DE FAAKTO OUTBREAK INTELLIGENCE
BACKGROUND-CONGO GOVERNMENT-DECLARED OUTBREAK OF CHIKUNGUNYA VIRUS DISEASE
The World Health Organization is Reporting,
- 9 February 2019, the government of Congo officially declared an outbreak of chikungunya virus disease
- The outbreak was detected following an increase in the number of patients presenting to several health facilities with signs and symptoms of sudden onset of fever, joint pain and muscle pain
- Samples taken during a joint investigation of the Ministry of Health (MoH) and WHO tested positive to chikungunya
- 6,149 suspected cases of chikungunya have been reported in the country
- 173 blood samples have been collected with 61 (35.3%) testing positive
- The scale of this outbreak has likely been underestimated given the limited detection capacity of the surveillance system in the country
- Several mosquito breeding sites in affected areas and inadequate vector control mechanisms also represent major contributing factors for the outbreak
- The Ministry of Health has reported that the outbreak has spread to eight of twelve health departments in the country
- No deaths have been reported
- This is the second outbreak reported in Congo since 2011 and no seasonal pattern has previously been observed
WHO Risk Assessment
- Based on available information, the risk of continued transmission and spread of chikungunya to unaffected areas cannot be ruled out
- The overall risk is considered moderate at both the national and regional levels
- Geographic spread of the vector and human cases is likely due to the high number of cases reported in several health departments
- The presence of Aedes vectors in many parts of the country, ubiquity of breeding sites in and around living areas and poor coordination of response activities including vector control is complicated by the ongoing rainy season
- Strengthened disease surveillance will help inform the implementation of appropriate public health actions to control the outbreak
What is Chikungunya?
• Chikungunya is a viral disease transmitted to humans by infected mosquitoes
What are the symptoms of Chikungunya?
• Severe joint pain- debilitating with various durations
• Muscle pain
• Rash (WHO, 2018)
Is the disease difficult to diagnose?
• Signs and symptoms are similar to Dengue & Zika, which makes it challenging to diagnose in some areas (WHO, 2018)
Where does the disease traditionally occur?
• Indian subcontinent
• A major outbreak occurred in 2015, affecting several countries of the Region of the Americas
• Chikungunya has been identified in over 60 countries (WHO, 2018)
Is there a cure for Chikungunya?
• There is no cure
• There is no specific antiviral drug treatment for chikungunya
• Treatment is supportive in nature with focus on symptom relief (WHO, 2018)
How are symptoms treated?
• Joint pain is treated using anti-pyretics, optimal analgesics and fluids (WHO, 2018)
What areas are at risk of Chikungunya?
• Human habitations close to mosquito breeding sites are at risk (WHO, 2018)
What are the long term effects of Chikungunya?
• Joint pain is debilitating, lasting for a few days but may be prolonged for weeks or months even years
• The virus can cause acute, subacute or chronic disease
• Majority of patients fully recover
• On occasion, cases of eye and gastrointestinal complaints, neurological and heart complications have been reported
• In older people, the disease may contribute to cause of death (WHO, 2018)
How is the virus transmitted?
• The virus is transmitted from human to human by the bites of infected female mosquitoes
• Most commonly, the mosquitoes involved are Aedes aegypti and Aedes albopictus, two species which can also transmit other mosquito-borne viruses, including dengue
• Aedes aegypti and Aedes albopictus bite throughout daylight hours early morning and late afternoon
• Both species are found biting outdoors, Aedes aegypti will feed indoors (WHO, 2018)
What is the onset time of illness?
• Onset of illness occurs between 4 and 8 days after bite, but can range from 2 to 12 days
How is Chikungunya Diagnosed?
• Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies
• IgM antibody levels are highest 3 to 5 weeks after the onset of illness and persist for about 2 months Samples collected during the first week after the onset of symptoms should be tested by both serological and virological methods (RT-PCR)
• Various reverse transcriptase–polymerase chain reaction (RT–PCR) methods are available but are of variable sensitivity (WHO, 2018)
Prevention of Chikungunya
• Reducing natural and artificial water-filled container habitats that support breeding of the mosquitoes
• During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae
• Clothing which minimizes skin exposure to the day-biting vectors is advised
• Repellents can be applied to exposed skin or to clothing
• Repellents should contain DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester) or icaridin (1-piperidinecarboxylic acid, 2-(2-hydroxyethyl)-1-methylpropylester)
• Insecticide-treated mosquito nets afford good protection
• Mosquito coils or other insecticide vaporizers may also reduce indoor biting (WHO, 2018)
Chikungunya-World Health Organization (2018) http://www.who.int/en/news-room/fact-sheets/detail/chikungunya
Chikungunya Virus-Center for Disease Control (2018) https://www.cdc.gov/chikungunya/symptoms/index.html
Disclaimer-De Faakto Intelligence Research is provided to first responders for situational awareness, advice, guidance and educational purposes. Intelligence is perishable and fluid. Intelligence is updated and reassessed as new information becomes available. Sources are evidence based and multiple sources are used when possible. Sometimes intelligence assessments present gaps in information, this is a reality in intelligence led operations and gaps are filled when information presents. Emergency first responders should always follow best industry practices, organizational policy-procedures and regulatory standards.