Chikungunya outbreaks

This article discusses the recent outbreak. For general information about Chikungunya, see the dedicated article.

An analysis of the virus's genetic code suggests that the increased severity of the 2005-present outbreak may be due to a change in the genetic sequence, altering the virus' coat protein, which potentially allows it to multiply more easily in mosquito cells^[1] and utilise the Asian tiger mosquito (an invasive species) as a vector in addition to the more strictly tropical main vector, Aedes aegypti. In July 2006, a team analyzed the virus' RNA and determined the genetic changes that have occurred in various strains of the virus and identified those genetic sequences which led to the increased virulence of recent strains. ^[2]

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2005

In February 2005, an outbreak was recorded on the French island of Réunion in the Indian Ocean. As of May 18 2006, 258,000 residents have been hit by the virus in the past year (out of a population of about 777,000). 219 official deaths have been associated with Chikungunya. ^[3]

In neighboring Mauritius, 3,500 islanders have been hit in 2005. ^[4] There have also been cases in Madagascar, the Comoros, Mayotte and the Seychelles.

In Nandurbar city of Maharashtra State (India), many people over age 60 died due to chikungunya induced complications. Three months after the viral infection, patients were still suffering from severe joint pain in the morning, dyspepsia, relapsing fever, swelling in the joints. Doctors should also be alert for platelet count abnormalities suggestive of Dengue or Falci. Malaria. (Dr.Manoj Tamboli)

2006

In 2006, there was a big outbreak in the Andhra Pradesh state in India. The initial cases were reported from Hyderabad and Secunderabad as well as from Anantpur district as early as November and December 2005 and is continue unabated. In Hyderabad alone an average practitioner sees anywhere between 10 to 20 cases every day. Some deaths have been reported but it was thought to be due mainly to the inappropriate use of antibiotics and anti inflammatory tablets. The major cause of morbidity is due to severe dehydration, electrolyte imbalance and loss of glycemic control. Recovery is the rule except for about 3 to 5% incidence of prolonged arthritis. As this virus can cause thrombocytopenia, injudicious use of these drugs can cause erosions in the gastric epithelium leading to exsanguinating upper GI bleed (due to thrombocytopenia). Also the use of steroids for the control of joint pains and inflammation is dangerous and completely unwarranted. On average there are around 5,300 cases being treated everyday. This figure is only from public sector. The figures from the private sector combined would be much higher.

There have been reports of large scale outbreak of this virus in Southern India. At least 80,000 people in Gulbarga, Tumkur, Bidar, Raichur, Bellary, Chitradurga, Davanagere, Kolar and Bijapur districts in Karnataka state are known to have been affected since December 2005. ^[5]

A separate outbreak of Chikungunya fever was reported from Malegaon town in Nasik district, Maharashtra state, in the first two weeks of March 2006, resulting in over 2000 cases. In Orissa state, at most 5000 cases of fever with muscle aches and headache were reported between February 27 and March 5, 2006. ^[6]

In Bangalore, the state capital of Karnataka (India), there seems to be an outbreak of Chikungunya now (May 2006) with arthralgia/arthritis and rashes. So also in the neighbouring state of Andhra Pradesh. In the 3rd week of May 2006 the outbreak of Chikungunya in North Karnataka was severe. All the North Karnataka districts specially Gulbarga, Koppal, Bellary, Gadag, Dharwad were affected. The people of this region are hence requested to be alert. Stagnation of water which provides fertile breeding grounds for the vector (Aedes aegypti) should be avoided. The latest outbreak is in Tamil Nadu, India - 20,000 cases have been reported in June 2006. Earlier it was found spreading mostly in the outskirts of Bangalore, but now it has started spreading in the city also (Updated 30/06/2006). More that 300,000 people are affected in Karnataka as of July 2006. ^[7]

Reported on 29/06/2006, Chennai - fresh cases of this disease has been reported in local hospitals. A heavy effect has been reflected in south TN districts like Kanyakumari and Tirunelveli. Residents of Chennai are warned against the painful disease.

June 2006 - Andaman_Islands (India) Chikungunya cases had been registered virtually for the first time in the month of June 2006. In the beginning of the September cases have gone as much as in thousands.As reported in a local news magazine it has taken the state of epidemic in Andamans. Health authorities are doing their best to handle the situation.Relapsed cases have been noticed with severe pain and swelling in the lower limbs, vomiting and general weakness.

As of July 2006, nearly 50,000 people were affected in Salem, Tamil Nadu. ^[8]

As of August 2006, nearly 100,000 people were infected in Tamil Nadu. Chennai, capital of Tamil Nadu is one of the worst affected.

On 24 August 2006, The Hindu newspaper reported that the Indian states of Tamil Nadu, Karnataka, Andhra Pradesh, Maharashtra, Madhya Pradesh, Gujarat and Kerala had reported 1.1 million (11 lakh) cases. The government's claim of no deaths is questioned. ^[9]

As of 31 August 2006, neighbouring cities of Salem, Erode and Coimbatore have been severely affected by this epidermic. All the above places are in South India

11 September 2006 - an outbreak is under way in the western parts of India, specifically the southeast parts of the state of Gujarat, which are recovering from the heavy rainfall caused floods. Chicken gunya is also noticed in some parts of Goa, specially the south Goa. About 5,000 people have already been suffering from chicken gunya.

19 September 2006 - after the flood and heavy rains in Rajasthan in August 2006, India, thousands cases been detected in Rajasamand, Bhilwara, Udaipur, Chittorgarh district. However surprisingly there is no mention of all these in media or by Government.

21 September 2006 - Delhi-based family members got infected as well.

22 September 2006 - case detected back home in the United Kingdom traveller based in Udaipur at the time of floods in August/September. Symptoms included rash, fever, muscle and joint pain, severe headache. Antihistamines prescribed for itching. Advised six weeks of fatigue to follow after five days of acute illness. Recommended rest and plenty of fluids.

2 October 2006 - Total of 61 deaths has been reported in the state of Kerala, India. 30,000 people are reported to have admitted in hospitals run by govt. agencies, the number from private clinics are unknown. ^[10]

15 October 2006 - Chikungunya cases have been reported in the town of Etawah in Uttar Pradesh, India.

16 October 2006 - Many confirmed cases in Kanpur, UP (Uttar Pradesh). Etawah confirmed above. It is slowly spreading towards Northern India perhaps.

2007

01 September 2007 - 130 cases confirmed in the province of Ravenna, Italy, in the contiguous towns of Castiglione di Cervia and Castiglione di Ravenna and one deceased. ^{[11] [12]}

Notes

1. ^ http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030263
2. ^ http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463904
3. ^ http://www.lemonde.fr/web/depeches/0,14-0,39-27336219@7-37,0.html?xtor=RSS-3208
4. ^ http://news.bbc.co.uk/2/hi/europe/4674376.stm
5. ^ http://timesofindia.indiatimes.com/articleshow/1482202.cms]
6. ^ http://www.mdtravelhealth.com/destinations/asia/india.html
7. ^ http://www.hindu.com/2006/07/10/stories/2006071007210400.htm
8. ^ http://www.hindu.com/2006/07/04/stories/2006070403940300.htm
9. ^ http://www.hindu.com/2006/08/24/stories/2006082419390900.htm
10. ^ http://www.manoramaonline.com/cgi-bin/MMOnline.dll/portal/ep/contentView.do?contentId=1524920&contentType=EDITORIAL&BV_SessionID=@@@@0397953503.1159849530@@@@&BV_EngineID=ccckaddimkjdegmcefecfikdghodgik.0
11. ^ http://ocasapiens.blog.dweb.repubblica.it/2007/09/01/chikungunya-continua/
12. ^ http://it.notizie.yahoo.com/adnkxml/20070901/tit-ravenna-finora-151-segnalazioni-di-s-afde0ec_1.html