From the Scriptures

Bless the Lord O my soul; 
And all that is within me bless His Holy Name.
Bless the Lord, O my soul
And forget not all his benefits.

Psalms 103.1-2

Chikungunya is a viral disease caused by an arbovirus (arthropod borne virus) known as the Chikungunyavirus. It is transmitted by the bite of the Aedes aegypti mosquito which incidentally is the vector of Dengue Fever as well. The disease was first identified in 1955 by Marion Robinson and W.H.R. Lumsden in the Makonde Plateau, which lies between Tanganyika and Mozambique in Africa. The word “Chikunguya” comes not from the Swahili language as reported in a popular newspaper recently but from the Makonde word kungunyala which means “that which bends up”.  It must be mentioned here that the disease is not caused by chicken as some lay people believe.

Symptoms of Chikungunya Fever

The illness begins 2 to 3 days after the bite of an infected Aedes mosquito.

Like in all viral fevers, there is a sudden onset of high fever and severe body pain. The characteristic feature of the disease is the severe pain with or without swelling of multiple joints. The pain may be so severe that it causes the patient to bend up (hence the name). There may also be reddish rashes over the trunk and limbs caused by bleeding from minute blood vessels of the skin.

Other symptoms include headache, nausea, vomiting, sore-throat and low back-pain. The illness resembles Dengue and indeed may co-exist with it but unlike in Dengue the incidence of shock and bleeding manifestations is absent or extremely rare.

The entire illness lasts for 3 to 10 days. However, in some patients the joint pains may persist for weeks or even months.

Complications

The disease is usually self limiting.

Death due to the disease is extremely rare though a few deaths have been reported both from our country and Reunion Island of the Indian Ocean in recent times. Shock, bleeding and encephalitis have been the causes of death among those who died.

The commonest complication is the persistence of joint pains which has been reported to occur in as many as 12 % of all patients.

Young children under 5 years of age may develop convulsions because of the high fever.

Treatment

Treatment is purely supportive and symptomatic.

These include bed-rest, adequate fluid intake and a nourishing diet.

Analgesics and antipyretics like Paracetamol are necessary for controlling fever and pain. Drugs like Ibuprofen may be needed for the relief of joint pains.

Aspirin should be avoided since this may cause bleeding manifestations.

Antibiotics are of no use since it is a viral disease.

Chloroquine (an antimalarial drug) has been used in treating prolonged joint pains, but this is not recommended for routine use in the acute stage of the disease.

Prevention.

Mosquito control measures are the only effective ways of controlling Chikunguya since vaccine is not available.

The Aedes mosquito is a day time biter and prefers clean water collections for breeding. Hence one should prevent water stagnation around the house. This includes water in water-coolers, potted plants, sumps and uncovered water-tanks.

Mosquito repellants are also useful.

History of the Disease in India

Chikungya is not new to India.  The first case was reported from Calcutta in 1963 and since then several outbreaks of the disease have occurred in the country. Numerous reports about the disease have been published from Christian Medical College, Vellore in the 1960s. However the disease apparently died out in 1971.

The present epidemic started in December 2005 and has involved the states of Maharashtra, Karnataka, Andhra Pradesh and Orissa. About 180,000 cases have been reported so far.

Experts are not too sure about the cause for the re-emergence of the disease and in the absence of any specific treatment or vaccine, mosquito control measures seem to be the only way to control this disease.