From: Press Trust of India (PTI) – Pallava’s Sunday column
Dated: Sept 18, 2016
Titled: No new mutant strain seen of Chikungunya in Delhi outbreak: AIIMS Director
By: Pallava Bagla
NEW DELHI: Large number of people are being afflicted by chikungunya, a debilitating viral disease, in the national capital region and some deaths are also being attributed to chikungunya. Till date, over 9000 cases have been reported from Karnataka while officially Delhi is reporting only 1724 cases, yet in Delhi there is a lot panic due to this viral disease. MC Misra, Director, All India Institute of Medical Sciences, dispels some of the notions held around the chikungunya upsurge in north India. He spoke to science writer Pallava Bagla.
Q: Is there a need to panic because of chikungunya and is it fatal? Why are people dying in Delhi?
A: It is an upsurge and not an epidemic of chikungunya in Delhi. There is no cause for panic due to chikungunya. It is a milder virus, there is no mutation, and the deaths that have been reported might not be only because of chikungunya.
It might be more related to other illnesses. Do not panic and think that everybody who gets chikungunya is going to die. One has seen chikungunya in south India for years and there has never been any panic.
Q) Is it a more virulent strain that is floating around in Delhi?
A: I would say there is no reason for panic because of chikungunya. I will say chikungunya is an even milder virus than dengue. It does not lead to the same phenomenon as dengue shock syndrome since such a thing does not happen with chikungunya. It is self-limiting disease.
The only other aspect of chikungunya is that it gives high fever when it begins which remains for 3-5 days and joint pain. I think joint pain is much more bothersome because of chikungunya and it would rarely kill if at all.
We cannot even blame chikungunya for the deaths as it there might be some associated medical illnesses in some people who are elderly, very young or immune suppressed which might lead to more virulence of the virus which generally happens in immune compromised people.
We used to hear about chikungunya affecting population in Kerala and Karnataka and we used to think that it happens only in that region. Only difference it has made is that this year we are seeing an upsurge of chikungunya instead of dengue. The tests that have been done so far and that have come out positive for chikungunya outnumber dengue.
Sixty per cent of the tested samples are positive for chikungunya; 2-3 per cent for dengue and rest are non-dengue, non-chikungunya. At times even these non-dengue, non- chikungunya virus can become extremely serious.
People have to understand that this is the season when it comes, post-monsoon there is an upsurge and then as the temperature cools down it goes away because the mosquito does not survive then.
Q: So how does a lay person tackle a chikungunya infection?
A: I would basically say follow a 3-H recipe. Home care, hydration and hydrotherapy. Meaning take rest at home, maintain nutrition and hydration and lastly hydro-therapy. It is not that one is putting some wet handkerchief on the forehead or on palms. It is best to cover the patient with very high fever with a good wet sheet to bring the temperature down.
If one thinks that only Paracetamol will bring down the fever that is not going to happen since Paracetamol will bring the fever down from 106 degrees to 104 degrees so if you really want the temperatures to come down which we want actually that it should come below 100 degrees as quickly as possible a wet sheet is the only remedy.
One needs to put a wet sheet over the patient and then put on the fan to a higher speed. This brings down the fever very rapidly and the ill effects of high temperature which can lead to organ damage can be easily avoided. The high fever itself can lead to organ damage, a high fever like 106 degrees if it remains for a considerable period of time can damage the organs.
Q: Why are people dying this year, chikungunya has been around for many years?
A: I think it is just that these people who died have come out positive for chikungunya also. There might be more than what meets the eye in these patients, they might be suffering from diabetes where any illness becomes much more severe. There could be compound infections, there could be both chikungunya and other type of virus so we don’t know.
We need to go into more depth whether it is only chikungunya. There is no mutation that has taken place. People should not panic. Chikungunya is happening to a large number of patients and they are recovering and getting better at home.
Except that joint pain may persist for weeks or some time even months. This generally takes time since if you look at the natural history of this virus it persists in the body for a considerable period of time.
Q: So you are not ruling out it to be a new strain but suggesting that it is unlikely to be a more virulent mutant?
A: It is unlikely to be a mutant, we spoke to virologists and they feel there is no mutation and there is no change in the DNA or RNA of this virus. So they feel it is a common chikungunya virus and they have not seen any mutation.
Q: Chikungunya and dengue both are mosquito-borne so if you control the mosquito you can control the disease?
A: Obviously, but that is something easier said than done because unless we control mosquito in our surroundings by avoiding water logging and accumulation.
We also need to take some more precautions if there are more number of mosquitoes in your vicinity then when walking or when sleeping one needs to cover ourselves, we need to put on full sleeved shirts. With the kind of construction activity under way it is very difficult to eradicate all possible sites for the breeding of this mosquito.
A: People are not allowing the inspectors inside. The responsibility of getting rid of the mosquitoes is with every citizen to make sure that at least in their houses no breeding is taking place. If every citizen contributes it would go a long way in bringing the disease levels down.
Q: Is it necessary to get a test done for chikungunya?
A: I do not think there any real need to get a chikungunya test done, viral fevers happen in this season everybody is well aware. If by taking Paracetamol and using hydro-therapy if the fever does not come down then consult a local physician.
Only if a doctor asks then get a chikungunya test done. Even if chikungunya comes out positive or negative or even if dengue comes out positive or negative, the treatment remains the same. By a confirmatory test the treatment regimen will not change.
Q: Is there a vaccine against chikungunya?
A: There is as yet no vaccine against chikungunya but vaccine against dengue could be coming soon.
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