Review of

Control Efforts for

Chikungunya

in New Delhi

Presenter: Dr Des K. Raj

Moderator: Dr Dinesh Kumar

Dated: 21st October 2016

Introduction

• RNA virus Disease: Alpha virus, an arbovirus of

Togaviridae family

• Transmitted from human to human

• Vector : Aedes aegypti and A. albopictus

• Causes: High grade fever, petechial/ maculopapular

rash, severe joint and muscle pain and headache

• High morbidity but minimal mortality

• Usually provides lifelong immunity, self limiting

• Endemic in Africa, Asia

Epidemiology: Global

• First outbreak reported in Makonde Plateau

in 1952

• Bangkok(1960s),Sri Lanka(1969),Vietnam and

Myanmar(1975), Indonesia( 1982)

• India: Calcutta(1963), Madras(1964),

Maharashtra(1973)

Definition of an outbreak

• Rural area

– If no. of fever cases is 5 or more in a village during a

period of 7 days

• Urban area

– 5 or more in a locality with a population of 10,000 to

15,000 during 7 days

Current epidemic: India

• 2015: 99913 cases with 220 deaths (2.2%)

• 2016: 27879 cases with 60 deaths (2.1%)

• Spurt due to cyclical trend, may be at peak of

7-8 year cycle

• May cause encephalitis

Epidemic: New Delhi

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North Delhi South Delhi East Delhi

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Re-emergence

• Susceptible population

• Viral mutation

• Increased air travel, tourism

• Cyclical peak

• Population explosion

• Global warming

• Unplanned urbanisation

• Inadequate sanitation

Reporting of an outbreak

• NVBDCP: Community based fever surveillance

• IDSP: Community based reporting

• New Delhi:– Hospital based

– Media reporting

– Community based surveillance and reporting as a passive effort

Vector : Aedes mosquito

• A. aegypti, A. albopictus, A. africanus, A.furcifur-taylori, A. luteocephalus

• Climate tropical: 27*c

• Life span of adult mosquito: 15 days

• Habitat: Indoor-living rooms, offices, business places, in isolated containers

• Flying capacity: 100 meters

• Bite: Only the female mosquito bites– Powerful bites / fearless bites/ day time

– Bites 3 to 4 times for a satisfactory meal

Breeding habits

Artificial accumulation of water in:

• Discarded tins• Fire brackets• Flower pots• Coconut shells• Earthen pots• Tree holes• Rubber containers• Broken bottles• Plastic containers

Symptoms

• Fever upto 104

• Petechial/maculopapular rash

• Arthropathy

• Headache

• conjuctival infection

• Mild photophobia, iridocyclitis, retinal lesions

• Poedal oedema unrelated to cardio-hepato-renal abnormalities

Case Definition

Suspected case

An acute illness characterized by sudden onset of fever with: myalgia, headache, backache, photophobia, arthralgia, rash

Probable case

As above and Occurrence at same location and time as other serologicaly confirmed cases of chikungunya

Confirmed case

A probable case with any of the following:

o Four fold IgG antibody difference in paired serum samples

o Detection of IgM antibodies

o Virus isolation from serum

o Detection of Chikungunya virus nucleic acid in sera by RT-PCR

A. Management

• Early Case reporting

Fever alert surveillance: • all fever cases to be reported

• Fever clinic in 262 dispensories, 106 mohalla clinics and

26 Delhi Government hospitals

Sentinel Surveillance sites with laboratory support :

• 33 sentinel surveillance sites using CHIKV specific IgM

ELISA test kits for diagnosis and RT-PCR and line listing

of cases

• NIV Pune is Apex laboratory

Strengthening of referral services:

• AIIMS and NCDC as Apex referral centers

• All hospital to remain open till 30 October

• Free diagnosis and treatment

Involvement of Private sector in sentinel surveillance:

private hospital and nursing homes permitted to increase bed

capacity

All institutes to send report to Government

• Case management : Guidelines issued

• Bed strength increased: 10% beds for fever cases and

1000 additional beds

Epidemic preparedness and rapid response: 12 RRT

constituted

B. Integrated vector management

• Entomological Surveillance including larval surveys:

Zonal entomological teams

3500 domestic breeding checkers, checks 60-70 houses/day

• Anti-larval measures

– Biolarvicide power sprays

– fish in 120 water bodies

B. Integrated vector management

• Anti- adult measures

– Indoor Space Spraying with Pyrethrum extract (2%)

– Fogging during outbreaks: once in 10 days for 2 hours

twice a day, since August

– Personal protection measures

– Protective clothing

– Insecticide treated bed nets and repellents: in July

C. Supporting Interventions

• Human Resource Development through capacity building

• Behaviour Change Communication (BCC)

• Activities during anti dengue/ Chikungunya months

• Inter-sectoral coordination

• Supervision and Monitoring

• Coordination Committees

• Legislative support: Challans of civic bodies for having mosquito breeding places: MTNL office, Hindu Rao Hospital, Delhi Jal Board

Thank you