Chikungunya Symptoms Diagnosis Treatment Prevention and control

Chikungunya Symptoms Diagnosis Treatment Prevention and control in Pakistan. Chikungunya virus cases spark fears of outbreak in Karachi. A mosquito-borne disease has reared its head in Karachi, affecting hundreds of people in Malir, Saudabad and Shah Faisal neighborhoods of the city. World Health Organization (WHO) says it’s Chikungunya virus that can become epidemic in the country.

The best means of prevention is overall mosquito control and the avoidance of bites in areas where the disease is common. This may be partly achieved by decreasing mosquitoes’ access to water and with the use of insect repellent and mosquito nets. There is no vaccine and no specific treatment as of 2016. Recommendations include rest, fluids, and medications to help with fever and joint pain.

While the disease typically occurs in Africa and Asia, outbreaks have been reported in Europe and the Americas since the 2000s. In 2014 more than a million suspected cases occurred. In 2014 it was occurring in Florida in the continental United States but as of 2016 there was no further locally acquired cases. The disease was first identified in 1952 in Tanzania. The term is from the Kimakonde language and means “to become contorted”.

Key facts

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash. Joint pain is often debilitating and can vary in duration. The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common. There is no cure for the disease. Treatment is focused on relieving the symptoms. The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.

The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in a localized outbreak in north-eastern Italy. Outbreaks have since been recorded in France and Croatia.

Signs and symptoms

Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pain. Other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash. The joint pain is often very debilitating, but usually lasts for a few days or may be prolonged to weeks. Hence the virus can cause acute, subacute or chronic disease.

Most patients recover fully, but in some cases joint pain may persist for several months, or even years. Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints. Serious complications are not common, but in older people, the disease can contribute to the cause of death. Often symptoms in infected individuals are mild and the infection may go unrecognized, or be misdiagnosed in areas where dengue occurs.

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Transmission

Chikungunya has been identified in over 60 countries in Asia, Africa, Europe and the Americas. The virus is transmitted from human to human by the bites of infected female mosquitoes. Most commonly, the mosquitoes involved are Aedes aegypti and Aedes albopictus, two species which can also transmit other mosquito-borne viruses, including dengue. These mosquitoes can be found biting throughout daylight hours, though there may be peaks of activity in the early morning and late afternoon. Both species are found biting outdoors, but Ae. aegypti will also readily feed indoors. After the bite of an infected mosquito, onset of illness occurs usually between 4 and 8 days but can range from 2 to 12 days.

Prevention and control

The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for chikungunya as well as for other diseases that these species transmit. Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes. This requires mobilization of affected communities. During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.

For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the day-biting vectors is advised. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions.

Repellents should contain DEET aminopropionic acid ethyl ester or icaridin piperidinecarboxylic acid, hydroxyethyl, methylpropylester. For those who sleep during the daytime, particularly young children, or sick or older people, insecticide-treated mosquito nets afford good protection. Mosquito coils or other insecticide vaporizers may also reduce indoor biting.

Symptoms

  • Most people infected with chikungunya virus will develop some symptoms.
  • Symptoms usually begin 3–7 days after being bitten by an infected mosquito.
  • The most common symptoms are fever and joint pain.
  • Other symptoms may include headache, muscle pain, joint swelling, or rash.
  • Chikungunya disease does not often result in death, but the symptoms can be severe and disabling.
  • Most patients feel better within a week. In some people, the joint pain may persist for months.
  • People at risk for more severe disease include newborns infected around the time of birth, older adults (65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease.
  • Once a person has been infected, he or she is likely to be protected from future infections.

Diagnosis

  • The symptoms of chikungunya are similar to those of dengue and Zika, diseases spread by the same mosquitoes that transmit chikungunya.
  • See your healthcare provider if you develop the symptoms described above and have visited an area where chikungunya is found.
  • If you have recently traveled, tell your healthcare provider when and where you traveled.
  • Your healthcare provider may order blood tests to look for chikungunya or other similar viruses like dengue and Zika.

Treatment

  • There is no vaccine to prevent or medicine to treat chikungunya virus.
  • Treat the symptoms:
    • Get plenty of rest.
    • Drink fluids to prevent dehydration.
    • Take medicine such as acetaminophen (Tylenol) or paracetamol to reduce fever and pain.
    • Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS until dengue can be ruled out to reduce the risk of bleeding).
    • If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.
  • If you have chikungunya, prevent mosquito bites for the first week of your illness.
    • During the first week of infection, chikungunya virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites.
    • An infected mosquito can then spread the virus to other people.

Basic precautions should be taken by people travelling to risk areas and these include use of repellents, wearing long sleeves and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering.

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