Re-emergence of chikungunya infection in parts of India causes public health threat

Chikungunya virus, which can cause severe morbidity, has re-emerged in certain geographic regions of India. The rates of infection are highest in South India, moderate in the Western region, and uncommon in North India.

Keys to diagnosis:

  • Fever for up to 7 days
  • Rashes, joint pain and swelling, vomiting, and abdominal pain
  • Rates are higher during the monsoon season when there is high breeding of the Aedes mosquito that transmits the virus
Key Point: Chikungunya infection, which is re-emerging in India, is a concern especially in South India and moderately so in West India. Patients who present with a fever and other symptoms such as joint pain and swelling, rash, vomiting, and abdominal pain, should be tested for the virus. Patients should be counseled about prevention through mosquito control and protection, especially during the monsoon season.

In what appears to be the first multi-center epidemiologic study of chikungunya fever in 3 geographic regions of India (East India was not included), researchers studied a diverse age group of patients from June 2008 to May 2009. The virus was confirmed through genomic and serology-based assays.

No vaccine exists to protect against chikungunya infection, which can cause fever and joint pains as well as[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] chills, vomiting, nausea, headache, and rashes. It is estimated that at least 1.3 million people in India have been affected by chikungunya in 150 districts and 8 states, though the actual disease burden is likely much higher due to underreporting.

The study included 540 patients who had a fever for up to 7 days. A total of 25.37% of the patients were found to be infected with the chikungunya virus. Adults tested positive for the virus more frequently than children. The rates of infection in these febrile patients in the 3 geographic regions included in the study were:

  • South India: 49.36%
  • West India: 16.28%
  • North India: 0.56%.

Patients who had sustained a fever for longer periods were more likely to test positive for the virus (P<0.05). Rashes, joint pain and swelling, vomiting, and abdominal pain were commonly reported in patients with confirmed chikungunya infection (P<0.05). Patients with the virus were found to have anti-chikungunya antibodies for >60 days of onset of fever.

While chikungunya infections were found to occur throughout the year, rates were higher during the monsoon season when there is high breeding of the Aedes mosquito that transmits the virus. Infections were more prevalent in coastal areas than inland ones, with dryer summers and extreme winters decreasing the infection rates.

The authors wrote: “The present multi-centre study confirms and extends the findings of recent reports from India and other parts of [the] world indicating a re-emergence of severe chikungunya disease, which is becoming a major public health threat in India.”

Source: Ray P, Ratagiri VH, Kabra SK, et al. Chikungunya infection in India: results of a prospective hospital based multi-centric study. PLos ONE. 2012;7(2):e30025.

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