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A public health challenge

Over the past decade, a number of vector-borne viral diseases have acquired renewed virulence in Asia. These include Japanese encephalitis and dengue fever. Others have also been found, but in restricted geographic areas. Chikungunya is one of them. Caused by a virus, it is spread to humans by mosquitoes. Patients typically develop inflammation of the joints besides fever, headache, and skin rashes. It is an acute infection that comes on suddenly. There is no specific treatment — or vaccine — available. The symptoms are generally self-limiting; and last up to 10 days. However, the pain in the joints can persist long after other symptoms disappear. The virus was relatively common in parts of Asia in the 1960s but virtually disappeared. In March 2005, chikungunya was notified in the Indian Ocean island of Reunion, where a third of the human population was affected. Since January 2006, several other countries of the southwest Indian Ocean have been hit by an outbreak of unprecedented magnitude. India is the latest victim. An outbreak of chikungunya, with sporadic cases of dengue, was reported in Andhra Pradesh between December 1, 2005 and February 17, 2006. In March, more than 2,000 cases were reported from Maharashtra. Since then, there has been something of a sweep-through in Andhra Pradesh and Karnataka. While the suspected cases in this phase in Karnataka numbered 2,36,840 in 23 out of 27 districts as on June 9, in Andhra Pradesh the aggregate was 27,607 in 16 out of 23 districts. More recently, 663 suspected cases were reported in Tuticorin district in Tamil Nadu.

Scientists have determined the genetic sequence of six virus samples isolated from patients. The results show that the outbreak began with a strain related to East African strains, which developed into variants. All of the Indian Ocean sequences share molecular features that differ from strains involved in earlier outbreaks, which suggests the disease could have become more "aggressive." Tests are on to find out which of these features might be responsible for the apparent increase in the virus's ability to infect humans. While no fatalities have been reported, the human cost of the debilitating disease is considerable; it hits livelihoods. India needs to wake up to the situation. Control of the vector through source reduction, public health education to encourage protective measures, reinforcement of epidemiological surveillance, and deployment of personnel to strengthen clinical management of cases are essential. In the age of globalisation and growing mobility, diseases and their carriers have extended their reach. The big question is how public health systems will respond.

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