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2. Outline Introduction Epidemiology transmission Clinical manifestation Treatment Prevention 2

3. Introduction Chikungunya is a virus that causes acute febrile polyarthralgia (inflammatory disorder. It results in muscle pain and stiffness in the body) and arthritis. The name is derived from a word in local language of Tanzania meaning "that which bends up" or "stooped walk” Multiple outbreaks occur Africa and beyond. 3

4. Epidemiology Endemic areas — Africa, Asia Chikungunya virus, 1 st indentified during an outbreak in Tanzania in the 1950s Then spread to countries of central, southern, and western Africa. Outside Africa, the first documented chikungunya fever outbreak was in Thailand in 1958. 4

5. Epidemiology Other outbreaks occurred in other Asian countries:- India, Sri Lanka, Malaysia, Indonesia, Spread — mainly through infected travelers between regions where mosquitoes exist for perpetuation of local transmission. Imported cases in European countries, USA and Australia. Since 2004 it has caused outbreaks in various parts of Asia 5

6. How serious is Chikungunya? December 9, 2013 PAHO issues Epidemiological Alert

7. How serious is Chikungunya? June 6, 2014 4,486 confirmed cases 17 Caribbean countries

8. TRANSMISSION Aedes Aegypti & Aedes Albopictus mosquitoes. The Reservoirs - Humans are the primary reservoir during epidemic periods. 8

9. TRANSMISSION Mosquitoes acquire the virus from a viremic host. Following an average extrinsic incubation of 10 days, the mosquito transmits the virus to a naïve host. So far there is no evidence to indicate a person- to-person transmission of the disease. 9

10. Risk & Immunity All individuals not previously infected with CHIKV are at risk of acquiring the infection Once exposed, one will develop long term immunity 10

11. Make No Mistake

12. Clinical Manifestation Most individuals will present with symptomatic disease after an incubation period of 3 – 7 days (range: 1−12 days) Not all individuals infected with the CHIKV develop symptoms. (between 3% - 28% does) CHIKV can cause acute, sub acute, and chronic disease. Acute disease is characterized by an abrupt onset of high fever (usually≥ 102°F/39°C) and severe joint pain. 12

13. Clinical Manifestation Fever typically may lasts from several days to a week. The fever may be continuous or intermittent A drop in temperature is not associated with worsening of symptoms. Fever may be associated with a relative bradycardia (slowness of heart rate < 60 beats/minute). 13

14. Main characteristics Fever Headache Fatigue Nausea, vomiting Muscle pain Rash Joint pain 14

15. Other common symptoms Redness in eye Difficulty in looking at light Severe fever with headache and joint pain Rashes on limbs and trunks Rash usually appears 2 – 5 days after onset of illness and lasts 3 – 7 days in 50% of cases. 15

16. Acute Presentation 16

17. High Risk Groups Infants and the elderly being at greatest risk for more severe disease. (day sleepers, lower immune system) Co-morbidities have been identified as a risk factor for severe disease. (chronic illnesses) Pregnancy – Most CHIKV infections that occur during pregnancy will not result in viral transmission to fetus. 17

18. High Risk Group Rare reports of spontaneous abortions following CHIKV infection in the mother. Neonates who had neurologic manifestations may develop long-term disabilities. There is no evidence of viral transmission through breast Fatalities related to CHIKV infection are uncommon. 18

19. Chronic Presentation 19

20. Treatment There is no specific antiviral drug treatment for CHIKV. Symptomatic treatment. - Rest - Fluids - Paracetamol Use of aspirin is not advised due to risk of bleeding 20

21. Prevention Prevent Mosquito Bites Mosquitoes which spread Chikungunya bite during the daytime. Protect yourself from mosquito bites : Wear light coloured clothing and cover your body as much as possible Use mosquito repellents containing DEET on exposed skin 21

22. Prevention Use mosquito coils and electric vaporization mats both day and night Use mosquito nets Use door and window screens (mesh) 22

23. Prevention Eliminate Mosquito Breeding Sites Mosquitoes live and breed in standing water in and around the home. Do your part by preventing mosquito breeding: Cover all drums, tanks, barrels and buckets that are used to store water 23

24. Prevention Get rid of all old tyres, tins, bottles, plastic containers, coconut shells and anything in which rain water settles Cover trash containers to keep out rain water Punch holes in the bottom of tins before placing them in the garbage Keep flower pot saucers dry Avoid over-watering potted plants 24

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26. Aedes Mosquito The Aedes mosquito needs only 2ml of water for breeding. After breeding the eggs can lay dormant up to one year. A carrier mosquito is capable of transmitting the virus to the next generation. The Chikungunya virus is sensitive to heat. 26

27. 27 Life Cycle of the Aedes aegypti From eggs to Larva - 1 – 3 days From larva to pupa - 4 days From Pupa to Adult- 2 days Lays egg 3 days after taking a blood meal

28. 28 Common Breeding Sites

29. 29 Potential Breeding Grounds

30. 30 Potential Breeding Grounds

31. 31 Potential Breeding Grounds

32. 32 Potential Breeding Grounds

33. 33 Potential Breeding Grounds

34. 34 Potential Breeding Grounds

35. 35 Potential Breeding Grounds

36. 36 Potential Breeding Grounds

37. 37 Potential Breeding Grounds

38. 38 Chikungunya Prevention & Control is in your hands – Do Something