1. Capt sayeed RMO 4FD Regt Arty Bangladesh Army

2. AIM To highlight Chikungunya virus,epidemiology, clinical feature,diagnosis, treatment, preventive measurers and recommendation.

3. SCOPE What is Chikungunya? Chikungunya virus. History Transmission Clinical feature Morbidity & mortality Diagnosis Diffential diagnosis Treatment Diffenence between chikungunya & dengue fever Prevention Recommendation Conclusion

4. What is Chikungunya ? Chikungunya name derived from Swahili word “that which bends up. in reference to the stooped posture Manifest with Crippling Arthritic disease of sudden onset. Virus isolated in 1953 from serum and Aedes mosquitoes and Culex spp

5. Chikungunya a Mosquito transmitted viral infection

6. Chikungunya Virus  Group-ssRNA  Family – Togaviridae  Genus - Alpha virus  Species- Chikungunya virus  Chikungunya viral infection manifests with febrile illness

7. History The disease was first described by Marison Robinson and W.W.R Lumsden in 1955,following an outbreak in 1952 in Tanzania(between Mozambique and Tanganyika) Since its discovery in 1952, chikungunya virus outbreak have occurred occasionally in Africa,South Asia and Southeast Asia.

8. Transmission Chikungunya fever is primarily transmitted by bites of mosquitoes of the genus Aedes,the same mosquito that transmits Dengue fever.only female mosquitoes are infective. Of two vectors in Asia,Aedes aegypti is believed to be the principal vector. Human and non-human vertebrates serve as the chikungunya virus reservoir.

9. Clinical Feature Fever : A period of fever may be followed by an afebrile phase and then recrudescence of fever Arthritis: Adults are susceptible to arthritis which causes early morning pain and swelling most often in the small joints. Back pain Headache Maculopapular rash Anorexia, nausea and vomiting Myalgia

10. Who are at greater risk Elderly people Newborns Women in general Diabetics Immuno-comprommised patients Patients with severe chronic illness

11. Morbidity and Mortality Fatalities are rare and when they occur are associated with either with young age or with Thrombocytopenia Hemorrhagic version of illness, that can lead to shock

12. Diagnosis Isolation of Virus Demonstrating of four fold or greater rise in antibody titre. ELISA testing for IgM antibody. Diagnosis by RT-PCR Test The antibody titre will be positive after 5th day of illness only.

13. Diffential diagnosis Dengue Group A streptoccus Leptospirosis Rubella Measles Post infectious arthritis Other alphavirus infections e.g. Sindbis viurs,O’nyong- nyong virus,Ross river virus and Mayaro virus

14. Treatment Chikungunya fever is not a life threatening infection. Symptomatic treatment for mitigating pain and fever using anti-inflammatory drugs along with rest usually suffices Rest to the patient and mild movements of joints Liberal fluid intake or iv fluids Analgesics and NSAIDS Antipyretic

15. Difference between Chikungunya & Dengue Clinical signschikungunyadengue FeverCommon RashDay 1- Day 4Day 5-Day 7 Retroorbital painrarecommon ArthralgiaConstantrare Myalgiacommon ArthritisCommon,edematousabsent Tenosynovitiscommonabsent Hypotensionpossiblecommon Minor blededingrarecommon ThrombocytopeniaEarly and mildDelayed and moderate to severe

16. How Chikungunya can be Prevented There is neither Chikungunya virus vaccine nor drugs are available to cure the infection. Prevention, therefore, centers on avoiding mosquito bites. Eliminating mosquito breeding sites is another key prevention measure. To prevent mosquito bites, do the following: Use mosquito repellents on skin and clothing When indoors, stay in well-screened areas. Use bed nets if sleeping in areas that are not screened or air-conditioned. When working outdoors during day times, wear long- sleeved shirts and long pants to avoid mosquito bite.

17. Chikungunya case in Bangladesh First indentified outbreak of chikungunya in Bangladesh,2008 (Health and Science Bulletin,volume 7.March 2009) 39 case in Rajshahi and Chapainawabganj- confirmed from laboratory at ICDDR,B. (Nov 23,2011)

18. Recommendation Preventive measures for vector control Awareness of CHIKV through mass media, TV, Radio, News paper Involvement of NGOs in integrated systemic approch Special campaigns for public awareness Assurance to the public about the disease morbidity and mortality Planned approach, besides knowledge and awareness of early warning signs, for prevention.

19. Conclusion In recent years there have been explosive outbreak of chikungunya fever in several parts of the sea region.Although the disease is self-limiting, morbidity, can be very high in major outbreaks resulting in heavy social and economic toll.Integrated vector management through the elemination of breeding sites,use of anti-adult and anti-larval measures and personal protection will contribute to prevent an outbreak.