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EDITORIAL Table of Contents   
Year : 2009  |  Volume : 2  |  Issue : 1  |  Page : 1-3
Mystery behind emergence and re-emergence of Chikungunya virus


1 Department of Microbiology, Kamineni Institute of Medical Sciences, Narketpally, India
2 Department of Community Medicine, Kamineni Institute of Medical Sciences, Narketpally, India

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Date of Web Publication10-Jun-2010
 

   Abstract 

Chikungunya (CHIK) virus is a ribonucleic acid (RNA) virus with a single stranded, positive sequence RNA genome. It causes CHIK fever, a vector borne disease transmitted by mosquitoes belonging to the genus Aedes. The disease is characterized by abrupt onset of fever, chill, headache and severe joint pain. The incubation period of the virus ranges from one to12 days; the infection is always self-limiting and rarely fatal. CHIK virus originated from Africa and spread to Asia and other parts of the world. It has different genotypes and varied modes of transmission. The virus, with a history of emergence and re-emergence, is responsible for several epidemics and isolated outbreaks involving large populations in many parts of Africa and Asia as well as other regions of the world. The mystery behind the repeated re-emergence of CHIK virus is still unresolved. This is a major challenge for the medical fraternity.

Keywords: Emerging virus, epidemiology, diagnosis

How to cite this article:
Ramana K V, Prakash G K. Mystery behind emergence and re-emergence of Chikungunya virus. Ann Trop Med Public Health 2009;2:1-3

How to cite this URL:
Ramana K V, Prakash G K. Mystery behind emergence and re-emergence of Chikungunya virus. Ann Trop Med Public Health [serial online] 2009 [cited 2019 Dec 10];2:1-3. Available from: http://www.atmph.org/text.asp?2009/2/1/1/64261

   Introduction Top


Chikungunya (CHIK) virus belongs to the family Togovridae and genus Alpha virus. It is responsible for Chikungunya fever. Ever since the virus was first isolated, in 1953, following an outbreak in Makunde plateau bordering Tanganyika (Tanzania) and Mozambique it caused several epidemics involving numerous countries and more predominantly Africa and Asia. [1] CHIK virus is spread by the bite of mosquito Aedes aegypti. The name Chikungunya comes from Swahili, the literature of Makonde, meaning "that which bends up" referring to the contorted posture of patients afflicted with severe joint pains. [2] CHIK virus originated in Africa and spread to other regions including Asia. [3] Though the CHIK virus has originated in Africa, it exhibits different genotypes and different modes of transmission. [3] The complete nucleotide sequence of CHIK virus has been determined.


   Pathogenecity and Clinical Features Top


Infected mosquitoes belonging to the genus Aedes (In Africa the species are Ae furcifer, Ae taylori, Ae luteocephalus, Ae africanus and Ae neoafricanus and in Asia the Ae aegypti and Ae albopictus (Asian tiger mosquito are vectors) infect humans through bites. Other modes of transmission include the vertical transmission of the virus from mother to child. CHIK virus is maintained in a sylvatic cycle involving wild animals, and monkeys are considered possible reservoirs of the virus. [4]

CHIK fever has an abrupt onset with fever, chills, headache and severe joint pain. The incubation period ranges from one to 12 days. Infected patients suffer from severe arthralgia, characteristically migrating and predominantly involving small joints of hands, wrists, ankles and feet with lesser involvement of larger joints.[5],[6],[7] The disease is almost self-limiting and rarely fatal. [24] Other clinical features demonstrated by infected patents include chronic joint pains and generalized myalgias. [8] In some patients cutaneous manifestations may be found as a maculopapular rash on face and trunk; photophobia and conjunctival redness may be observed in others and a few patients develop pharyngitis. [24]

Infection can be severe in elderly, newborn and immunocompromised individuals leading to meningoencephalitis. [9],[10] As evidenced by the clinical features, CHIK virus infection has to be differentially diagnosed from dengue and other viral infections. [2],[11],[12]


   Epidemiology Top


In Africa where the CHIK virus has originated, Aedes mosquitoes belonging to subgenera Stegomyvia (Ae africanus, Ae luteocephalus, Ae opok) and subgenera Diceromyia (Ae furcifer, Ae taylori Ae cordellieri) are responsible to maintain the virus in primates like monkeys and baboons. Initially the human infection was said to have occurred in African villages which later spread to urban areas leading to epidemics in Africa. [2],[13],[14]

The mode of transmission in Asia is primarily human to human though monkey to human infections are also reported. Bangkok in Thailand is where the virus was first isolated in 1958. It continued to spread till 1964 and infected around two million individuals. Incidentally, the virus disappeared then only to reappear in 1988. Since then the virus has led to occasional outbreaks rather than the usual epidemics. Documented reports of outbreaks of the virus are also available from Cambodia, Vietnam, Burma, Sri Lanka, Philippines, and Indonesia including India. [15]

India had its first outbreak of CHIK virus in 1963, reported by Sarkar et al. in Kolkata. [16] The data on outbreak suggests that CHIK viral infection was predominant among young children, infants and adults over 40 years with young adults showing least incidence. In 1964, an epidemic involving Vellore, Chennai and Puduchery was reported in the months of July - October.[6],[17],[18] The next incidence of CHIK viral infection was from Barsi, Sholapur districts of Maharashtra in 1973. [19]

After a quiescence of 30 years, in December 2005, the virus re-emerged as an outbreak in Rayalaseema, Hyderabad and Nalgonda districts of Andhra Pradesh. Simultaneous reports of CHIK infection emerged from Malegaon, Nasik, Beed and latur districts of Maharashtra and Gulbarga, Bidar, Bellary, Raichur, Koppal and Chitrdurge districts of Karnataka. [20] CHIK virus was also spotted in Orissa between February to March 2006.[21] Serological studies conducted in Gujarat, Rajasthan, Madhya Pradesh, Kerala suggest the presence of CHIK viral infection. [20] The 2005 December outbreak in India continues with reports of outbreaks from Andhra Pradesh, Karnataka and Maharashtra. Data shows similar clinical findings, age, sex distribution and no mortality. Unlike in previous outbreaks, cases have been reported from urban and periurban areas where entomological surveys revealed presence of high Aedes indices. In a global scenario, CHIK virus was recently reported from French reunion islands. [22]


   Laboratory Diagnosis Top


Immunological methods

Virus specific antibodies or antigens can be demonstrated by ELISA, hemagglutination inhibition and neutralization tests. [23],[24]

Molecular methods

CHIK viral nucleic acid can be detected by polymerase chain reaction (RT-PCR, nested PCR, Taq man RT-PCR, SYBR green 1 RT-PCR), NASBA (Nucleic Acid Sequence Based Amplification), SDA (strand displacement amplification), SSR (self sustained sequence replication), RT-LAMP (real time reverse transcription loop mediated isothermal amplification assay). [25],[26],[27]

Culture

CHIK virus can be cultured in vitro in mosquito cell lines (C6/36) and mammalian cell lines. In vivo, the virus can be cultured by intracerebral inoculation of mice. [28]


   Discussion Top


There is no specific antiviral agent or vaccine against CHIK virus. Hence, prevention and control are the only methods to contain the virus infection. Active epidemiological and entomological surveillance should be carried out to identify the areas prone to infection and initiate appropriate control measures. Since the virus spreads only through Aedes mosquitoes, breeding sites must be eliminated like the open water tanks to be closed or sealed, preventing water clogging in old containers, etc.

Medical and health professionals should sensitize the community about the disease, mode of transmission, control measures and treatment availability. People should be encouraged to protect themselves from the bite of mosquitoes by using insect mosquito nets (ITN), recommend fogging with two per cent pyrethrum, use of insect repellant containing DEET (N,N, Diethyl m- toluamide), wear protective clothing etc.

The health department should encourage the participation of NGOs, community-based organizations, Medical Associations and NCC/NSS units in schools and colleges. Information on the disease must be widely disseminated in the form of mass media, news paper, TV or radio and in the form of posters, hoardings and pamphlets etc. Though the cause of emergence and re-emergence of CHIK virus is yet to be understood, studies conducted during the recent outbreaks show an increased severity of disease and genetic sequence of virus to multiply more early in mosquitoes. [10]

We should, therefore, understand that extensive research work should be carried out during and after the outbreaks to analyze the reason for repeated re-emergence of the virus. Studies to develop easy laboratory tests are required even in tertiary centers. Regional laboratories should be well equipped to diagnose CHIK virus infection during an outbreak. Molecular epidemiology of the CHIK viral infection along with active sero surveillance must be carried out.

 
   References Top

1.Robinson MC. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53 I: Clinical features. Trans R Soc Trop Med Hyg 1955;49:28-32.   Back to cited text no. 1      
2.Lumsden WH. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53 II: General description and epidemiology. Trans R Soc Trop Med Hyg 1955;49:33-57.   Back to cited text no. 2      
3.Powers AM, Brault AC, Tesh RB, Weaver SC. Re-emergence of Chikungunya and o′nyong - nyong viruses: Evidence for distinct geographical lineages and distant evolutionary relationships. J Gen Virol 2000;81:471-9.   Back to cited text no. 3      
4.Khan AH, Morita K, Parquet MC, Hasebe F, Mathenge EG, Igarashi A. Complete nucleotide sequence of chikungunya virus and evidence for an internal polyadenylation site. J Gen Virol 2002;83:3075-84.   Back to cited text no. 4      
5.Alphaviruses. In: Fields Virology Third Edition; Fields BN, Knipe DM, Howley PM, editors. Lippincott-Raven Publishers: Philadelphia; 1996. p. 858-98.   Back to cited text no. 5      
6.Thiruvengadam KV, Kalyanasundaram V, Rajgopal J. Clinical and pathological studies on chikungunya fever in Madras city. Indian J Med Res 1965;5:729-44.   Back to cited text no. 6      
7.Aikat BK, Konar NR, Banerjee G. Haemorrhagic fever in Calcutta area. Indian J Med Res 1964;52:660-75.   Back to cited text no. 7      
8.Brighton SW. Chloroquine phosphate treatment of chronic Chikungunya arthritis: An open pilot study. S Afr Med J 1984;66:217-8.  Back to cited text no. 8      
9.Chatterjee SN, Chakravarti SK, Mitra AC, Sarkar JK. Virological investigation of cases with neurological complications during the outbreak of haemorrhagic fever in Calcutta. J Indian Med Assoc 1965;45:314-6.   Back to cited text no. 9      
10.Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, Vaney MC, et al. Genome microevolution of Chikungunya viruses causing the Indian Ocean outbreak. Plos Medicine. Available from: http://www.plosmedicine.org . [Last accessed on 2006 Mar 1-13].   Back to cited text no. 10      
11.Vanlandingham DL, Hong C, Klingler K, Tsetsarkin K, McElroy Kl, Powers AM, et al. Differential infectivities of onyong-nyong and chikungunya virus isolates in Anopheles gambiae and Aedes Aegypti mosquitoes. Am J Trop Med Hyg 2005;72:616-21.  Back to cited text no. 11      
12.Chikungunya fever, CD Alert, Monthly Newsletter. National Institute of Communicable Diseases 2006;10:1-8.   Back to cited text no. 12      
13.Moore DL, Reddy S, Akinkugbe FM, Lee VH, David-West TS, Causey OR, et al. An epidemic of chikungunya fever at Ibadan, Nigera 1969. Ann Trop Med Parasitol 1974;68:59-68.   Back to cited text no. 13      
14.Moore DL, Causey OR, Carey DE, Reddy S, Cooke AR, Akinkugbe FM, et al. Arthropod borne viral infections of man in Nigeria, 1964 - 1970. Ann Trop Med Parasitol 1975;69:49-64.   Back to cited text no. 14      
15.Centers for Disease Control. Chikungunya fever among US Peace Corps Volunteers - Republic of the Philippines. MMWR Morb Mortal Wkly Rep 1986;35:573-4.   Back to cited text no. 15      
16.Sarkar JK, Pavri KM, Chatterjee SN, Chakravarty SK, Anderson CR. Virological and serological studies of cases of haemorrhagic fever in Calcutta: Material collected from Calcutta School of Tropical Medicine. Indian J Med Res 1964;52:684-91.   Back to cited text no. 16      
17.Carey DE, Meyers RM, DeRanitz CM, Jadhav M. The 1964 Chikungunya epidemic at Vellore, South India, including observations on concurrent dengue. Trans R Soc Trop Med Hyg 1969;63:434-45.   Back to cited text no. 17      
18.Myers RM, Cary DE, Reuben R, Jesudass ES, Ranitz CD, Jadhav M. The 1964 epidemic of dengue-like fever in South India: Isolation of Chikungunya virus from human sera and from mosquitoes. Indian J Med Res 1965;53:694-701.   Back to cited text no. 18      
19.Chikungunya fever, CD Alert, Monthly Newsletter. National Institute of Communicable Diseases 2006;10:1-8.   Back to cited text no. 19      
20.Chhabra M, Mittal V, Bhattacharya D, Rana U, Lal S. Chikungunya fever: A re-emerging viral infection. Indian J Med Microbiol 2008;26:5-12.  Back to cited text no. 20  [PUBMED]  Medknow Journal  
21.Chikungunya and Dengue in the south west Indian Ocean. Epidemic and Pandemic Alert and Response (EPR). http://www.who.int/csr/don/2006.   Back to cited text no. 21      
22.Quatresous I. The Investigation Group, E-alert 27 January: Chikungunya outbreak in Rιunion, a French ′overseas dιpartement′. Euro Surveill 2006;11:E060202.1. Available from:http://www. eurosurveillance. org/ew/2006/060202.asp  Back to cited text no. 22      
23.Alphaviruses. In: Fields Virology Third Edition; Fields BN, Knipe DM, Howley PM, editors. Lippincott-Raven Publishers: Philadelphia; 1996. p. 858-98.   Back to cited text no. 23      
24.Carey DE, Meyers RM, DeRanitz CM, Jadhav M. The 1964 Chikungunya epidemic at Vellore, South India, including observations on concurrent dengue. Trans R Soc Trop Med Hyg 1969;63:434-45.   Back to cited text no. 24      
25.Pfeffer M, Linssen B, Parke MD, Kinney RM. Specific detection of chikungunya virus using a RT-PCR/nested PCR combination. J Vet Med B Infect Dis Vet Public Health 2002;49:49-54.   Back to cited text no. 25      
26.Pastorino B, Bessaud M, Grandadam M, Murri S, Tolou HJ, Peyrefitte CN. Development of a TaqMan RT-PCR assay without RNA extraction step for the detection and quantification of African Chikungunya viruses. J Virol Methods 2005;124:65-71.   Back to cited text no. 26      
27.Parida MM, Santhosh SR, Dash PK, Tripathi NK, Saxena P, Ambuj S. Development and evaluation of reverse transcription-loop-mediated isothermal amplification assay for rapid and real-time detection of Japanese encephalitis virus. J Clin Microbiol 2006;44:4172-8 .  Back to cited text no. 27      
28.Shah KV, Gibbs CJ Jr, Banerjee G. Virological investigation of the epidemic of haemorrhagic fever in Calcutta: isolation of three strains of Chikungunya virus. Indian J Med Res 1964;52:676-83.  Back to cited text no. 28      

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Correspondence Address:
K V Ramana
Department of Microbiology, Kamineni Institute of Medical Sciences, Narketpally
India
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