Chikungunya cases are on the rise in Karachi. Don't let it catch you off guard!

Karachi is currently experiencing a significant surge in Chikungunya virus (CHIKV) infections, with cases steadily rising since May 2024. Chikungunya is a viral illness transmitted to humans by infected mosquitoes found in Africa and Asia, which are also responsible for spreading other viruses like Dengue and Zika. As the city grapples with this outbreak, public health officials at the Aga Khan University Hospital (AKUH) are urging citizens and authorities to prioritise prevention and timely intervention.

Symptoms and Diagnosis

Chikungunya presents with a sudden onset of fever, often accompanied by severe joint pain, joint swelling, muscle aches, headaches, fatigue, nausea, and rashes. These symptoms typically start 4-8 days after a mosquito bite but can range from 2-12 days. Due to the overlap of symptoms with other mosquito-borne illnesses like Dengue and Zika, misdiagnosis is common.

Chikungunya can cause rashes to appear within the first 2-3 days of the illness and last about 7-10 days. They are typically red and can be flat or appear as raised bumps. They usually appear on the face, trunk, and limbs, and can occasionally be itchy.

In most patients, the acute illness resolves within 1 week, but joint pain can persist for weeks or relapse in the months following the acute illness.

Complications of Chikungunya

While most patients recover fully and develop immunity against future infections, those at greater risk for severe complications include newborns, older adults, individuals with chronic heart disease, and people with poorly controlled diabetes. In these patients, Chikungunya infection can increase the risk of death.

In recent months, there have been reports of severe Chikungunya cases in Karachi, especially among elderly patients and patients with Diabetes Mellitus. Complications include neurological complications such as encephalitis (inflammation of the brain), paraplegia, or quadriparesis, leading to loss of limb function or coma, as well as heart and eye complications.

In such critical cases, patients often require intensive care, including advanced life support such as mechanical ventilation. The chances of recovery in these cases are unpredictable and may involve extended hospitalisation or even death.  

No Specific Treatment or Vaccine Available

Currently, there is no specific antiviral treatment or vaccine for Chikungunya. Supportive care is the only option, involving fever and pain management with medications like paracetamol or acetaminophen, adequate hydration, and rest. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are not recommended until Dengue is ruled out, due to the increased risk of bleeding. In severe cases, hospitalisation for intravenous (IV) fluids and intensive care may be necessary.

Prevention is Key

Given the lack of a vaccine or targeted treatment, prevention is the most effective strategy for controlling the spread of Chikungunya. The primary focus should be on avoiding mosquito bites and controlling mosquito populations. Individuals infected with Chikungunya should take precautions to avoid mosquito bites during the first week of illness to prevent further transmission to people around them.

Some key preventive measures include:

• Reducing mosquito breeding sites: Weekly empty out and clean containers that hold water and dispose of waste properly to eliminate standing water where mosquitoes breed.
• Using insecticides: During outbreaks, local authorities may spray insecticides to kill mosquitoes or treat water containers to prevent larvae from developing.
• Personal protection: Wearing long sleeves and pants, applying mosquito repellents containing DEET, IR3535, or icaridin, and using insecticide-treated nets are recommended, especially for individuals who sleep during the day, such as children, the elderly, and those who are ill.
• Screening homes: Installing window and door screens to keep mosquitoes out is also advised, along with using fans or air conditioning to reduce mosquito presence indoors.

Call to Action

As Karachi faces this Chikungunya outbreak, AKUH urges both public health authorities and the community to take immediate action in controlling mosquito populations and spreading awareness of preventive measures. The Hospital reiterates that prevention is the best way to avoid severe complications and fatalities associated with this virus.

Authors:

Dr Masooma Aqeel, MD

Dr Nosheen Nasir, FCPS

Department of Medicine, The Aga Khan University Hospital

https://hospitals.aku.edu/pakistan/AboutUs/News/Pages/chikungunya-cases-in-karachi.aspx