Chikungunya. How to Receive Your CE Credits

Transcription

1 Chikungunya How to Receive Your CE Credits Read your selected course Completed the quiz at the end of the course with a 70% or greater. Complete the evaluation for your selected course. Print your Certificate CE s will automatically be reported to the CE Broker Purpose The purpose of this continuing education course is to stress the challenges, and the increase in reported cases of Chikungunya (CHIK). In addition to educated health care professional on the prevalence of (CHIK) and how this disease affects individuals and the communities in that the live. Objectives 1. Describe how the Chikungunya virus is transmitted. 2. Discuss the signs and symptom of Chikungunya. 3. List laboratory tests performed for diagnosing Chikungunya. 4. Understand the treatment Options for Chikungunya. 5. Discuss the Prognosis for Chikungunya. 6. Describe the educational and preventative measure for Chikungunya. 1

2 Chikungunya Chikungunya virus is a mosquito-borne alpha-virus that has the ability to cause acute febrile illness, severe pain and stiffness of the joints (polyarthralgia). Mortality is rare but the joint pains can be debilitating. According to Staples, Breiman, and Powers, (2009) the acute symptoms typically resolve within 7-10 days. However, some patients experience persistent joint pains for months to years. According to Panning et al. (2009), chikungunya virus (CHIKV) is the cause of chikungunya disease. The disease is primarily transmitted by two mosquito species known as Aaedes aegypti and Aedes albopictus (Center for Disease Control and Prevention, 2014). The effects of chikungunya can be widespread in very short amounts of time as mosquitoes are known to be fundamentally everywhere. In 2005 and 2006 an endemic in south Asia impacted 1.3 million people in India and another 37,000 in Sri Lanka, (Panning et al., 2009). Because of the ease and increase in transmission, similarities in symptoms to many other diseases, and the debilitating effects, it is best for western medical professionals to remain up-to-date on chikungunya-related developments. Furthermore the widespread appearance of the disease in certain sub-tropical and tropical climates, have lead a nationwide health alert. Health Notices were issued for many countries, and healthcare workers should note that patients recently returning from these countries with appropriate symptoms should be questioned about mosquito bites and tested for chikungunya as a precaution. Furthermore as of an updated report, most cases in the United States are from Florida (12) and New York (nine). All other states have none or less than five. Chikungunya has been found in worldwide in the following continents and 2

3 regions: Africa (25 countries), Europe (Italy and France), Oceania/Pacific (nine countries), Asia (20 countries), Americas (44 countries) (Center for Disease Control and Prevention, 2014). Symptoms Individuals infected with the virus will be symptomatic, and the period of incubation may last anywhere from 1-12 days, however more commonly 3-7 days after contact with a vector. Symptoms from chikungunya may include: a. Severe, high fever of 102 Fahrenheit [39 Celcius] b. Polyarthralgia [multiple-joint joint pain] which can be so painful a sufferer cannot function. The pain is typically symmetric and bilateral. c. Headaches d. Nausea and vomiting e. Arthritis f. Conjunctivitis g. Myaligia h. Maculopapular Rash (this rash may only appear on lighter-skinned patients. It is a red area of skin with similarly raised bumps) (Center for Disease Control and Prevention, 2014). Ruiz-Moreno et al. (2012) further clarify that the debilitating and prolonged joint pain can be specific for chikungunya. This is important to note because it is so similar to dengue fever. Laboratory tests can find other less obvious symptoms such as: 3

4 a. Hepatic transaminases b. Lymphpenia c. Elevated creatine d. Elevated hepatic transaminases (Ruiz-Moreno et al., 2012; Center for Disease Control and Prevention, 2014). The CDC, (2014) notes that there can be other atypical symptoms associated with the virus and should these symptoms occur prompt medical attention is required: a. Neurological concerns: meningoencephalitis, encephalopathy, neuropathy, seizures, Gullain-Barré syndrome, cerebellar syndrome, palsies, paresis b. Cardiovascular: Myocarditis, hemodynamic instability, pericarditis, arrhythmias, heart failure c. Dermatological: Hyperpigmentation, photosensitive, intertriginous aphthouslike ulcers, vesiculobullous dermatosis, d. Ocular concerns: Episcleritis, uveitis, retinitis, optic neuritis, irirdocyclitis When evaluating these atypical symptoms, it is crucial that medical staff know what key differences to look for. Chikungunya can easily be mistaken for dengue fever. Amazingly there can be two viruses that circulate in the same area and can cause occasional coinfections in the same patient because both Chikungunya, and dengue fever are transmitted by the same type of mosquitoes and have similar clinical features. In addition health care providers should also be on alert for lab results ruling out other associated diseases for example; the alphavirus infections, adenovirus, leptospirosis, rickettsia, 4

5 malaria, rubella, measles, streptococcus, parvovirus, and enteroviruses (Center for Disease Control and Prevention, 2014). Tests Laboratory tests for chikungunya can be used to rule out the potential for other diseases such as dengue fever. Blood serum or plasma can be used to find virus-specific immunoglobulin M, viral nucleic acid, Chikungunya Virus, or neutralizing antibodies. It is recommended that blood sample be coagulated, and the blood serum be separated from the coagulation (clot) before submitting the blood for ( Diagnostic testing, 2014). Treatment According to Panning et.al. (2012) vaccination is the most cost-effective means of protecting the at-risk populations in Chikungunya Virus-endemic developing countries. As Chikungunya Virus outbreaks occur only sporadically and unpredictably in affected countries, the vaccine efficacy cannot be proven as a requirement for traditional regulatory approval by the US FDA at this time (Panning et. al., 2012). Nonetheless there is no cure for chikungunya. The goal is to treat the symptoms (Ruiz-Moreno et al., 2012). Joint pain may require analgesic and long-term antiinflammatory therapy (World Health Organization-South-East Asia Regional Office, 2015). Because of the danger of dengue overlap, if there is not a confirmed diagnosis refrain from using aspirin and NSAIDs because they can encourage hemorrhaging in patients that do have dengue. Additionally, caretakers should monitor the hemodynamic condition, and patients should also get plenty of rest and have his or her fluids monitored to avoid dehydration (CDC, Symptoms 2014). 5

6 Prognosis Chikungunya was believed to a non-fatal and self-limiting disease (Bonn, 2006). However there has been several cases on the Indian Ocean island of Reunion, that have reported Central Nervous System (CNS) and fulminating involvement in one third of the population that was affected and the disease had caused 237 deaths (Bonn, 2006). However the mortality from chikungunya is low, and patients that are more affected by the virus are the elderly, compromised patients, and infants (Ruiz-Moreno et al., 2012). Prevention Majra, and Acharya, (2011) current studies have proven that people who had knowledge about the vector (the two mosquito species known as Aaedes aegypti and Aedes albopictus) and methods of preventing the disease are less likely to be affected by chikungunya. Ruiz-Moreno et al. (2012) suggest that the best way to contain the recent outbreak of chikungunya is to gain control over the mosquito population. Because no vaccine exists, in order to prevent chikungunya, the CDC ( Prevention, 2014) recommends the following steps: a. Know the species that spread chikungunya are more likely to bite during the day b. If you must go outside, wear long sleeve shirts and pants whenever possible c. Use insect repellant (ex. DEET, picaridin, etc.) (Sunscreen first, than repellant when using both) d. Use air conditioning instead of opening windows 6

7 e. Use window screens or sleeping nets to prevent mosquitoes from entering indoor spaces f. Use items treated with permethrin when outdoors for prolonged activities like camping Conclusion According to a study conducted by Ruiz-Moreno et al. (2012) on highlypopulated locations in the United States on the east coast indicate that, in sub-tropical climates like Miami, medical workers should anticipate year-round cases, while New York, and Atlanta should anticipate cases to spike in the rainy and summer months. Health care workers should remain vigilant and report any suspected cases of chikungunya to their local health departments so that appropriate tracking and origins of disease can be surveyed (CDC, Clinical evaluation, 2014). Education should heighten for communities to remove all areas of standing water during the rainy seasons and report and increase of mosquitos to local cities for fumigation. It is recommended that there must be increased awareness about the potential of this disease how it can affect all areas during the summer travel season, because chikungunya is spreading to new areas every year despite its tropical and sub-tropical tendencies. In the absence of any specific cure or effective vaccine, health education can prove to be an important tool for the control of chikungunya epidemic (Bonn, 2006). 7

8 References Bonn, D. (2006). How did chikungunya reach the Indian Ocean? Lancet,6, 543 Center for Disease Control and Prevention. (2014). Chikungunya: atypical and severe disease manifestations. National center for Emerging and Zoonotic Infectious Diseases Division of Vector-Borne Diseases. Retrieved from Center for Disease Control and Prevention. (2014). Chikungunya virus in the caribbean, Retrieved from Center for Disease Control and Prevention. (2014). Chikungunya: What you need to know. Center for Disease Control and Prevention. Retrieved from - Center for Disease Control and Prevention. (2014). Chikungunya Information for healthcare providers. National center for Emerging and Zoonotic Infectious Diseases Division of Vector-Borne Diseases. Retrieved from Center for Disease Control and Prevention. (2014). Diagnostic testing. Retrieved from 8

9 Center for Disease Control and Prevention. (2014). Prevention. Retrieved from Center for Disease Control and Prevention. (2014). Symptoms, diagnosis & treatment. Retrieved from Lindsey, N. P., Prince, H. E., Kosoy, O., Laven, J., Messenger, S., Staples, J. E., & Fischer, M. (2015). Chikungunya virus infections among travelers-united States, The American Journal of Tropical Medicine and Hygiene, 92(1), doi: /ajtmh Majra, J. P., & Acharya, D. (2011). Impact of knowledge and practices on prevention of chikungunya in an epidemic area in India. Annals of Tropical Medicine & Public Health, 4(1), 3-6. Panning, M., Wichmann, D., Grywna, K., Annan, A., Wijesinghe, S., Kularatne, S.A.M., Drosten, C. (2009). No evidence of chikungunya virus and antibodies shortly before the outbreak on srilanka. Medical Microbiology and Immunology, 198(2), Ruiz-Moreno, D., Sanchez Vargas, I., Olson, K., Harrington, L. (2012). Modeling dynamic introduction of chikungunya virus in the united states. PLoS Neglected Tropical Diseases, 6(11), Sharp, T. (2014). Differentiating chikungunya from dengue: A clinical challenge. Center for Disease Control and Prevention in collaboration with Medscape. Retrieved from 9

10 Staples, J., Breiman, R., Powers, A., (2009). Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clinical of Infectious Disease 49, Weaver, S. C., Osorio, J. E., Livengood, J. A., Chen, R., & Stinchcomb, D. T. (2012). Chikungunya virus and prospects for a vaccine. Expert Review of Vaccines, 11(9), World Health Organization-South-East Asia Regional Office. (2015). Chikungunya Fever, a re-emerging Disease in Asia. Retrieved from searo.who.int/en/section10/section2246.htm. 10