Chikungunya
Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. The disease mostly occurs in Africa, Asia and the Indian subcontinent. The disease shares some clinical signs with dengue and zika, and can be misdiagnosed in areas where they are common.
There is no cure for the disease. Treatment is focused on relieving the symptoms.
The mosquito-borne disease was first described during an outbreak in southern Tanzania in 1952. The name chikungunya derives from a word in the Kimakonde language, meaning to become contorted, and describes the stooped appearance of sufferers with joint pain.
Signs and symptoms
Chikungunya is characterised 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.
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 unrecognised, or be misdiagnosed in areas where dengue occurs.
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 Aedes 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.
Diagnosis
Several methods can be used for diagnosis. Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibody levels are highest 3 to 5 weeks after the onset of illness and persist for about 2 months. Samples collected during the first week after the onset of symptoms should be tested by both serological and virological methods (RT-PCR).
The virus may be isolated from the blood during the first few days of infection. Various reverse transcriptasepolymerase chain reaction (RTPCR) methods are available but are of variable sensitivity. Some are suited to clinical diagnosis. RTPCR products from clinical samples may also be used for genotyping of the virus, allowing comparisons with virus samples from various geographical sources.
Treatment
There is no specific antiviral drug treatment for chikungunya. Treatment is directed primarily at relieving the symptoms, including the joint pain using anti-pyretics, optimal analgesics and fluids. There is no commercial chikungunya vaccine.
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, including saucers for plant pots, flower vases, tyres and water tanks in bathrooms, which support breeding of the mosquitoes. This requires mobilisation 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 minimises 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.
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.
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.
Source: WHO
