ISSN: 1391 - 0531
Sunday, January 14, 2007
Vol. 41 - No 33

A nation felled by chikungunya

By Kumudini Hettiarachchi

Nimal was perfectly normal, getting about his work, both official and domestic. One night, as he was driving back home, shivers and rigors wracked his body.

Back at home, teeth chattering, he was hardly able to climb into bed, for his bones felt as if he had been put on the rack and each and every limb pulled and strained.

Nimal was another, like the hundreds and thousands across Sri Lanka, who have been felled by chikungunya.

“Chikungunya cases are being reported from almost all districts,” confirmed Deputy Epidemiologist Dr. Paba Palihawadana, however, explaining that it was very difficult to give the exact numbers because the Epidemiology Unit gets only the official figures under the ‘notified categories’.

Even at state hospitals, chikungunya would fall under the “viral fever” category and many people are also seeking treatment from private doctors and hospitals, she said. “We have sent a special investigation form to state hospitals to try and collate statistics.”

With regard to how chikungunya has affected not only households but also whole streets and communities, she says only a tiny mosquito-bite is needed to spread the disease.

“Sri Lanka had had an outbreak in 1965 and by now we have lost our immunity. So it’s like a virgin population that is falling victim. The other factor is that many people are travelling abroad even to places like Madagascar for gem mining, and so it is easy to pick up the infection,” she says.

It first hit Mannar and then there was an outbreak in Kalmunai. When the Epid Unit checked, it was found that a bus plies between Mannar and Kalmunai, so obviously not only would it have carried passengers but also a few mosquitoes, she says.

Stressing that in the early stages it is very difficult to differentiate between chikungunya and dengue, Dr. Palihawadana said the Epid Unit became alert when in October 2006, a doctor reported “unusual” fever cases, people who took a long time to recover and also came repeatedly for treatment. The symptoms included fever, a red rash and joint pains and aches.

The Epid Unit immediately instructed its Regional Epidemiologists to collect blood samples for testing and as reports came negative for dengue, rubella and measles, the suspicion fell on chikungunya.

Incidentally, chikungunya comes from Makonde, the language of the ethnic group Makonde in southeastern Tanzania and northern Mozambique and refers to “that which bends up”, the crippling nature of the illness.

With chikungunya being identified as the likely cause, samples were sent out for verification, as Sri Lanka did not have the facilities for testing. “Now, however, we have testing facilities at state institutions like the Medical Research Institute and Ragama Hospital and private places like Genetech,” she says, explaining that most doctors go by clinical examination yet.

The most common complaint being joint pains, Dr. Palihawadana says they could last from a few days to a few weeks or rarely even a year. “The joint pains are very bad as soon as you wake up. That’s why most people double up in pain. In adults the pains are severe and the limbs that are used more often get affected the worst,” she says citing the example of a bartender who keeps opening bottles whose finger-joints ached the most.

Some of the other symptoms may include headache, photophobia (aversion to light), fatigue, nausea and vomiting, The Sunday Times understands.

Explaining that there is no vaccine or specific treatment for chikungunya, Dr. Palihawadana advises patients to rest, take lots of fluids and paracetamol six-hourly to relieve fever and joint-pain.

If the fever persists, see a doctor because more dangerous dengue masquerades as chikungunya, she warns.

What is chikungunya?
It is a viral fever transmitted to humans by the bite of infected mosquitoes. The virus, CHIKV, a member of the genus Alphavirus, in the family, Togaviridae, was first isolated from the blood of a febrile patient in Tanzania in 1953.
How do humans get infected?

The virus is spread by Aedes aegypti (the dengue fever vector) and Aedes albopictus (Asian Tiger) mosquitoes. These mosquitoes are household container (vases, yoghurt cups, coconut shells, discarded tyres, blocked gutters etc) breeders and aggressive day-time biters (between around 6 a.m. and 10 a.m. and 4 p.m. and 6 p.m.). Various forest-dwelling mosquito species in Africa have also been found to be infected with the virus.

The mosquitoes become infected when they feed on a person infected with the virus. Infected mosquitoes can then spread the virus to other humans when they bite. The mosquito can fly in a range of 2 km.

What is the incubation period?
The incubation period (time from infection to illness) can be 2-12 days, but is usually 3-7 days.
Who is the host?
Monkeys and baboons are the principal vertebrate hosts in the viral transmission cycle. It is likely that other wild animals may also serve as the reservoirs of the virus. The human is an accidental host.
How to prevent chikungunya?

The best way to avoid the infection is to prevent mosquito-bites by wearing protective clothing.

  • Use mosquito nets whenever possible.
  • Get rid of mosquito breeding sites – discarded tyres, plastic containers, leaf axils, coconut shells, blocked gutters, bird baths and flower pots etc. -- where water can collect after rain.
  • A person with chikungunya should limit his/her exposure to mosquito bites by staying indoors or under a mosquito net to prevent the infection spreading.


Tackling the menace

By Dhananjani Silva

As chikungunya keeps spreading, with no signs of abating, The Sunday Times contacted many local bodies to find out their response to this mosquito-borne disease.

“We started fumigating all the areas within Jaffna town where chikungunya is suspected and the situation is now under control,” said Dr. M. Mariyadasan, Medical Officer of Health of the Jaffna Municipal Council, explaining that earlier they had about 102 notifications a day from the hospital which later reduced to 20.

In the last few days it has only been about 10-15 notifications. “Health education programmes too were carried out by PHIs, Health Wardens and Family Health Assistants,” the MOH said.

In the Trincomalee Urban Council area, clean-up programmes have limited the spread of the virus, said MOH Dr. R. Sathees Kumar, however adding that 30 dengue cases have been reported from the area.

Unless there is public cooperation, it is difficult for the authorities to combat the situation alone in all mosquito-borne infections, he stressed.

“We launched a 15-day programme from January 6 to clean the gutters and clear all sand and garbage. We distributed disposal bags to the public so that they can collect plastic containers, tins, polythene bags and hand them over to us on a specified day,” he said.

A Dehiwala-Mount Lavinia Municipal Council official said they raised public awareness, paying special attention to schoolchildren.

“People expect us to carry out fumigation all the time, but this has its bad effects. Therefore, we fumigate areas where the disease is at its peak. We advised people to clean up their home gardens, by allocating at least half-an-hour per week for this,” he said.

Colombo Municipal Council’s Chief Medical Officer Dr. Pradeep Kariyawasam said awareness campaigns were launched at the initial stages of the spreading of the fever.

There was special focus on areas where there are slums and shanties, such as those near the garbage dump at Bloemendhal while clearing the land. Spraying the canals and marshy lands was carried out immediately as part of the mosquito-control programme, with these activities done almost daily, he said.

Housing complexes such as Elvitigala, Gunasinghepura, Bambalapitiya and Maligawatte were sprayed and fogged while other housing complexes too will be attended to in the future, he added.

“That is all what we can do as a department but there are lot of other neglected lands belonging to the Railways and Ports Authority.

“It is their responsibility to ensure that there are no mosquito-breeding sites such as blocked drains etc on those. Where neglected lands are concerned, we have issued notices and legal action will be taken within two weeks,” he added.

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Copyright 2007 Wijeya Newspapers Ltd.Colombo. Sri Lanka.