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Questions and Answers
In which year was Chikungunya fever reported from Italy?
Which of the following countries reported Chikungunya fever outbreaks for the first time in December 2006?
What is the primary reason for developing guidelines on Clinical Management of Chikungunya Fever?
What is the consequence of high morbidity rates and prolonged polyarthritis due to Chikungunya fever?
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What is NOT available for the prevention of Chikungunya fever?
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Why is it essential to develop guidelines on Clinical Management of Chikungunya Fever?
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Which region has reported Chikungunya fever outbreaks from countries like India, Indonesia, Maldives, Myanmar, Sri Lanka, and Thailand?
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Why has Chikungunya fever not received sufficient coverage yet in the medical curricula of Member States?
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What is the recommended route for rehydration therapy?
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What is the purpose of collecting blood samples for serology?
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Which of the following is not a consideration for referral to a higher healthcare centre?
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What is the cut-off value for blood urea nitrogen in CURB-65 scoring system?
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What is the age cut-off for referral to a higher healthcare centre?
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What is the purpose of monitoring for adverse effects from NSAID use?
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What is the recommended management for cutaneous manifestations of Chikungunya fever?
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What is the duration of persistent fever that requires referral to a higher healthcare centre?
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What should be done if the peripheral smear is positive for malarial parasite?
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How should children be treated with Paracetamol?
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What should be suggested to a patient with fever, headache, and pain?
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What should be avoided during the acute stage of Chikungunya fever?
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What should be suggested to a patient with joint pain?
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Who should be referred to a higher healthcare centre?
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What should be done at the secondary level (district hospital)?
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What should be encouraged in patients with Chikungunya fever?
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What percentage of patients with Chikungunya fever complain of various neurological symptoms?
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What is the most common type of neuropathy associated with Chikungunya fever?
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What is the primary goal of physiotherapy in Chikungunya fever patients?
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What is the estimated percentage of patients with Chikungunya fever who experience persistent neurological manifestations?
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What type of exercises may be suggested to Chikungunya fever patients?
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What is the purpose of occupational assistance in Chikungunya fever patients?
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What is the estimated percentage of patients with Chikungunya fever who experience ocular involvement during the acute phase?
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What is the purpose of using anti-neuralgic drugs in Chikungunya fever patients?
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What is the primary method to minimize shady spaces for adult insects?
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What is the purpose of reporting to the nearest public health authority?
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What is the recommended method to minimize vector-patient contact at the household level?
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What is the recommended material for bed nets to prevent Chikungunya Fever?
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What is the purpose of having infants in the house sleep under bed nets?
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What is the recommended method to prevent adult insects from hiding and resting?
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What is the recommended location for insecticide sprays?
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What is the recommended method to prevent Chikungunya Fever from spreading?
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Study Notes
Chikungunya Fever
- Chikungunya is an emerging vector-borne disease of high public health significance in the WHO's South-East Asia Region.
- The disease has been reported from countries in South and East Africa, South Asia, South-East Asia, and Italy.
- Outbreaks have been reported from India, Indonesia, Maldives, Myanmar, Sri Lanka, and Thailand.
- Chikungunya fever is not a killer disease, but it has high morbidity rates and prolonged polyarthritis, leading to considerable disability and socioeconomic impact.
Clinical Management
- There is no specific treatment available, and no vaccine for prevention.
- Symptomatic treatment involves paracetamol (1g three to four times a day) for fever, headache, and pain, and antihistamines for itching.
- Tepid sponging can be suggested for fever reduction.
- If the case has already been treated with paracetamol/other analgesics, start an NSAID (as per standard recommendations).
- Monitor for adverse effects of NSAID use.
- Cutaneous manifestations can be managed with topical or systemic drugs.
Referral Criteria
- Refer immediately to a higher healthcare centre if the person has hemodynamic instability, oliguria, altered sensorium, or bleeding manifestations.
- Refer persons not responding or having persistent joint pain or disabling arthritis even after three days of symptomatic treatment.
- Refer persons above sixty years and infants (below one year of age) as well.
Physiotherapy and Rehabilitation
- Mild forms of exercise and physiotherapy are recommended in recovering persons.
- Patients may be encouraged to walk, use their hands for eating, writing, and regular isotonic exercises.
- Cold compresses may be suggested depending on the response.
- Exposure to warm environments (morning and evening sun) may be suggested as the acute phase subsides.
Laboratory Diagnosis
- Collect blood samples for serology (IgM – ELISA) or IgG (to be followed by a second sample after two to four weeks).
- Investigate the person for renal failure, hepatic insufficiency, cardiac illness, malaria, and thrombocytopenia.
Neurological Complications
- Approximately 40% of those with Chikungunya fever will complain of various neurological symptoms, but hardly 10% will have persistent manifestations.
- Peripheral neuropathy with a predominant sensory component is the most common (5-8%).
- Anti-neuralgic drugs (Amitryptyline, Carbamazepine, Gabapentin, and Pregnable) may be used in standard doses in disturbing neuropathies.
Vector Control
- Introduce larvivorous fish in aquaria, garden pools, etc.
- Cut weeds and tall grasses to minimize shady spaces where adult insects hide and rest.
- Drain all water stagnating after rains.
- Minimize the vector-patient contact by using bed-nets, full sleeves, and insecticide sprays.
Reporting
- Occurrence of the case in the community needs to be communicated immediately to the nearest public health official for identification of clusters by person, place, and time.
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Description
Understanding the clinical management of Chikungunya fever, a vector-borne disease of high public health significance in WHO's South-East Asia Region.
