the house. 

Using the cream or spray that can be applied to the skin. This masks body odor and effectively you are invisible from mosquitoes. Very useful if you are visiting an area where Chikungunya have been reported.

Another way to reduce mosquito bites is to take steps to reduce its progeny. This must be a community effort, with only one person alone can not achieve much. Some of the following steps can be taken to reduce mosquito breeding in your area

Reduction of mosquito breeding

The circled areas on the image displayed on the right side shows the potential mosquito breeding areas.

Drain all the water collected around your house (for example, in a pot or water cooler). 

Ensure that drainage, etc. are either closed or chemicals used to kill mosquito larvae (larvicides).

Another technique is to collect water in a container, and where mosquitoes lay eggs in it destroy them. This technique can be quite effective if more people use it in their territory. 

If there is a pond of stagnant water, biological method is best. Guppy fish varieties can be introduced into the pond which will eat mosquito larvae.

Note that most infections occurred outside the house and thus mosquito control is the most effective way to prevent Chikungunya outbreak. It is also important that patients with infection do not get bitten by mosquitoes.