Chikungunya

Chikungunya viral illness came to the world’s attention in 2005-2006 after 5 decades of obscurity

July 13, 2014, 5:45 p.m. Published in Magazine Issue: Vol: 08 No. -3 July. 11- 2014 (Ashar 27, 2071)

Chikungunya viral illness came to the world’s attention in 2005-2006 after 5 decades of obscurity. There were large scale outbreaks that swept through East Africa and India including the eastern Indian Ocean Islands. In addition for the first time, it struck a country with Western health care facilities, Reunion Island ( a French overseas territory). Then it even presented as a mysterious illness in certain parts of Italy, and for a while the Italians did not know what hit them.

It took some detective work on the part of Italian scientists to figure out that the vector ( carrier) of this debilitating disease came to town in motor vehicle tires imported from foreign countries. The Italian scientists found out that in  small water droplets inside the rubber tire the mosquito vector carrying the Chikungunya virus was very comfortably lodged. This mode of travel and survival in small droplets of water in tires by this group of mosquitoes seemed to suggest that these mosqutoes were of a hardier sort than the anopheles mosquito which helps transmits the malaria parasites.

Clearly when a disease is prevalent in India, the Indian border with Nepal is porous not only for free human travel but also forfor“emerging diseases” like Chikungunya.

Over the past several years this disease has been documented in Nepal. Recently  laboratory confirmed cases of Chikungunyahave been reported by the Sukraraj Tropical and Infectious Disease Hospital in Teku Kathmandu. The first group of patients came from Dhading district, which neighboursKathmandu.

The Ministry of Health and Population ( MoHP) has also been conducting a surveillance in Kathmandu.it is therefore relevant to find out more about this strange sounding viral illness.Clearlyeven Kathmandu clinicians do not know much about this “new”illness.

Chikungunya is a viral illness that is closely related to the dengue virus which is known to be present in Kathmandu. Both are transmitted by the vector mosquito (AedesAegypti) and cause a similar set of symptoms.

The patient complains of fever, headache, back pain with usually a skin rash present. A remarkable distinction between this illness and dengue fever is the inflammation (arthritis) of small joints of the hands in Chikungunyawhich is usually not found in dengue fever.

For Chikungunya, as in dengue, there is no specific treatment, only paracetamol and other symptomatic treatment. There is also no vaccine available.Protective clothing, using insect repellents (odomas) and other measures to prevent day- time mosquito bites ( as opposed to night- time mosquito bites for malaria transmission)  are important means to avoid this disease. Public health measures like not letting water collect in used tires, flower pots, and plastic containers where the mosquito breed are obviously important. The good news is that in most instances this disease like dengue fever, is self-limiting and most people do well. 

Both dengue and chikungunyamay be brought to Kathmandu by migrant workers and others from the Terai( where both dengue and chikungunya are thought to be more prevalent) entering Kathmandu in large numbers. The specific mosquito vectors are apparently in plentiful supply here, and when people afflicted with the disease come to Kathmandu, the AedesAegypti mosquito enjoys a hearty blood meal including the virus from them. The same mosquito then happily bites another victim and transmits the virus.

Finally, the emergence of Chikungunya is a good example of rich- country travelers being sentinels for diseases from poor countries. Since 2005 thousands of travelers from South Asia have been afflicted by this disease, and as a result, investigators in well-resourced countries were able to study and provide awareness about this new emerging illness.

 

Buddha Basnyat.jpg

Buddha Basnyat MD

Buddha Basnyat, MD, MSc, FACP, FRCP, Director of the Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu.

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