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(IJMSIR) P Age ISSN- O: 2458 - 868X, ISSN–P: 2458 – 8687 Index Copernicus Value: 68 . 16 PubMed - National Library of Medicine - ID: 101731606 International Journal of Medical Science and Innovative Research (IJMSIR) IJMSIR : A Medical Publication Hub Available Online at: www.ijmsir.com Volume – 5, Issue – 1, January - 2020, Page No. : 189 - 196 Distribution of Chikungunya Cases in Madurai District during Outbreak 1Dr. Vasanthapriyan Moongilpatti Ramasami, 2Dr.Sugumari Chandrasekaran, 3Dr.Selva Prabhu Antonyraj 1Assistant professor, Institute of Microbiology, Madurai Medical College, Madurai 2Associate professor, Institute of Microbiology, Madurai Medical College, Madurai 3Research Scientist, VRDL, Institute of Microbiology, Madurai Medical College, Madurai Corresponding Author: Dr. Vasanthapriyan Moongilpatti Ramasami, Assistant professor, Institute of Microbiology, Madurai Medical College, Madurai. Citation this Article: Dr. Vasanthapriyan Moongilpatti Ramasami, Dr.Sugumari Chandrasekaran, Dr.Selva Prabhu Antonyraj, “Distribution of Chikungunya Cases in Madurai District during Outbreak”, ijmsir- January - 2020, Vol – 5, Issue -1, P. No. 189 – 196. Type of Publication: Original Research Paper Conflicts of Interest: Nil Abstract were Negative. The major symptoms were fever Background: Chikungunya is an acute viral fever (100%), followed by joint pain(93.3%), which occurred as an epidemic form with the main headache(64%), myalgia (86.6%), and rash (29.3%) symptoms of joints pain for prolonged duration. It respectively. CHIKV IgM positivity was seen persists as major public health problem till date.This throughout the year, with a peak between September study was done to assess the magnitude of the and October. outbreak & to evaluate the epidemiological and Conclusion: This study emphasizes the need for virological features of Chikungunya infection in continuous surveillance for disease burden & to patients with acute febrile illness from several establish an effective syndromic surveillance system Primary health centres under Madurai HUD. for early detection and timely public health Methods: A retrospective observational study was intervention of future chikungunya outbreaks in conducted on the 75 blood samples received from resource-limited settings like VRDLs. This was high suspected cases of chikungunya fever from different in late monsoon and winter, suggests that it PHCs in Madurai are tested for IgM antibody against continues to be a major health problem in our setup (CHIKV) using ELISA as evidence of recent infection and indicates the need of appropriate strategies to in Viral Research Diagnostic Laboratory, Institute of reduce the severity of disease. Microbiology, Madurai Medical College from March to Introduction October, 2018. We diagnosed 13 epidemis of Chikungunya fever is an acute febrile illness caused by chikungunya during the study period. an arthropod borne alphavirus,Chikungunya virus 189 Results: Of the 75 cases tested, 51 cases (68 %) (CHIKV),which is transmitted by the bite of infected were positive for IgM antibodies; 19 cases (25.33%) Aedes mosquitoes. Chikungunya virus was first Page Corresponding Author: Dr. Vasanthapriyan Moongilpatti Ramasami, ijmsir, Volume – 5 Issue - 1, Page No. 189 - 196 Dr. Vasanthapriyan Moongilpatti Ramasami, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR) isolated in Tanzania by Ross and colleagues [48]. It is hours later by myalgia and generalized arthralgia and an arbovirus that belongs to the genus Alphavirus in arthritis, which are often incapacitating and debilitating, the Togaviridae family. The virus has a diameter of 60– the most significant feature of this disease. After a few 70 nm, a positive-sense, single-stranded RNA genome days, fever may abate and recrudesce, giving rise to a with 11,438 nucleotides and a phospholipid envelope “saddleback” fever curve. These are often associated with hemagglutinin protein spikes [16, 17] Two with chills, headache, malaise, vomiting, headache and different transmission cycles exist for the CHIKV, back pain. Most cases of chikungunya fever are self namely the sylvatic cycle seen mainly in Africa and the limiting and the symptoms usually resolve within 7 urban cycle that was initially seen in Asia but is also days (Mahendradas, 2009). now found in Africa.The disease presents with sudden Joint pain is mostly polyarticular, bilateral and onset of fever, joint pain, myalgia ,head ache, nausea, symmetrical. This polyarthropathy frequently involves fatigue & rash. Most cases of chikungunya fever are the peripheral joints of the hand, wrist, and ankles and self limiting and the symptoms usually resolve within 7 the larger joints such as the knee and shoulder. days, however joint pain may persist for several months Disabling acute tenosynovitis is also frequently present or even years in some patients. Emerging and and Periarticular swelling is frequently constantly evolving arthropod –borne viruses observed.Following initial infection, a rapid humoral (Arboviruses) represent a significant warning to human response occurs with huge production of neutralizing health worldwide. Chikungunya is endemic in parts of Anti Chickungunya antibody. The immunoglobulin M Africa, South East Asia and the Indian sub-continent. In (IgM) can be detected very early, usually from the third India, the disease was first reported and isolated in to fourth day after the onset of clinical symptoms and Calcutta in 1963 (Shah, et.al., 1964). Thereafter, antibody levels are highest 3 to 5 weeks after the onset Chikungunya Virus (CHIKV) infection reappeared in of illness (Litzba et al., 2008). Due to rapid late 2005 with large outbreaks being reported from the seroconversion, Immunoglobulin G (IgG) appears only States of Andhra Pradesh, Maharashtra, Orissa, after two or three days of appearance of IgM where IgG Karnataka, Tamil Nadu, Madhya Pradesh and Gujarat subclass 3 is the predominant. In addition, CHIKV (IMA 2006). infection is clinically similar to other arboviral CHIKV can damage collagen and alter connective infections such as dengue virus and Zika virus which tissue metabolism in cartilage and joints to produce makes the diagnosis of this disease quite challenging. severe acute arthritis. Several studies have reported The testing algorithm to diagnose CHIKV infections is persistent clinical manifestations mainly arthralgia for based on the characteristics of CHIKV infection and the several months after acute infection, suggesting the timing of specimen collection. Reverse Transcriptase possibility of chronic forms of CHIKV infection Polymerase Chain reaction (RT-PCR) act as the most (Ciampi de Andrade, et. al.,2010). sensitive method for the detection of CHIKV. Clinical disease manifestations emerge after an The CHIKV from the East/Central/South African incubation period that lasts an average of 4 to 12 days. (ECSA) genotype was the main causative agent for this 190 190 190 The first symptom is usually a high fever, followed re-emergence and Aedes albopictus was identified as 190 190 Page Page Page PagePage © 2020 IJMSIR, All Rights Reserved Dr. Vasanthapriyan Moongilpatti Ramasami, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR) the main vector in several regions. In India, the VRDLs receive samples from district public health National Vector Borne Disease Control Program authorities for laboratory confirmation of disease (NVBDCP) conducts surveillance for chikungunya in clusters (suspected outbreaks) to provide diagnosis sentinel hospitals while the Integrated Disease (Joshua, et. al., 2016). Demographic, clinical and Surveillance Program (IDSP) conducts surveillance for laboratory data from all patients are entered in a web- chikungunya as a part of surveillance for outbreak- based data entry system. As per the protocol, patients prone diseases. Both surveillance systems report the with AFI with joint swelling, rash, arthralgia& myalgia aggregate number of cases. During 2013–2018, the were investigated for chikungunya. Indian Council of Medical Research and the The sera samples were tested for immunoglobulin M Department of Health Research (DHR) established a (IgM) antibodies against CHIKV using IgM antibody network of 102 Virus Research and Diagnostic capture (MAC) enzyme-linked immunosorbent assay Laboratories (VRDLs) in 30 states/union territories of (ELISA) developed by the National Institute of India to strengthen laboratory capacity to provide Virology (NIV), Pune (Hundekar, et. al., 2002). timely diagnosis of disease outbreaks. Period of Study Recently Madurai District has confronted about 13 This study was carried out in 13 different fever outbreaks on Chikungunya in 2018 where severe outbreaks between March 2018 and October 2018. damages have been imposed on the social and Sample Size economic lives of people. Although several minor cases Totally 75 patient’s blood samples were received from have been reported in Madurai District previously in different areas of the Primary Health Care centres under the year of 2006, this was first time when the scale is so Madurai HUD from March 2018 to October 2018 immense where such a wide distribution (totally 13 outbreaks) were included in the study. As occurred.There is a lack of sufficient data to properly such, there are no exclusion criteria. understand the magnitude and assess the different Method for Detection of IgM Antibody against perspectives of this disease. Hence, this study aims to Chikungunya evaluate the epidemiological & vorological
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