Wednesday, August 13, 2014

Health Care and Chikungunya

A new disease has recently cropped up in the US called Chikungunya. According to the Centers for Disease Control (CDC), this virus is transmitted to people by mosquitoes. The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Outbreaks have occurred in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans.

In late 2013, chikungunya virus was found for the first time in the Americas on islands in the Caribbean. There is a risk that the virus will be imported to new areas by infected travelers. There is no vaccine to prevent or medicine to treat chikungunya virus infection. More details from the CDC can be found at this site: http://www.cdc.gov/chikungunya/ .

According to the World Health Organization (WHO), Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae. The name ‘chikungunya’ derives from a word in the Kimakonde language, meaning "to become contorted" and describes the stooped appearance of sufferers with joint pain (arthralgia).

Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pain. Other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash. The joint pain is often very debilitating, but usually lasts for a few days or may be prolonged to weeks, according to WHO.

Most patients recover fully, but in some cases joint pain may persist for several months, or even years. Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints. Serious complications are not common, but in older people, the disease can contribute to the cause of death. Often symptoms in infected individuals are mild and the infection may go unrecognized, or be misdiagnosed in areas where dengue occurs. More details can be found at this website: http://www.who.int/mediacentre/factsheets/fs327/en/ .

According to ESPN, this rather painful disease is not particularly lethal, with a mortality rate of less than 1 percent and acquired immunity to it once infected. The disease does carry with it an increased risk of developing an arthritic condition, though.

The Americas chikungunya epidemic is continuing to spread, rising from seven cases in St. Martin in November to half a million cases throughout the region with most centered in the Caribbean, a major area for Major League Baseball player development. The Dominican Republic has been hit particularly hard, with an epidemic of over 300,000 cases since it appeared on the island in April. At the moment, one out of every 40 people in the country has been infected, and that number is still growing.
 

Things are not so worrying in the United States, where most people suffering from the disease contracted it while on vacation or on missions. At least four cases of localized infections have occurred in Florida, and mosquitoes have tested positive for the disease in Texas, but it is important to note that the range of the mosquito species that can transmit the disease here is limited.  

The primary driver, the yellow fever mosquito (Aedes aegypti), almost exclusively feeds on people at dawn and dusk and is found only in the most southern regions of states bordering the Gulf of Mexico. The secondary driver, the invasive tiger mosquito (Aedes albopictus), is found throughout the Southeast, Midwest and up along the Appalachians, dog-legging out to Long Island. This second species is a poor vector for chikungunya, however, even though it feeds throughout the day. This mosquito does not exclusively bite humans, according to ESPN.

Further inhibiting the spread in the United States is that diseases that are so reliant on person-to-person infection through mosquitoes tend to do poorly when a society uses air conditioning. A study on a dengue fever outbreak along the Texas-Mexico border showed that the air-conditioned Texas side had an infection rate one-seventh of that seen in Mexico.

The researchers concluded the primary difference between the two populations was simply the ability to close off a home from the outside world with air conditioning, preventing mosquitoes from spreading the disease as easily. More details can be located at this website: http://espn.go.com/blog/sweetspot/post/_/id/50537/how-chikungunya-may-impact-baseball .

According to CNN, however, usually about 25 to 28 infected travelers bring it to the United States each year. And, a new case recently reported in Florida represents the first time that mosquitoes themselves are thought to have transferred the disease within the continental United States. Those with weak immune systems, such as the elderly, are more likely to suffer from the virus' side effects than those who are healthier. About 60% to 90% of those infected will have symptoms.

The ecological makeup of the United States supports the spread of an illness such as this, especially in the tropical areas of Florida and other Southern states, according to the CDC.
The other concern is the type of mosquito that carries the illness. Unlike most mosquitoes that breed and prosper outside from dusk to dawn, the chikungunya virus is most often spread to people  by mosquitoes which are most active during the day, which makes it difficult to use the same chemical mosquito control measures.

These are the same mosquitoes that transmit the virus that causes dengue fever. The disease is transmitted from mosquito to human, human to mosquito and so forth. A female mosquito of this type lives three to four weeks and can bite someone every three to four days. Health experts recommend people remember the mosquito-control basics:

·         Use bug spray if you are going out, especially in tropical or wooded areas near water.
·         Get rid of standing water in empty plastic pools, flower pots, pet dishes and gutters to eliminate mosquito breeding grounds.
·         Wear long sleeves and pants.


According to the Florida Department of Health, An infected person will typically become ill three to seven days after the mosquito bite, but symptoms can begin anywhere from two to 12 days post-bite. These symptoms can last 3-10 days. Up to 28% of people who are infected will not have any symptoms (asymptomatic), although they can still be infectious to mosquitoes for a short time if bitten. Persons at greatest risk for severe illness include newborn infants, those over 65 years of age, and those who have other health conditions. Treatment is symptomatic or supportive. Symptoms may include the following:

·         Sudden high fever (usually >102ยบ F) which may be continuous or intermittent
·         Severe joint pain that commonly involves the hands and feet
·         Joint swelling
·         Back pain
·         Rash usually 2-5 days after fever starts

Other symptoms may include headache, body ache, nausea, vomiting, and redness around the eyes. In unusual cases, infection can involve the brain, eyes, heart, kidney and other organs.

Fatal infections are rare, however many patients have chronic joint pain, arthritis, loss of energy and depression lasting weeks to years. More details on chikungunya can be found at this website: http://www.floridahealth.gov/diseases-and-conditions/mosquito-borne-diseases/chikungunya.html .

Watching out for areas where mosquitoes breed is critical to avoiding this disease. Following standard procedures in those areas can help prevent acquiring chikungunya. Avoiding travel to certain hot spots is also advised. Since there is no cure, anyone infected should immediately seek medical attention, especially if they have any underlying health or immunity issues. Be careful when you may be exposed to mosquitoes, and learn to take common sense precautions.

Until next time.

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