Transmission of Chikungunya Virus
Discuss about the Chikungunya Risk Assessment for Infectious Disease.
Chikungunya virus (CHIKV) is transmitted by a mosquito Alpha virus that belongs to the family Togoviridae. It is endemic in India, Africa, Western Pacific and South-East Asia. However, CHIKV has shown emergence and re-emergence in other regions including the warmer temperate world. The virus is transmitted from infected humans via mosquitoes to an uninfected human host. Outbreaks of the disease usually occurs and pose a public health problem for local health authorities (Viennet, Knope, Faddy, Williams, & Harley, 2013) This is because of inadequate vector control strategies, surveillance and the fact that humans are the host therefore there is sustained blood supply to the vector. CHIKV has complex antigens that causes rheumatic and hematological manifestations in the human host. Incubation period for the virus varies according to the type of vector. Some of the symptoms that one presents with include headache, fever, myalgia and arthralgia that are severe and of sudden onset and they resolve within one to two weeks. Arthralgia usually persists for up to months therefore leads to loss of productivity especially when a large population is affected. Complications range from liver failure to encephalopathy. Diagnosis of CHIKV is by clinical assessment and laboratory confirmation to separate the virus from others belonging in the same family as it, this is according to an article by Health.gov.au, (2018). Numerous challenges exist when it comes to the virus surveillance and control. As a consequence, there are no robust policy measures to ensure adequate control of the virus. Chikungunya risk assessment in Austria will be reviewed in this assignment.
Chikungunya in Australia continues to be a major threat as the vectors are competent and widely distributed. Transmission is also facilitated by huge numbers of travelers who return from endemic areas like Africa and India. Health.gov.au, (2018) illustrates a ten year study on CHIKV in Australia. Findings show that 168 cases were reported between 2002 and 2012, with regional differneces. South Wales and Victoria had the highest cases and the main sources for transmission was from visitors from India, Indonesia and Malaysia. Quarterly reports by the National Notifiable Disease Surveillance System (NNDSS) by each jurisdiction from April to October 2017 show that CHIKV infections were reported by all jurisdictions except the Australian Capital Territory. This is according to article by Health.gov.au, (2018) on Communicable Diseases Intelligence by Austria Department of Health.
Symptoms and Diagnosis of Chikungunya Virus
Chikungunya is one the numerous communicable disease. This means that they can be transmitted from one person to another. The virus is currently not epidemic in Austria, and local transmission is rising as demonstrated by studies. As any other communicable disease, CHIKV transmission if favored by a number of factors. They include:
- Importation of the virus by travelers who are infected. The virus is then presented to competent vectors (Aedes albopictus in Torres Strait Islands and Aedes aegypti in North Queensland). Health.gov.au, (2018).
- Presence of mosquito vectors that are competent (Aedes albopictus and Aedes aegypti) (European Centre for Disease Prevention and Control, 2018).
- Presence of a susceptible population. Since Chikungunya is not endemic in Austria, the local population is less immunized against the virus therefore are at high risk of getting it (European Centre for Disease Prevention and Control, 2018).
- Changing climatic conditions in Europe. Austria is one of the countries in Europe. Studies have proven that not only travelling poses a risk for CHIKV transmission but also climate change in Europe (Fischer et al., 2018). Micro evaluation of CHIKV gene shows that albopictus is responsible for epidemics in temperate regions in absence of the primary vector A. aegypti.
- Weak disease surveillance system, since the infection is not well established in the country. A strong surveillance system in cooperates research and public health approaches to ensure that disease is contained on borders. (Staples, Breiman and Powers, 2018).
- High attack rates of the virus. It has been shown that Chikungunya Virus causes about a third to three quarters of outbreak in an area where it is circulating. (Staples, Breiman and Powers, 2018).
- High levels of blood viremia. Staples, Breiman and Powers, (2018) Suggests that above 5 log 10 plaque-forming units per mL of blood is high and causes infections in humans.
Reducing the risk of transmission of CHIKV requires a multidisciplinary approach, with both government parastatals, non-government organizations and the public at large. The vector surveillance system should be integrated in vector control, social mobilization like private and public collaboration and sociocultural measures.
- Public education about the virus, its spread and control. It is critical for a community to understand how to eliminate mosquito and enhancing their own personal protection (International, 2018).
- Enhancing proper surveillance system to determine vector distribution, species in the area and the density (International, 2018).This also provides evidence of increased risk for transmission of CHIKV.
- Vector control for both larva and adult mosquito. Larval control by trained ground crews reduce breeding habitat in stagnant water and use of larvicides. Adult vector control is through barrier method (International, 2018). Austria should ensure that all the population in high risk areas are provided with free nets. This method is highly effective in reducing population of high risk mosquitoes.
Apart from the above measures, Austria should ensure that the following elements of Integrated Vector Management (IVM) are fulfilled at a national level.
- Advocacy for CHIKV vector control, social mobilization of people and funds for the process and legislation of laws that ensure good surveillance method (Islam, 2017). This involves both the private and public health sectors in collaboration with the state and its citizens.
- Ensuring that there is adequate collaboration between the health sector under Ministry of Health (MoH) and with other sectors dealing with health and population. (Islam, 2017). Good collaborative measures ensures shared decision making in coming up with best solutions for a problem.
- Having an integrated approach towards vector control and surveillance. (Islam, 2017). Integrating the psychosocial, community and other aspects of health together to come up with nearly fool proof recommendations.
- Putting in place evidenced based decision making through conducting research. This needs more dedication by putting more funds in this area. (Islam, 2017). Evidence based practice has shown to improve efficacy and satisfaction.
- Promoting capacity building in the health sector to ensure that the virus biology in terms of transmission, pathophysiology, clinical manifestations, diagnosis, management and control is understood. (Islam, 2017).
Ministry of Health should be in a position to put stringent measures to ensure proper control and possibly elimination of Chikungunya. The New South Wales (NSW) department of health should be well advised so as to direct immediate and future actions for CHIKV control. Immediate control measures include:
- Put Chikungunya in the viral fever control guidelines as other viral hemorrhagic fevers have been included as a public health priority and act as a guide to quick response and ensure surveillance (International, 2018).
- Proper surveillance and reporting system by the state and local partners responsible for disease control and surveillance. An outbreak threshold for CHIKV should be reevaluated (International, 2018). Austria’s state health agency should be included in developing national surveillance strategies particularly for the virus.
- Establishing effective infectious disease control like prevention by larva and adult vector (International, 2018). This should also be a collaborative effort between the state and other public health officials, enhancing surveillance focusing on high risk countries that the virus originates from and building surveillance for controlling the new virus type.
- Maintaining good communication and collaboration. By providing timely and accurate information about the outbreak of CHIKV to citizens, health care providers and to other countries and regions that are likely to be affected for a quick response to be established. Collaborations between affected states should also be established in response to emerging infections. This involves law enforcement agencies, health officials and border protection staff (International, 2018).
- Recruiting and putting in place a skilled workforce by state and territorial health agencies to respond to the virus in relation to emergencies and public health emergencies (International, 2018). Good collaboration between public health officials, clinics, laboratory, an active community and health educators will help in fast elimination of CHIKV outbreak and keep it in check. Good funding source should be there to enhance success of this program.
Future control measures that should be undertaken by NSW department of health include:
- Finding a vaccine against the CHIKV and updating it in the Australian Immunization Handbook. The vaccine should target the high risk areas and travelers from regions of high transmission rates like Africa, India and South East Asia. Vaccine against this virus will also promote herd immunity among locals further immunizing a larger population (Astho.org, 2018).
- Engaging legal authorities and public health department to enact laws governing transmission and preventive measures (Astho.org, 2018). Patient reviews, case investigations, population surveys among other measures can be evaluated by state to evaluate its ability for prevention and control while determining the gaps to be filled.
- Strengthening preparedness of Austria as a state towards such virus in the future. A national preparedness plan is necessary for effective detection, response to and recovery from emerging diseases. Preparedness can be enhanced effectively when there is shared and integrated surveillance on emerging diseases like Chikungunya (Astho.org, 2018). Other intelligence systems like those form public health sector are necessary to maintain real time situational awareness of the virus, symptoms arising from the disease and incidence. Funding is also an important aspect of this process. Continuous funding to public health preparedness activities is necessary to improve readiness and commitment to prevent further disease emergence.
- Establishing research centers for the disease using locally available data after an outbreak. Research helps in finding gaps in disease transmission and control, the factors favoring disease emergence and developing vaccines. The government of Austria through its ministry of health can retrieve information from the patient data base. This contributes to critical information to comprehend the disease entities (Astho.org, 2018). Policies should be developed to help develop research centers. A good funding stream is also necessary for buying research equipment, establish research centers and for human resource fulfillment. Incentives for public and private sectors should be developed so that improved testing and diagnosis of any suspicious infection like CHIKV can be detected early. Research, once fulfilled will be a gateway for vaccine development and trial in a population as a way for future primary prevention.
A press conference provides one with an opportunity to relay vital information to the masses. For instance, concerning CHIKV outbreak in a country, a health minister will deliver a press conference to the citizens who are concerned about their health safety. Therefore for them to gain trust and confidence in one, the following can be put into practice by the health minister:
- Be confident as this makes the public believe more in what you say and consider it legitimate.
- Display a good knowledge of the Chikungunya virus, by providing evidence based information and scientifically correct content.
- Be fluent and avoid stammering. This also shows that one has a good mastery of content.
- Maintaining good eye contact with the camera.
In conclusion, the report highlights major aspects of Chikungunya its risk assessment in Austria.
References
Association of State and Territorial Health Official. (2018). Infectious Disease Guiding Principles. Retrieved from Astho: https://www.astho.org/Policy-and-Position-Statements/Policy-Statement-on-Infectious-Disease/
European Centre for Disease Prevention and Control. (2018). Risk assessment for chikungunya in the EU continental and overseas countries, territories and departments. [Online] Available at: https://ecdc.europa.eu/en/chikungunya/threats-and-outbreaks/risk-assessment-chikungunya-eu.
Fischer, D., Thomas, S., Suk, J., Sudre, B., Hess, A., Tjaden, N., Beierkuhnlein, C. and Semenza, J. (2018). Climate change effects on Chikungunya transmission in Europe: geospatial analysis of vector’s climatic suitability and virus’ temperature requirements.
Health.gov.au. (2018). Department of Health | Assessing the threat of chikungunya virus emergence in Australia. [Online] Available at: https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3702f.htm.
Health.gov.au. (2018). Department of Health | Communicable Diseases Intelligence – Current issue – December?2017. [Online] Available at: https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-cdicur.htm.
Health.nsw.gov.au. (2018). Chikungunya control guideline – Control Guidelines. [Online] Available at: https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/chikungunya.aspx.
International, V. (2018). Chikungunya Virus: Education, Public Health, Mosquito Management. [Online] Vdci.net. Available at: https://www.vdci.net/vector-borne-diseases/chikungunya- virus-education-and-mosquito-management-to-protect-public-health.
Islam, Q. (2017). Chikungunya Fever. Journal of Medicine, 18(2), p.54.
Staples, J., Breiman, R. and Powers, A. (2018). Chikungunya Fever: An Epidemiological Review of a Re?Emerging Infectious Disease.
Viennet, E., Knope, K., Faddy, H., Williams, C., & Harley, D. (2013, October 01). Assessing the threat of chikungunya virus emergence in Australia. Retrieved from Communicable Diseases Intelligence: https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3702f.htm
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