Chikungunya : A viral disease transmitted by Infected Mosquito bite

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Chikungunya

Introduction:

Chikungunya is a mosquito-borne viral disease and patient presented with fever and severe joint pain. It is a viral diseases caused by ribonucleic acid (RNA) virus. The transmission to humans is due to the bites of infected female mosquitoes are Aedes aegypti and Aedes albopictus. They are also responsible for transmission of other mosquito-borne diseases from viruses like dengue and Zika. The mosquito bite during daylight, especially during early morning and late afternoon.

The first case of mosquito-transmitted chikungunya reported in Americas in 2013, after that various large outbreaks reported in most of the countries in the region. This disease is now reported worldwide in 118 countries in Asia, Africa, Europe and the Americas. 

Symptoms

The symptoms starts appearing form 4 to 8 days after patient had infected mosquito bite. This diseases is rarely fatal. Most of the symptoms are self-limiting and last for 2to 3 days. It is characterized by onset of fever and joint pain, muscle pain, headache, nausea, fatigue and rash. The joint pain is the characteristic feature and lasts from few days to few weeks sometimes a month. 

The patients mostly fully recovered from the diseases. The rarely reported complications reported are eye, heart and neurological manifestations. The elderly patients are at higher risk of severe disease. The newborns and older people with underlying medical conditions are at risk of diseases infection and death. The symptoms usually in infected individuals are mild and may go unrecognized, misdiagnosed in areas where dengue and arboviruses are common.

Treatment

There is no specific antiviral drug treatment for chikungunya. It is directed towards reducing fever and relieving joint pain through anti-pyretic drugs to reduce fever, use of pain medication for joint pain and by administering fluids to maintain hydration. It is recommended that Aspirin and other non-steroidal anti-inflammatory drugs should not be administered until dengue is ruled out to reduce the risk of bleeding. 

Prevention

Prevention and control depends upon reducing the number of water-filled habitats that allow mosquitoes to breed. During outbreaks, insecticides should be sprayed to kill flying mosquitoes; applied to surfaces in and around water-filled habitats where the mosquitoes resides; used to treat the habitats to kill the immature larvae. There is one vaccine approved in the United States of America and in Europe for use in travelers and laboratory workers; however, the vaccine is not widely available for public health use in endemic or outbreak settings. For protection in areas of chikungunya transmission, people with risk of exposure to infected mosquitoes are advised to wear clothing which minimizes skin exposure to day-biting mosquitoes. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions.

For those who sleep during the daytime, particularly young children or sick or older people, insecticide-treated mosquito nets afford good protection. Mosquito coils or other insecticide vaporizers may also reduce indoor biting

Chikungunya vaccine for travelers and laboratory workers

 

A live attenuated chikungunya vaccine (manufactured by Valneva as IXCHIQ) is currently licensed in the United States. This vaccine was approved by the Food and Drug Administration (FDA) in November 2023. The U.S. Advisory Committee on Immunization Practices (ACIP) approved recommendations for use of the vaccine in travelers and laboratory workers in February 2024.

Vaccine administration, contraindications, and precautions

IXCHIQ is licensed for use in adults aged 18 years and older. It is administered intramuscularly as a single 0.5mL dose. There are currently no recommendations for a booster dose of vaccine.

To minimize the risk of serious adverse events, healthcare providers should carefully observe the contraindications and consider the precautions about vaccination prior to vaccine administration.

Contraindications

  • Immunocompromising condition (due to immunodeficiency or immunosuppressive and immunomodulatory therapies)
  • History of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine.

Precautions

  • Pregnancy
    • Pregnant persons should avoid the risk for chikungunya virus infection, if possible.
    • In general, vaccination should be deferred until after delivery. However, when the risk of infection is high and exposure cannot be avoided, a health care provider should discuss with a pregnant person the potential risks of chikungunya virus infection and the potential benefits and risks of vaccination so that vaccination can be considered.
    • If pregnant persons choose to be vaccinated, out of caution vaccination should generally be avoided during the 1st trimester (until 14 weeks gestation) and after the 36th week of gestation.
  • Breastfeeding
    • Breastfeeding persons and their infants should avoid the risk for chikungunya virus infection, if possible.

    • In the absence of data, breastfeeding is a precaution for vaccination. However, when the risk of infection is high (e.g., during an outbreak) and exposure cannot be avoided, a health care provider should discuss with a breastfeeding person the health benefits of breastfeeding for the infant, the risks of chikungunya virus infection, and the potential benefits and risks of vaccination, and offer the vaccine to the breastfeeding person.

Vaccine immunogenicity and side effects

Clinical trial results indicated that vaccination resulted in sero-response rates ≥96% through at least 6 months after vaccination. Data are being gathered on responses over the longer term.

Common adverse reactions following vaccination that occurred in >10% of vaccinated persons in clinical trials included tenderness, headache, fatigue, myalgia, arthralgia, fever, and nausea. IXCHIQ also caused severe or prolonged chikungunya-like adverse reactions in some persons.

Considerations for chikungunya vaccine for travelers

All travelers to countries or territories with risk of chikungunya virus transmission should take steps to avoid mosquito bite. The risk for chikungunya for most U.S. travelers is low. However, some travelers are at increased risk for infection or more severe disease. Factors to assess when considering use of chikungunya vaccine include the likelihood of exposure to chikungunya virus, a traveler's risk factors for severe disease outcomes, and traveler preferences.

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