UNGUNYA (Article From Nammude Arogyam) viral Virus Prevalence: Symptoms:- Epidemic in Kerala 2007:- Virological Investigations

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Oliver Bates
5 years ago
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1 CHIKUNGUNYA (Article From Nammude Arogyam) Chikungunya is a viral disease which spread exclusively by the bite of infected mosquitoes. Aedes aegypti is the major vector and also Aedes albopictus. It was first isolated in 1953 in Tanzania; it affects hundreds of thousands of people there. It is rarely a life threatening disease. The disease resembles dengue fever or it can be a combination of both since the vector is same for Chikungunya and Dengue fever. Virus Chikungunya virus, belong to family Togaviridae, Alpha Virus. Man is the reservoir of this virus for mosquitoes. An infected person cannot transmit the disease to another but only through mosquito by biting infected person and then biting someone else. Incubation Period:-1-12 days after the bite of the infected mosquito Aedes aegypti and Aedes albopictus Prevalence: - First reported cases in Africa (1953), India and Southeast Asia. In India the first outbreak was at Calcutta in 1963, cases were in Lakhs. In 1964 epidemic occurred in lakhs. Since 1973 there was no cases reported till now. In periods there were more than 8 lakhs cases reported. In 2005 epidemics in Andrapradesh and Maharashtra at Sholapur nearly 37% people were affected with Chikungunya but death was not reported. It is disease found primarily in Urban Area. Symptoms:- 1. The disease starts suddenly with fever, chills, headache, nausea, vomiting, 2. Low back ache, joint pain, and Maculo-papular rashes after 5 th day is noticed. 3. The affected patient is in stooped posture which is the most common feature of the disease. 4. The out come of the disease is the persistent arthritis which may need long term anti-inflammatory therapy. 5. Children may be asymptomatic can present as head ache, pharyngitis, loose stools and vomiting 6. Almost always self-limiting, Epidemic in Kerala 2007:- Total number reported cases in 2007 were 2, 40,052. Non reported cases may be more.in Kottayam alone the reported cases were Following Pre-monsoon showers epidemic of Chikungunya started in Pathanamthitta and Palakkad Walayar check post, affected more in hilly areas. Pathanamthitta, Kottayam, Alleppey, Part of Ernakulam were severely affected. Idukki Palghat and Trissur were less affected; similarly reported cases in northern part of Kerala were low. So we should be very careful about the less affected area because next attack will be severe in the less affected areas. Unless we are very agile in containing the mosquito breed the epidemic out break will be very severe in non affected and less affected areas. Virological Investigations:- National Institute of Virology, Pune Rajiv Gandhi Institute for Biotechnology, Trivandrum Kerala State Institute of Virology & Infectious Diseases, Alleppey,.not strengthened properly so far

2 Diagnostic facilities at:- Kerala State Institute of Virology & Infectious Diseases, Alleppey. So far this institute has not strengthened in spite of the repeated epidemics. There is no full fledged facility for research & study available, but still depending on National institute at Pune Medical College Trivandrum Medical College Kottayam State Public Health Laboratory Trivandrum Rajiv Gandhi Institute for Biotechnology (Genetic Methods) so not useful for routine investigation Spread by Bite of infected Aedes aegypti and Aedes albopictus, in daylight hours. If no water, the eggs can remain alive up to 1 year Prevention:- ONLY WAY OF CONTROLLING THE DISEASE IS ERRADICATION of MOSQUITO & MOSQUITO BREEDING SOURCES. There is no preventive Treatment available in the World so far Avoid mosquito bites and eliminate mosquito breeding sites,use mosquito nets to prevent mosquito bite and repellents help to drive mosquito away. IMA Action Plan for Prevention and Control of Chikungunya/Dengue in Kerala IMA is very much concerned about the Emerging disease Chikungunya, and Re- Emerging of Dengue, Leptospirosis, and Malaria. We cannot afford one more epidemic, So IMA has set up a state level epidemic cell and Action-Plan to contain these diseases especially Chikungunya on war footing. State President has appointed Dr.C.V.Pratapan Rtd DHS as the Chairman and Dr. C.V Prasanth as Convener of the IMA State Epidemic Cell.The first state level meeting of the cell was held on 16/01/2008 at 8.30 PM in the IMA Head Quarters and evolved an IMA Action Plan. First outbreak of Chikungunya in India was at Calcutta in1963. Since 1973 there was no cases reported till now. In period there were more than 8 lakhs cases reported.. In Maharashtra at Sholapur nearly 37% people were affected with Chikungunya but only one death reported. As on 4/10/2006 in Kerala 71 death due to suspected Chikungunya is reported by the news media, majority are old people, few newborn cases also among the list but no scientific evidence. So in our case the death due to Chikungunya is doubtful unless clear evidence is available. State Level Office Bearers of State Level, Regional Level, District Level and Local Branch level Committees were formed under the Chairman Dr..C.V Pratapan Rtd. DHS and Convener Dr.C.V Prasanth to coordinate them. Action Plan formulated as shown below Phase I - Preparedness (Inter epidemic) - Jan to March 2008 Phase II - Apprehensive (Pre-epidemic) April to June2008 Phase III - Attack/ Response (Epidemic) - June to Dec 2008

3 Slate level meetings / sittings of state leaders concerned Epidemic Control Cell, Research Cell combined meeting periodically and as and when required. Review meetings off and to evaluate the then present scenario. Liaison with the Governmental set up, Media, etc. To detail Medical teams to epidemic threat areas. Special T.V. Program in India Vision. Special issue of IMA. Nammude Arogyam on Epidemic diseases. Chikungunya. Dengue, Leptospirosis. Press conferences and interview to /with visual media. Prevention on avoiding mosquito bites and eliminating mosquito breeding sites Aim;- 1. Contain the disease first in epidemic areas 2. Create task force in District Level and Branch level 3. Mosquito source reduction 4. Vector control is the only solution to contain the disease can be done with the cooperation of Residential associations, local body involvement and other voluntary associations Suggestions:- 1. Bring out facts sheets for recording and 2. Advice to Government on control measures to contain the disease time to time 3. There should be short term planning and long term policy: - It is advisable to start a State Level separate wing for the control of epidemics. Disease surveillance system for early identification and rapid control of epidemics 4. Set up well equipped Virology lab for Kerala 5. Mobilization of Doctors and Paramedical staff 6. There should be a protocol for the management of cases - Fever protocol Decisions:- 1. Curative and preventive action has to start immediate 2. Uniform guide line for the management of Chikungunya 3. Preventive measures-urgent measures to reduce mosquito population 4. Health education to the public 5. Individual isolation of infected cases for 4 to 5 days to prevent mosquito bite 6. Promote mosquito Nets use and Mosquito repellants. 7. Formation of District level Crisis Management team 2. Integrated Vector Management with the cooperation of local bodies and other Voluntary Organisations about:- Entomological Surveillance including larval surveys ( in inter-epidemic period) At ward level, block level and district level Vector Control Measures educating School children, residential Associations and local body leaders its importance of eradicating.

4 Transmission Risk Reduction through identification of region specific potential sources & source reduction larvivorous fish, chemical larvicides, environmental management IMA Meetings for Implementation of the action plan Ward level. Discuss with The Ward Health & Sanitation Committee Identification and reporting of fever syndromes, Vector surveillance Management protocol Zonal Level IMA State Vice President will take initiative to organize District level CME in each District under the area involving IMA leaders at District Level. Various topics: Prevention Control and containment of epidemic diseases with relevance to C.G. & D.F, high lighting the threat of C.G. epidemic. Action to be initiated for opening as many fever clinics attached to private hospitals / Clinics. FUNCTION OF DISTRICT LEVEL BODY DTF Chairman and Convenor will take initiative to organize CME / Seminar in the District. Ensure involvement of the Zonal vice president, Joint Secretary and Senior IMA leaders and subject experts. Subjects: As mentioned for branches It was decided to set up district level act force on epidemic of Chikungunya. All the local branches in the district have to be mobilized and set up an Action Plan to contain the disease. All the District Task force Chairmen should take up the challenge. Suggestions:- 1. Set-up a district level Action Body to face the threat of Chikungunya epidemics 2. All the branch presidents and secretaries should meet regularly under the chairman and the convener should coordinate the meetings and prepare a programme 3. Concerned branch officials should prepare fact sheets for doctors and public 4. Regularly report to the district cell and in turn to state cell 5. Measures to contain the disease immediately 6. Make the Voluntary associations and local bodies to come into action for vector control. 7. Health awareness classes for school children and students of the locality and make them also participate in the campaign of vector control 8. Update the doctors with latest information about the disease and treatment guidelines Branch level Action: - In the months of February / March Fever Clinics to be started in all hospitals IMA Branch President and Secretary will take initiative to high light the threat of Viral Fever Epidemic in the state during the coming months February, March, April, May, June.

5 At least one CME/Seminar/Workshop to be organized in each branch. IMA leaders of State level/district level / Regional Level residing in the jurisdiction of the branch if any will be involved. Subject experts may be exploited. Subjects, General talk about epidemic, viral diseases especially Chikungunya, Dengue and Leptospirosis. Mosquito Control measures Importance of observation of the patient for 5 to 7 days after the onset of fever. Protect the patient from mosquito bite. Importance of proper reports of the fever under the classification of C.G; DF; and other viral fevers. Should Co-operate with Government Epidemic Control activities involving actively. Conduct as many CMEs and special classes for Nurses, Paramedical & Public (including teachers, Politicians, voluntary organizations) Have Liaison with Press and Media people.

Zika Virus Update. Florida Department of Health (DOH) Mark Lander. June 16, Florida Department of Health in Columbia County

Zika Virus Update. Florida Department of Health (DOH) Mark Lander. June 16, Florida Department of Health in Columbia County Zika Virus Update Florida Department of Health (DOH) Mark Lander June 16, 2016 Florida Department of Health in Columbia County 1 Zika Virus Originally identified in Africa and Southeast Asia First identified