Delhi's Chikungunya: Unpredicted Outbreak, Predictable Suspects

A large number of chikungunya cases have occurred due to heavy rainfall in many parts of the country, especially in Delhi, posing a serious health threat.

An Aedes aegypti mosquito. Credit: John Tann/Flickr, CC BY 2.0

An Aedes aegypti mosquito. Credit: John Tann/Flickr, CC BY 2.0

New Delhi: Following the onset of monsoon this year, chikungunya resurged in India to put many lives at risk. According to the National Vector Borne Disease Control Programme, which oversees the prevention and control of vector-borne diseases like malaria and dengue as well as chikungunya, a large number of chikungunya cases have occurred due to heavy rainfall in many parts of the country, especially in Delhi, posing a serious health threat.

When rainwater accumulates close to homes, it attracts mosquitoes like Aedes aegypti which breed in stagnant dirty water and in and around garbage dumps. Even water tanks located in high-rise buildings and residential areas have also been found to be larval habitats, where Aedes mosquitoes thrive. The diseases are transmitted through these mosquitoes when the latter bites people inside their homes in the day.

And when the diseases’ symptoms are not diagnosed in time, the condition turns grim, sometimes leading to death.

Some of the worst affected by this virus were found to be those who belong to marginalised communities, residing in J.J. Colonies, toward the city’s northwestern outskirts. Apart from poor awareness, a majority of the people who live in these areas did not receive any health care treatment or support. In a village in South Delhi, a distraught lady who lost her fifteen year old son due to chikungunya, stated that nearly a hundred people in the vicinity where she lives have been ailing due to chikungunya however, they have not received any support or care due to which she believes that they may not survive.

The same disease outbreak occurred in Yamuna Khadar, a village located close to a riverbank, where many migrants reside. The villagers mentioned that this year the rainfall was very high. The water level at the river bank rose so high that each home was filled with water allowing Mosquitoes to breed and bites the families. As a result, many people fell ill due to chikungunya. But like in the past, they had no access to health care.

Since they work as labour, their income is minimal. Therefore they are unable to approach hospitals for treatment. This year, they mentioned that a new disease has occurred which they are unaware of but it has taken lives of many children, women and the elderly. They mentioned how Rani, a young girl who was a new resident in this small colony, was suffering due to high fever for quite some time and had not improved at all since she did not get medical treatment. She was bedridden since she was unable to move. Two days after she was found ailing, she succumbed to chikungunya.

The villagers found out that Rani had chikungunya only after a local doctor, who was on his way to the hospital, identified the condition in the village and did a blood test on her after she passed away. They stated that even though many fell ill routinely in the village, especially children, no healthcare support was provided and therefore they continue to face the risk of multiple diseases, especially chikungunya.

Unless steps are taken to prevent this viral disease, at the early onset, this severe health risk will continue to put people at risk as well as take lives.

Role of AIIMS in providing medical care

Dr Lalit Dar, a professor at the department of microbiology at the All India Institute for Medical Sciences (AIIMS), stated that between 2006 and 2007 about 600 to 700 people were infected by chikungunya and which led to severe disability. Even though the disease is usually self-limiting, it more adversely impacts those patients who are sometimes unable to physically move.

In 2007-2010, no chikungunya cases were reported since there was no change in the environment; many simply hadn’t been exposed to the virus. The streak ended in 2011 and continued to be the case until 2015.

In 2016, there has been an uptick in the number chikungunya cases due to high rainfall. Dr. Dar mentioned that cases of chikungunya had been reported in July. The largest number of cases came to light in August. About 1,012 patients were treated in AIIMS, of which six patients needed to be moved to the ICU since their conditions were serious. About 60 other patients were also admitted but they were finally released after being treated.

In many patients with chikungunya, high fever and joint pain were noted. Among those who continued to have fever for more than five days, their blood samples were taken and antibody tests were conducted to identify if the antibody persisted in their blood. In cases of severe infections, polymer tests were also done to isolate the viruses. In all, only one patient did not survive. He died within 12 hours due to pneumonia and sepsis. One main cause was linked to high intake of alcohol and smoking.

Doctors have stated that, while chikungunya is typically not a disease that kills, it is imperative to identify the warning signs at the onset to reduce chances of death.

Many people were found to have clinical features such as chills with high-fever, severe joint pain, edema, oral ulcers, red eyes, nausea, diarrhoea, arthritic swelling and extensive rashes and itching as well as heavy bleeding. Some also had mild swelling and recurrent vomiting, loose stools and decreased urine and general weakness, which need to be addressed on time to protect the affected people. It is also imperative to manage severe bleeding since it leads to organ failure. Management of shock by providing liquid fluid is required as well.

About 3-25% of people showed serological evidence of asymptomatic chikungunya infections but no obvious symptoms, except rashes and joint swelling. About 90% of the time, infected patients were found to recover within three to four weeks. However, it was found that about 5% to 10% do not recover and need special care – while those with severe joint pains take about one or two months to recover.

Doctors mentioned that there is no need for antibiotics or steroid for patients who have chikungunya. For those who are suffering from acute febrile disease, the patient primarily needs to rest. In mild cases, no antiviral drug is needed. Among those who have high-grade fever, paracetamol is provided. Besides, mild exercise can also improve health status.

Children too are prone to chikungunya if they are exposed to the virus. A doctor from AIIMS stated that the principal symptom in children infected by the virus is high fever. If they have low blood pressure and also dehydration, they need to be given paracetamol along with adequate water. They are also required to be given glucose in case of blood loss.

Those with acute disease infection suffer from fever and inflammatory arthralgia for three weeks. However, doctors stated that chikungunya does not necessarily lead to death. If immunity level as well as platelet count is low and the patient suffers from comorbidity such as kidney and liver infections, there is a need to be careful because it can be life threatening. For all infected patients, proper care, food intake and appropriate fluids are required to ensure their wellbeing.

To ensure personal protection within the infected community, it is imperative that steps are taken for reduction of breeding sources. Areas where water level is high need to be managed in a manner that the water is not accessible, which will prevent mosquitoes from breeding. Since most transmission occurs at home, fogging must be done at regular intervals. Besides, households that have water tanks need to close them since the water tanks are quite susceptible to becoming larval habitats.

On the part of the state, apart from the continuing delay to provide support, it is imperative to know the health status of various communities and address the gaps in terms of providing appropriate healthcare facilities. Those groups that face indifference, or are not provided support, would deserve special attention from the state government’s working team for health facilities.