Beware of Fake Doctors

Health Minister R Ashok has said that some fack doctors are doing the round offering "preventitive injections" for Chikungunya at a cost of Rs. 100 that it won't work.

"We have received complaints from the public that these fake preventive medicines have taken a lot of people for a ride. I have put the district and health authorities on the alert to nab any such quacks and take strict measures against such activities," Mr Ashok commented.

Chikungunya Deaths Will Be Probed

Union Minister for Health and Family Welfare Anbumani Ramadoss commented on 25th July that the reported deaths from Chikungunya will be investigated, even though he asserted that no-one had died from the disease.

According to Mr. Ramadoss , the fever had returned after a three-decade dormancy to affect 121 districts across seven States with the total level of expected infections reaching 974,541. And he futher commented that the largest number of cases were in Karnataka, Maharashtra and Andhra Pradesh while Tamil Nadu, Madhya Pradesh, Gujarat and Kerala were among the States affected by the fever.

Related: "Chikungunya Deaths Will Be Probed"/ Chikungunya afflicts seven states / Four states affected by Chikungunya, says government / All Assistance To Contain Chikungunya Fever: Ramadoss / Four states affected by Chikungunya, says government / Chikungunya prevalent in seven states

No Chikungunya deaths in Chennai

No deaths due to Chikungunya have been reported in Chennai according to the Health Minister K.K.S.S.R Ramachandran who reported the fact to the Assembly on Thursday 27th July 2006.

He gave a good summary about the spread of the disease which was first spotted in the border viallages of Vellore in March 2006 and then spread to Tamil Nadu.

Up to July 26 a total of 115 have been affected with Chikungunya in Chennai and as such the Local Administration Ministry and the Health Ministry were taking measures to restrict the disease and have allocated Rs. 2.85 crore.

Related: No Chikungunya found in state.

100 Cases of Chikungunya in Pune

Having already infected 19 districts of Maharashatra, Chikujgunya has now visited Pune according to the National Institute of Virology after 100 of the 250 samples from various hospitals tested positive for the fever.

'Chikangunya' death toll reaches 12 in Madhya Pradesh

To date 12 lives have been lost in Betul. 'With three more deaths Sunday - two from remote Dunava and one from Multai - the total number of deaths allegedly due to Chikangunya fever in Betul district has reached 12,' a source in the medical industry said on 6th July 2006.

The source continued:

'The dead include a 10-year-old girl, Preeti, and a senior citizen and freedom fighter, Laxman Singh Parihar. Over a dozen others are in critical condition with no signs of improvement even after regular medical aid. Chikangunya, affecting over 60,000 odd population, is now spreading to other districts - Chhindwara, Badwani and Burhanpur. However, 70 blood samples have been dispatched to New Delhi-based National Institute of Communicable Diseases and a report is expected next week.'

Health Minister Ajay Vishnoi admitted that Chhindwara, Badwani and Burhanpur were affected with the fever. And commented: 'The situation is under control and even the Maharashtra government has praised my department's rapid action to tackle the disease.'

Copyright:
Indo-Asian News Service

Government Stepping Up Chikungunya Action

The Health Minister R. Ashok, The Mayor of Bangalore and others have initiated measures to combat the spread of Chickungunya.

One tactic was the production of posters designed to create awareness of the disease. The only issue is that they'll be put up in hostpitals and primary health centres. We hope they're also recreated in newspapers.

Furthermore, the Health Minister has also ordered the purchase of 100 extra fogging machines to help prevent the breeding of the Aedes aegypti mosquito which spreads the disease.

They also asked Health officials to visit the hospitals to see if they have sufficient stocks of medicines to combat the symptoms.

Ashok commented on the campaign: "I have asked the department as well as MLAs and corporators to spread awareness about chikungunya among the public. College students are being made aware of the disease and its symptoms so that people are not misled."

Picture:
The Hindu

Doctors suspended for not visiting chikungunya-hit areas

Seven doctors in Mandhya Pradesh have been suspended after they didn't arrive for work in an area affected by Chikungunya.

On that day ten doctors were asked to reprort for work but on three turned-up in the area neighbouring Betul district where 30,000 people have been affected in 120 villages.

The virus has only recently been discovered in Mandhya Pradesh and spread from Betul.

‘A victim of chikungunya gets fever, which can reach 104 degrees Fahrenheit. After an incubation period of three-12 days, there is a sudden onset of flu-like symptoms, including severe headache, chills, nausea, vomiting and joint pain,’ said S.C. Tiwari, Hamidia Hospital superintendent.

‘A rash may occur sometimes and arthritis affects multiple joints, which can be debilitating. Most patients recover within three-five days. Some can suffer from joint pain for months. The joints of the extremities in particular become swollen and painful to touch. Children may display neurological symptoms,’ Tiwari said.

‘The situation is being regularly monitored and every step is being taken to curb the disease. Required medicines are being supplied in ample quantity. Arrangements for spraying insecticide to kill the mosquitoes is also being dministered in all the affected areas,’ state Health Minister Ajay Vishnoi told IANS.

‘Chikungunya’ grips Kadathur

The New Ind Press (warning - many pop-ups) reports that Chikungunya is appeared in Kadathur in recent days and has affected 200 people.

Information gained from local authorities state that the fever has spread from Puddireddipatti to the villages of Mottankurichi, Sillarahalli, Nathamedu and Linganaickenahalli in Kadathur Block.

The solution given to the local residents is to chlorinate the water and try to improve local sanitation.

WHO - Chikungunya Outbreak News

Between 28 March 2005 and 12 February 2006, 1 722 cases of chikungunya have been notified by physicians from a sentinel network in La Réunion, including 326 cases reported during the week 6 to 12 February. Estimations from a mathematical model indicate that 110 000 people may have been infected by chikungunya virus since March 2005 in La Réunion, including 22 000 persons during the week 6 to 12 February. During the first week of February, other countries in the south west Indian Ocean have reported cases: Mauritius (206 cases) and the Seychelles (1 255 cases).


From Who.int.

A Summary

PATHOGENICITY: Self limiting febrile viral disease; characterized by arthralgia or arthritis typically in the knee, ankle and small joints of the extremities, high fever, followed by a maculopapular rash; buccal and palatal enanthema can occur; nausea and vomiting may occur; mild hemorrhaging may be present especially in children; inapperent infections are common, immunity is long lasting.
HOST RANGE: Humans, primates, other mammals, birds

MODE OF TRANSMISSION: By bite of an infective mosquito

COMMUNICABILITY: No evidence of person-to-person transmission

DRUG SUSCEPTIBILITY: No antiviral available to date.

SUSCEPTIBILITY TO DISINFECTANTS: Sensitive to 70% ethanol, 1% sodium hypochlorite, 2% glutaraldehyde, Sensitive to lipid solvents
Read more.

First Characterization Of Chikungunya Viruses From Indian Ocean Outbreak

From: Public Library of Science & BioCompare

Since late 2004, a large outbreak of chikungunya fever in the Indian Ocean has caused a public health crisis and alarmed international experts. A team of scientists led by Sylvain Brisse (of the Pasteur Institute) now reports the first molecular data on the viruses involved in the outbreak in the international open-access journal PLoS Medicine

The report states that up to a third of the population of of Comoros, Mayotte, Madagascar, Mauritius, Seychelles, and Réunion are infected with also several states of India seeing cases.

The article continues:

The disease is caused by the chikungunya virus, which is spread to humans by mosquito bites. It was first described in Tanzania in 1952 and has since been found in Africa, India, and South East Asia. The name is derived from a local Tanzanian word meaning "that which bends up", a reference to the stooped posture many patients develop as a result of painful inflammation of the joints commonly associated with the disease. Other symptoms of the disease include fever, headache, and a skin rash. There is no specific treatment available. Most patients get better after a few days, but the pain in the joints can persist for long after the other symptoms have disappeared.

The authors note, the mosquitoes that transmit the Chikungunya virus in Africa and Asia are not limited to these areas--in fact they are the same ones that transmit yellow fever and dengue fever in many parts of the world--which raises the possibility that the chikungunya virus could spread and cause disease elsewhere.

230 Chikungunya Cases Reported in Belgaum Area

Although it appears that Chickungunya is falling in other areas, it looks like it's spreading fast in Belgaum district NewIndPress reports.

As many as 230 people are said to be suffering from Chickungunua in the villages of Ramdurg, Bailhongal, Gokak, Khanapur, Chikkodi and Athani.

The District Health Officer, Dr P A Pattanshetti, has stated that the disease is under control in Telsang now as medical teams were sent in.

A Homeopathic Cure?

The New India Press talks of the assertion of Dr A N Sundaresh from the Homepathy Medical Association of India.

At the moment there appears to be no cure to this contagious disease in traditional medicine, only the control of symptoms is offered.

Sundaresh said that homeopathy can help fight against the disease with Eupatorium, Rustax, Pyrogenium and Gelsemium being the most effective.

We would never believe we have the knowledge to recommend any treatment so make sure you seek informed medical advice.

Epidemiology

Chikununya was first described in Tanzania, Africa in 1952. An outbreak of chikungunya was discovered in Port Klang in Malaysia in 1999 affecting 27 people [1].

Recent outbreaks
In February 2005, an outbreak was recorded on the French island of Réunion in the Indian Ocean. As of February 25, 2006, 157,000 residents have been hit by the virus in the past year (out of a population of about 777,000 - 20%). Since October 2005, 52 deaths have been associated with chikungunya (French health minister Xavier Bertrand said 77 deaths in January 2006 may have been "directly or indirectly attributable" to the outbreak[2]). France initiated a massive effort to eradicate mosquitos' nesting grounds involving over 4000 people, including 800 troops.

In neighboring Mauritius, 3,500 islanders have been hit in 2005.[3] There have also been cases in Madagascar, Mayotte and the Seychelles. In 2006 there was a big outbreak in the Andhrapradsh state in India. Nearly 200,000 people were affected by this disease in the districts of praksham and nellore in this state. Some deaths have been reported but it was thought to be due mainly to the inappropriate use of antibiotics and anti inflammatory tablets. As this virus can cause thrombocytopenia, injudicious use of these drugs can cause erosions in the gastric epithelium leading to exsangunating upper GI bleed (due to thrombocytopenia)
There has 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 be affected since December 2005. [4].

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, amost 5000 cases of fever with muscle aches and headache were reported between February 27 and March 5, 2006. [5]

While supportive or palliative medical care with anti-inflammatories and analgesics is available, there is no specific treatment for chikungunya. The illness is usually self-limiting and will resolve with time. Symptomatic treatment is recommended after excluding other more dangerous diseases. Vaccine trials were carried out in 2000, but funding for the project was discontinued [4] and there is no vaccine currently available.

A serological test for chikungunya is available from the University of Malaya in Kuala Lumpur, Malaysia.

Possible role for chloroquine in the treatment of chikungunya: There is an interesting dialogue, mostly in French, about the possible use of chloroquine in the treatment of the arthralgia associated with CHIK.

1. A paper published in South Africa in 1984 concerning 10 cases of CHIK showed some effect of CQ in treating the symptoms of arthritis. Brighton SW. Chloroquine phosphate treatment of chronic Chikungunya arthritis. An open pilot study. S Afr Med J 1984 Aug 11;66(6):217-8.
The abstract of the paper:

"Over 12% of patients who contract Chikungunya virus infection develop chronic joint symptoms. These symptoms respond only partially to the non-steroidal anti-inflammatory drugs. An open pilot study on the efficacy of chloroquine phosphate was carried out and 10 patients completed 20 weeks of therapy. Both the Ritchie articular index and morning stiffness improved significantly. In the patient's assessment, 7 out of 10 considered their conditions to have improved. On the basis of the doctor's assessment, 5 of the 10 had improved. These results justify further controlled blind trials of chloroquine in chronic Chikungunya arthritis."

2. From the University of Malaya: http://www.vadscorner.com/alphaviruses.html

"Treatment [of chikungunya]:Supportive care with rest is indicated during the acute joint symptoms. Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbate rheumatic symptoms. In unresolved arthritis refractory to aspirin and nonsteroidal antiinflammatory drugs, chloroquine phosphate (250 mg/day) has given promising results."

3. From the French government: http://agmed.sante.gouv.fr/pdf/10/chicungu.pdf
Rough translation:

"In the context of the search for molecules with activity against the chikungunya virus, lab tests on cell cultures in vitro have shown that chloroquine (NivaquineR) has some antiviral activity against this virus. The Fench agency of health and medicines safety (AFSSAPS) points out that this involves preliminary tests and that at this stage, no information on the efficacy or safety in humans is available. In this context, the Agency reiterates the conditions of proper usage of Nivaquine (CQ ). Nivaquine/ CQ is indicated primarily for the prevention and treatment of malaria. It is also used in the symptoms of rheumatoid polyarthritis and of lupus. The use of this medication requires a prescription". (the rest of the statement reminds users of the hazards of over dosage with chloroquine, etc.)

Symptoms

The symptoms of chikungunya include fever which can reach 39 °C, a petechial or maculopapular rash usually involving the limbs and trunk, and arthralgia or arthritis affecting multiple joints which can be debilitating. There can also be headache, conjunctival injection and slight photophobia.

About the Disease

Chikungunya is a relatively rare form of viral fever caused by an alphavirus that is spread by mosquito bites from the Aedes aegypti mosquito. The name is derived from the Makonde word meaning "that which bends up" in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. The disease was first described by Marion Robinson[1] and W.H.R. Lumsden[2] in 1955, following an outbreak on the Makonde Plateau, along the border between Tanganyika and Mozambique, in 1952. Chikungunya is closely related to O'nyong'nyong virus[3].

Chikungunya is not considered to be fatal. However, in 2005-2006, 77 deaths have been associated with chikungunya on Réunion island.

1. Robinson Marion (1955). "An Epidemic of Virus Disease in Southern Province, Tanganyika Territory, in 1952-53; I. Clinical Features". Trans Royal Society Trop Med Hyg 49 (1): 28-32.

2.Lumsden WHR (1955). "An Epidemic of Virus Disease in Southern Province, Tanganyika Territory, in 1952-53; II. General Description and Epidemiology". Trans Royal Society Trop Med Hyg 49 (1): 33-57.

3. Vanlandingham DL, Hong C, Klingler K, Tsetsarkin K, McElroy KL, Powers AM, Lehane MJ,
Higgs S (2005). "Differential infectivities of o'nyong-nyong and chikungunya virus isolates in Anopheles gambiae and Aedes aegypti mosquitoes". Am J Trop Med Hyg 72 (5): 616-21. PubMed.

4. Enserink M (2006). "Massive outbreak draws fresh attention to little-known virus". Science 311 (5764): 1085.