Epidemiology & Public Health

Biography

Biography: Reza Nassiri

Abstract

Chikungunya fever (CF) is an emerging mosquito-borne viral disease caused by an alphavirus, Chikungunya virus (CHIKV). The disease is transmitted predominantly by Aedesaegypti and Aedesalbopictus mosquitoes, the same species involved in the transmission of dengue. The most common symptoms of Chikungunya virus infection are fever, arthralgia, backache, and headache. Outbreaks have occurred in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. The socioeconomic factors and public health inadequacies facilitate rapid spread of this viral infection. CHIKV has expanded its geographical range producing new outbreaks including the Caribbean region, and therefore, the Dominican Republic.In December 2013, the Pan American Health Organization issued a warning about indigenous cases of CHIK in Saint Martin,therefore the Ministry of Public Health (MPH) from the Dominican Republic (Pimentel, 2014)released an epidemiological alert in conjunction with the National Plan for Preparedness and Response to CHIK, on January 2014. In February 2014, notifications ofcases with febrile syndrome at the Paniagua Maria Hospital in the municipality of San Gregorio de Nigua, province of San Cristobal, indicated a sustained prevalence. After ruling out other infectious diseases such as dengue, malaria, measles and rubella, the outbreak of CHIKV was then confirmed bythe Center for Disease Control and Prevention (CDC) on April 3rd, 2014.The main commercial port in the country, located in Haina, is supposed to have been the gateway to the virus.The MPH activated the Interagency Committee on Health Surveillance, created the Vice Ministry of Public Health’s Situation Room, where a group of health professionals was assigned to coordinate and assess needs and actions to respond to the epidemic, composed of six working groups: epidemiology, health services, strategic communication, planning and logistics, fast response and vector control. Among the first actions taken, was the development of the Clinical Management Guide for CHIKV (MPH, 2014) and its national distribution among health care networks.In addition, community forums and meetings with provincial and regional hospitals were organized to inform of the epidemic, prevention activities and the need to eliminate mosquito breeding sites, using larvicides in water storage tanks in homes. The General Direction of Epidemiology (DIGEPI) elaborated instruments of recollection and notification of cases and outbreaks, which were presented in a meeting with the National Epidemiology Network. The volume of cases (DIGEPI, 2014) of CHIKV overwhelmed the health services, at all levels, increasing the total health costs during the 9 months of its prevalence, affecting 524,297 cases with six mortality registered. The incubation period was from 2-6 days with clinical symptoms usually appearing 4–7 days post-infection, which included rash, pain in the lower back, joint pain (with or without the presence of swelling), and vomiting, nausea, headaches, chills and fevers. As a complication, rheumatoid arthritis-like symptoms persisted for months. Due to a lack of vaccine and specific medication for the CHIKV, the support care of symptoms was recommended such as taking plenty of fluid, having bed rest, IV fluid in case of dehydration and medications for fever and pain. In conclusion, CF is an emerging vector-borne disease of high public health significance in Dominican Republic. Vector-borne diseases management, control and prevention should include cross-sectoral solutions involving all stakeholders. The One Health approach can greatly enhance communication and collaboration among the stakeholders to control and prevent CF.