Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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I wish all success to your journal and look forward to sending you any suitable similar article in future"



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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Reviews
Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3374 - 3379

Chikungunya- An Update

SUJATA M BYAHATTI* AND GIRISH L DANDAGI**

*BDS, MDS Reader, at Department of Oral medicine and Radiology, Maratha Mandals N.G.Halgekar institute of dental sciences and reaserch centre,Belgaum,India; **MBBS, MD Assistant Professor, Department of Pulmonary Medicine Belgaum Institute of medical sciences,Belgaum

Correspondence Address :
Dr. Sujata M Byahatti
Plot no 49, sector # 9, Malmaruti Extn, Belgaum-590016
Mobile: 9449308081 Res: 08312456931
E-mail: sujatabyahatti@rediffmail.com

Abstract

Chikungunya is an arboviral disease which is transmitted by the bite of the Aedes mosquito, which recently reemerged as a massive epidemic in the Indian Ocean islands and India. Chikungunya is generally considered as a self-limiting disease and has been reported to be non-fatal. The Chikungunya virus (CHIKV) was isolated in Tanganyika (now Tanzania) in 1953. Chikungunya outbreaks were reported in India in 2005, and 1.4 million Chikungunya cases were reported from different states. This disease has reemerged in India after 32 years. It should be pronounced as CHICK_EN_GUN_YAH not as CHICKENGUINEA. There are many cases which have been noted, but very few deaths have been reported. The lack of any official reports of the deaths could remain as a poor recording of the ‘Causes of Death’ in India. Correct reporting, recording and monitoring are essential for the screening of this disease for the purpose of the proper management and the prevention of the spread of this disease.

Keywords

Chikungunya fever, epidemic, polyarthritis.

How to cite this article :

SUJATA M BYAHATTI AND GIRISH L DANDAGI. CHIKUNGUNYA- AN UPDATE. Journal of Clinical and Diagnostic Research [serial online] 2010 December [cited: 2019 Aug 19 ]; 4:3374-3379. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2010&month=December&volume=4&issue=6&page=3374-3379&id=1102

INTRODUCTION
Chikungunya virus (CHIKV) was isolated in Tanganyika (now Tanzania) in 1953(1). The name is derived from the word ‘Makonde’, meaning 'that which bends up', with reference to the stooped posture which develops as a result of the arthritic symptoms of the disease (2), (3). In Asia, this virus is transmitted almost exclusively by Aedes aegypti mosquitoes. India had its first CHIKV outbreak in 1963, which was followed by epidemics in other parts of the country (4). Recently, massive outbreaks of CHIKV have been reported from many islands in the Indian Ocean (5). Like CHIKV, the dengue virus (DENV) is also transmitted by Ae. Aegypti and is endemic to the urban and semiurban areas of India (6). In Asia, the CHIKV-affected areas overlap with the DENV-endemic areas (7), (8) and provide opportunities for mosquitoes to become infected with both the



viruses. The co infection of CHIV with (4) dengue viruses (DENV-1 and DENV-4) was reported in Puerto Rico in 1982 (9). Since then, many cases of concurrent infections with multiple DENV serotypes have been reported in many countries.

The aim of the present article is to enlighten the health professionals in detail regarding the epidemiology, clinical features with the mode of spread, complications, different treatment modalities and precautions which need to be taken to prevent the spread of the disease.

Discussion

This disease was first described by Marion Robinson and W.H.R.Lumbsden in 1955, following its outbreak on the Makonde Plateau, in 1952 (10).

Virology
Recent search by the Pasteur institute in Paris claims that the virus has suffered a mutation that enables it to be transmitted by Aedes Albopictus (Tiger Mosquito). Chikungunya is closely related to the O’nyong’nyong virus (10). Chikungunya is a dengue-like disease which is transmitted by the Aedes, Culex and the Mansonia Mosquitoes (11). ‘Chikungunya’ is a local word, meaning ‘Doubling Up”, owning to the excruciating joint pains (12).

Clinical Features
Clinically (10) the patients develop fever which can reach 39 degree Celsius. The fever lasts for 2 days and comes down. Petechial or maculopapular rashes are noted, involving the limbs and trunk, and arthralgia or arthritis affecting multiple joints are observed, which can later be debilitating. However, joint pain, intense headache, insomnia and an extreme degree of prostration lasts for about 5-7 days; other manifestations include nasal blotchy erythema, lymhoedema over the acral area, nasal blotchy erythematic, multiple echymotic spots, vesiculobullous lesions, sublingual hemorrhage, photourticaria and acral urticaria. Orally, lichenoid eruptions, apthous ulcers and freckled pigmentation over the facial area are noted in some cases (10).

Epidemiology
Chikungunya virus is an important human pathogen, a member of the Alphavirus genus in the family of Togaviridae, which causes a syndrome which is characterized by fever, chills, headache and severe joint pain, with or without swelling (usually the smaller joints). Chikungunya fever outbreaks had affected many countries since January 2005. The outbreak which occurred in 2006, appeared to be the most severe and one of the biggest outbreaks which was caused by the chikungunya virus (CHIKV) in India, affecting over 13 lakh people (13), (14). This disease was first described in 1955, following an outbreak on the Makonde Plateau, along the border of Tanganyika and Mozambique (15). The Chikungunya virus is no stranger to the Indian subcontinent. Since its first isolation in Kolkata (16), (17) in 1963, there have been reports of its incidence from different parts of India viz. Vellore (18), Chennai (19), Nagpur (20), Barsi and Solapur District (21). Since the last outbreak of chikungunya fever, there had been hardly any active or passive surveillance which was carried out in our country, which suggested the disappearance of the virus from the subcontinent. However, large scale outbreaks of fever which have been caused by this virus in several States of India, including Andhra Pradesh and Maharashtra, have confirmed its re-emergence (22). Recently, massive outbreaks of CHIKV have been reported from many islands in the Indian Ocean (15). Since 2005, co-infections with DENV serotypes have been reported in Delhi, India (23). Co-infections with DENV and CHIKV were reported in Calcutta, India, in 1967 (24). Subsequent serological investigations in southern India indicated that the 2 viruses can coexist in the same host (25). For many years, it appeared that CHIKV had disappeared from India, but late in 2005, the virus reemerged on Reunion Island and in India (22). Confirmed cases of CHIKV infection have been reported from Delhi, Haryana, Uttar Pradesh, and Rajasthan provinces in northern India, although these states did not have large-scale epidemics (26). DENV infections are endemic to northern India; in recent years, increasing trends of the co circulation of multiple DENV serotypes in Delhi, suggest that DENVs are becoming hyper endemic to this region (23). During 2006, DENV and CHIKV were detected in Delhi (26). Because the clinical features of DENV and CHIKV are similar, CHIKV infections may go undiagnosed in the DENV-endemic areas. In India, the Ae aegypti mosquitoes are the primary vectors for DENV and CHIKV, and opportunities for co-infections in humans are increased by the feeding behaviour of the mosquito (27), the low socioeconomic conditions, and the high population density.

Various complex diseases (28) are generally influenced by more than one gene or an environmental factor, and as a consequence, do not exhibit a simple mode of inheritance. In community, although only a small percentage of exposed individuals will develop the disease. Some individuals often show variation in the susceptibility/resistance to certain diseases. Therefore, host susceptibility, genetic factors and, possibly, environmental factors may be important for the development of these diseases. A study (29) noted that Rh positive blood group individuals are more susceptible than others. Among them, the blood group O +ve individuals are more susceptible to chikungunya than those with other blood groups. No blood group with Rh negative was found to be affected with chikungunya; it indicates that people with the Rh -ve group have more resistance to chikungunya. Chikungunya disease is an acute arboviral illness which is characterized by a sudden onset of fever, skin rashes and incapacitating arthralgia (30).

Diagnosis
A suspected case (31) is confirmed by either the isolation of Chikungunya virus, or a detection of the antichik IgM in serum with a two fold rise in its titres, or by the detection of the CHIK nucleic acids in the serum by RT-PCR.

Pathophysiology
Human epithelial (32) and endothelial cells, primary fibroblasts and monocyte-derived macrophages are susceptible to infection with these viruses. Lymphoid and monocytoid cells, primary lymphocytes and monocytes and monocyte-derived dendritic cells are not susceptible to infection. Viral entry occurs through pH-dependent endocytosis. The infection is cytopathic and is associated with the induction of apoptosis in the infected cell. The infection is highly sensitive to the antiviral activity of type I and II interferon’s.

Spread of Disease
Chikungunya re-emerged in India in December 2005 after a gap of 32 years. The official figures from the Government of India indicate 1.39 million suspected Chikungunya cases from 152 districts across 10 states in India (33), (34). This epidemic disease has spread rapidly and has affected many communities with an attack rate of 40-60% (35). The most likely explanation of this rapid spread of the virus could be the lack of herd immunity in the population, unplanned development, poor public health systems- specifically the vector control systems and perhaps, a mutation in the virus. Recently, the first reported Chikungunya deaths on the Réunion Island took the French authorities and the world by surprise, as Chikungunya was previously considered to be non-fatal. French scientists reported a mortality rate of about 1 per 1000 cases on this island (36). The strains of the virus in this Indian Ocean Island’s outbreak and in the Indian subcontinent were found to be of the same strain as that of the African sub-type. (37) Surprisingly, the Government of India has not reported any deaths in spite of 1.39 million officially reported cases.
The key (38) reasons for not finding any Chikungunya deaths could be due to:
1. Poor reporting of death, and the causes of death.
2. Lack of availability of blood testing facilities for the virus (with only two government institutes in the whole county). Only 13000 samples have been sent for testing out of 1.3 million suspected cases. Many hospital authorities are afraid to stamp a death case as Chikungunya without a positive blood test. Instead, such deaths are attributed to fever, viral fever, multi-organ failure or Cardio Respiratory Failure (CRF).
3. The clinical case definition of a Chikungunya death has not been developed or disseminated widely by any national/state health authority or any research institute.
4. No systematic efforts have been made to screen all the deaths during the epidemic to identify as to which of them were caused due to Chikungunya.
5. No system was developed to follow up the 1.3 million reported cases of Chikungunya to see if any of them had resulted in death.

Management
The management of these patients is very essential, although diagnosis of these cases remains a difficult task, due to overlapping
features with that of other viral infections. The only symptomatic treatment in the form of analgesics (topical and systemic) provides a better result (10).

a. Vector control- The Aedes aegypti mosquito should be the main target of the control activities. It requires active community involvement to keep water storage containers free of mosquitoes and to eliminate other breeding places of the mosquitoes in and around houses and dwellings (41).

The organophosphorous insecticides abate are increasingly being used as laviceides. They can prevent breeding for up to 3 months when applied on sand granules, they do not harm man and they do not affect the taste of water. A new technique consisting of an aerosol spray of ultralow volume (ULV) quantities of malthion or sumithion (250 ml/hectare) has been found to be effective. These tiny droplets kill the mosquitoes in the air, as well as on water.

b. Vaccine: No vaccine has yet been developed, that has been considered as suitable for use (42), (43).

Conclusion

The controversy on Chikungunya deaths shows that India must take action urgently to improve the system of death registration and should also publish and make public mortality data on a weekly basis, with a proper cause- of- death analysis. This will be useful in predicting and understanding such epidemics better. This calls for a political and administrative commitment to strengthen the state, district and city/town offices of ‘registrar of births and deaths’ and epidemiological units. It also calls for more training of doctors, nurses and medical record clerks to accurately report the causes of death. Strict monitoring and follow up of the reporting of the causes of death are needed. Non-reporting or misreporting has to be reprimanded to improve the situation. Hence, the Government of India, the WHO, the CDC, the Gates foundation and other global health leaders must invest in improving the death reporting and the epidemic analysis response mechanisms which are the basics of any public health system. If we do not improve the cause of death reporting, then in the future, more dangerous diseases like SARS and the Bird flu may spread wildly and kill many more people before these epidemics are even detected.

References

1.
Ross RW. The Newala epidemic III; the virus: isolation, pathogenic properties and relationship to the epidemic. J Hyg (Lond). 1956; 54:177–91.
2.
Pialoux G, Bernard-Alex Gaüzère, Stéphane Jauréguiberry, Michel Strobel: Chikungunya, an epidemic arbovirosis. Lancet Infect Dis 2007, 7:319-27.
3.
Martin E: Chikungunya: No Longer a Third World Disease.Science 2007, 318:1860-61.
4.
Shah KV, Gibbs CJ JR, Banerjee G. Virological investigation of the epidemic of haemorrhagic fever in Calcutta: isolation of three strains of chikungunya virus. Indian J Med Res. 1964;52:676–83.
5.
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[Table / Fig - 1]
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