Bernardo, Bea

Ramirez, Kennie

Villanueva, Michelle February 17, 2017

Chikungunya

Introduction

Chikungunya is an infection caused by the chikungunya virus (CHIKV). It is a

viral disease transmitted to humans by infected mosquitoes. It is translated from

the African dialect of Swahili or Makonde, chikungunya means, that which bends

up, what bends, or to walk bent over and refers to the effect of the

incapacitating arthralgia experienced by patients with CHIKV fever. CHIKV

infection has an abrupt onset, characterised by fever, and severe arthralgia which

is seen in 70% of cases

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.

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. Infected species

include: Birds, humans, chimpanzees, some domes- tic animals, reptiles.

Human-to-mosquito-to-human infection occurs without the need for an

intermediate amplifying host. It is found to be an extremely efficient urban vector

since it preferentially feeds on humans, often bites several persons during

interrupted blood meals, and has adapted to live and breed peridomestically. A.

albopicus is an alternate vector in areas where A. aegypti are not present.

CHIKV is enzootic across tropical regions of Africa and Asia. In West and Central

Africa, CHIKV is believed to be main- tained in a sylvatic cycle involving wild

nonhuman primates and forest-dwelling Aedes mosquitoes.

CHIKV was first recognised in Tanzania (formerly Tanganyika) in 1953 during an

epidemic of dengue-like illness. Between the 1960s and 1990s, the virus was
isolated repeatedly from numerous countries in Central and Southern Africa,

including Sudan, Uganda, Democratic Republic of Congo, the Central African

Republic, Malawi, Zimbabwe, Kenya, and South Africa

CHIKV has also been isolated in Western African countries, including Senegal,

Benin, the Republic of Guinea, Cte dIvoire and Nigeria.

In Southeast Asia, frequent outbreaks were reported from the 1960s through to

2003 in India, Malaysia, Indonesia, Cambodia, Vietnam, Myanmar, Pakistan, and

Thailand.

Indeed, numerous cities, including Bangkok and Calcutta have been identified as

particularly active sites of transmission and disease

Beginning in 1986, CHIKV outbreaks resurged with major clusters documented in

Senegal (1986, 1996, and 1997), Cte dIvoire (1996 and1997), Democratic

Republic of Congo (1998-2000), Indonesia (2003), Kenya (2004), Comoros

(2005), the Seychelles, Mauritius, Madagascar and Runion islands (2005-2006),

and India (2006 and 2007). Cases have also been reported in Europe (United

Kingdom, Belgium, Germany, Czech Republic, Norway, Italy, Spain and France),

Hong Kong, Canada, Taiwan, Sri Lanka and United States; however, these were

directly associated with the return of tourists from India and the affected islands

of the Indian Ocean. At Present, CHIKV is endemic in 23 countries and

phylogenetic analysis of viral sequences has identified 3 distinct clades: West

African, Central/East African and Asian. There are 2 epidemiological transmission

cycles of CHIK fever: a sylvatic cycle, occurring primarily in Africa mainly

between wild primates and arboreal Aedes mosquitoes where humans are
accidental hosts; and an urban human-mosquito-human transmission cycle that

typically occurs in cities in Asia.

In the Philippines, On July 25, a state of calamity was declared in San Nicolas,

Ilocos Norte after the number of suspected chikungunya cases surged to more

than 300, affecting at least four neighboring villages. Meanwhile, the DOH

registered a total of 2,594 suspected chikungunya cases in the first half of 2013,

but only 157 of these cases had been confirmed. No deaths were recorded.

Outbreaks also occurred in Kiamba and Maitum in Sarangani; Villareal and

Daram in Western Samar; Ma. Aurora in Aurora; Sindangan in Zamboanga del

Norte; Sta. Rita in Samar; Concepcion in Romblon; Santiago in Agusan del

Norte; and Patnongon in Antique. According to ASec Tayag, the last significant

number of chikungunya cases in the Philippines happened when Tropical Storm

Sendong hit in 2011 and outbreaks occurred in Cagayan de Oro and Davao.

Biology of the Agent

A mutation affecting the CHIKV E1 gene (A226V) allows increased viral loads in

A. albopictus, which is believed to be responsible for the severity and extent of

the 2005-2007 out- breaks in the islands of the Indian ocean, western India,

southeast Asia and northern Italy.

CHIKV is an alphavirus, under family Togaviridae, that includes 29 viruses within

the genus comprising three groups. CHIKV is divided into two genotypes: Asian

and East Central South African (ECSA). It is a member of the Semliki Forest

antigenic complex along with Mayaro, Ross River and Onyong-nyong viruses; all

are human pathogens. It is enveloped, icosahedral nucleocapsid symmetry,

spherical particle, and with diameter of 60-70 nm.

Its nucleic acid is linear, positive-sense, single-stranded RNA, 11.8 kb in

length. Physicochemical properties included being susceptible to inactivation by

70% ethanol, 1% sodium hypochlorite, 2% glutaraldehyde and lipid solvents

(ether and detergents). Inactivated by dry or wet heat >58C and drying.

Relatively stable at 40C.

Temperature is one of the most important environmental factors affecting

biological processes of mosquitoes, including their interactions with viruses.

Mosquito adult survival was determined by adult-holding temperature, regardless

of rearing conditions of the immature stages. In contrast, spread of virus

throughout the body of the mosquito, a pre-requisite for transmission, was

reduced when the immature stages were reared in cool conditions. These results

show that immature-rearing temperature selectively modified mosquito traits that

influence competency for viruses, and they further our understanding of the

nature of temperature effects on interactions between mosquitoes and virus

pathogens and risk of disease transmission.

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.

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.

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.

The Department of Health (DOH) addresses the public to remember and use 4S

against Zika virus and other mosquito-borne diseases. The 4S means Search &

destroy mosquito breeding places, use Self-protection measures, Seek early

consultation for fever lasting more than 2 days, and Say yes to fogging when

there is an impending outbreak.

Health Secretary Janette Loreto-Garin said that the first step to prevent

mosquito-borne diseases is within our homes. We should not only remember the

information being delivered by DOH to the communities. Instead, let us make it a

practice and instill cleanliness in our surroundings. It is not only your family that

will benefit from this habit, but the entire community as well.

Reference

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