Chikungunya Virus Exposure Medical Response Guidance for the University of Wisconsin-Madison

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1 Chikungunya Virus Exposure Medical Response Guidance for the University of Wisconsin-Madison Instructions: Information in this guidance is meant to inform both laboratory staff and health professionals about the risks and treatment in the event of an infectious agent exposure. In using this guidance, please consider that multiple routes of exposure may occur in a lab and that organism strains will sometimes be genetically modified to incorporate traits such as antimicrobial resistance. Research protocols and other available guidance such as Health Canada material safety data sheets will be provided as supporting information when available. It should be assumed that when exposures do occur, that the healthcare provider will be provided information about the specific strain involved, route of exposure, inoculum concentration, and victim vaccination and serological status, when available. This document was developed by UW Occupational Health in consultation with the UW Department of Infectious Disease. The information provided below is intended to provide guidance for treating physicians. Treatment and evaluation plans should be individualized to the patient based on the patient s symptoms, exposure risk, and underlying health status. If there are any questions about this document, please contact Jim Morrison, UW Occupational Health Officer at or jmorrison@fpm.wisc.edu or University Health Services, Occupational Medicine at Signs and Symptoms of Infection- Describe signs and symptoms associated with the agent. Chikungunya fever is an arthropod borne arbovirus infection characterized by severe polyarthralgia and arthritis along with fever. Most commonly begins with abrupt onset of high fever and malaise after an incubation period of 2 to 4 days. Fever, often improves after a few days and then returns: saddleback Joint pains or polyarthralgias, can be severe and disabling, and begin 2 to 5 days after fever onset. Multiple joints are typically involved including the hands, wrists and ankles, and the knees and shoulders. Macular or maculopapular rash, with pruritus, of the limbs and trunk can occur three or more days after onset of illness.

2 Other symptoms can include headache, sore throat, nausea and vomiting. Chronic, persistent infection and severe complications can occur. Clinical signs of infection can include fever, swollen tender joints, joint effusions, and peripheral lymphadenopathy. Infectivity- Describe infective dose, relevant exposure routes (considering laboratory use), incubation period and potential severity of infection. Usually a mosquito-borne infection from an endemic area. Chikungunya epidemics have occurred in Africa, India and Indonesia. Natural hosts in endemic areas include humans and nonhuman primates. Laboratory model hosts include mice. Laboratory routes of exposure include exposure to non intact skin, mucous membranes, needlesticks, and aerosolization. Sources of exposure can include contact with blood or body fluids from an infected individual or host, exposure to virus isolates or cell lines or to tissues of infected primates or other hosts. Incubation period is most typically 2 to 4 days but can range from 2 to 12 days. Description of First Aid - Provide an overview of first aid treatment of exposures considering that multiple routes of exposure could occur (needlestick, aerosol, eye, skin and ingestion). For laboratory contact exposure to skin or from needlesticks, cleanse the affected area as soon as possible for at least 15 minutes. Scrub with the disinfectant product approved for your laboratory. For eye or mucous membrane exposure, irrigate for 15 minutes with sterile saline or water, preferably in an eye wash station. Urgency of Medical Care- Describe how soon medical attention should be sought, i.e. is an ER visit necessary, visit to University Health, or simply schedule a visit with a personal physician. Report incident and discuss additional measures and guidance with UHS occupational medicine Chikungunya virus can be transmitted from the mother to the fetus. Pregnant exposed individuals should also see their personal healthcare provider. Description of Medical Response- Provide an overview for clinical treatment of exposures to the agent considering that multiple routes of exposure could occur (needlestick, aerosol, eye, skin and ingestion) and that strains of agents will vary and sometimes include antimicrobial resistance. No prophylaxis available following exposure to the infective agent or for treatment after development of disease.

3 Antiviral agents have not been shown to be effective in human disease. Clinical treatment includes supportive care only, particularly relieving symptoms of pain and fever. Management of symptoms and cases would be by UW infectious disease.

4 Description of Medical Surveillance- Describe the advisability of medical surveillance strategies (in particular baseline and annual serology) for those working with the agent. If doing so would likely improve the identification, diagnosis or treatment of exposures, please indicate so. IgM anti chikungunya antibodies are present starting 5 days following symptom onset and persist from several weeks to 3 months. IgG antibodies are present about two weeks after symptom onset and can persist for several years. Acute and convalescent (1-3 weeks later) serology could be requested or ELISA testing. Considerations for Infection Control-Describe any special precautions required to prevent the further spread of infection. Include precautions for the healthcare, workplace, and home setting. There is no vaccine available for Chikungunya virus. Not communicable person-to-person Reporting-Describe any state public health or federal regulatory reporting requirements. Include the timing and mechanism for reporting. Public Health: Not reportable in Wisconsin unless there is an outbreak of occupationally related Chikungunya fever cases. Other: Date: 11/14/11; Julie Horbul; UW Infectious Disease Fellow Updated 05/03/2012/ASW, 05/17/12 DRA

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