Evaluation of the Level of Awareness towards the Effects of the

Chikungunya Virus

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A Research Paper

Presented to

Science, Technology, Engineering, and Mathematics Program

Urdaneta City National High School

Urdaneta City

___________________________

In Fulfillment

of the Requirements for the Subject

Practical Research II

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By:

Sidayen, Princess Ivy S.

Villanueva, Lady Venice M.

Operaña, Aethan Seth A.

Quitoles, Shawn Ahron V.

S.Y. 2022-2023
 CHAPTER I

The Problem

Background of the study

Chikungunya virus (CHIKV) is an alphavirus linked to a mosquito-

transmitted illness that often results in a systemic, self-limiting sickness with

various clinical symptoms. Fever, mild to moderate arthralgia, and a

Maculopapular Exanthema are the most common symptoms of the

Chikungunya virus. Asymptomatic CHIKV infections might make up around

15% of cases. There is presently no vaccination or medicine available to

combat the infection.

In southern Tanzania in 1952–1953, CHIKV initially came to be known

after an epidemic. Since then, the virus has been identified as one of the

primary vectors of mosquito-borne disease in tropical and subtropical areas,

leading to outbreaks affecting millions of people. Chikungunya virus (CHIKV)

has recently become a concern in temperate regions of the Northern

Hemisphere due to the spread of its mosquito vectors, Aedes aegypti and

Aedes albopictus, which were previously found primarily in tropical countries

(Africa and the Indian subcontinent). On the 7th of September 2017, the

Lazio Regional Service for Surveillance and Control of Infectious Diseases

(SERESMI) notified the Italian Ministry of Health (MoH) of a cluster of three

autochthonous cases of CHIKV infection in Anzio, a beach town with a focus

on domestic tourism one hour outside of Rome. The main focus was three
hundred seventeen cases having an epidemiological relationship to the Anzio

region. Latina (80 cases) and Rome (the other two foci) (8 cases). Anzio and

Latina had cumulative incidences of 331.4 and 7.13 per 100,000 people,

respectively. In Rome, the cumulative occurrences varied from 1.4 to

14.3/100,000. It is the first report of a chikungunya outbreak in a western

nation's heavily populated urban region (Vairo et al., 2018).

Based on geographic locations, phylogenetic analysis has identified

four distinct CHIKV genotypes. Isolates from Senegal and Nigeria constitute

the genotype from West Africa. In Africa, there is also an enzootic genotype

known as the East/Central/South African (ECSA). The Asian genotype includes

isolates from Asian countries. During 2005–2008, the more recent Indian

Ocean Lineage (IOL) genotype, which started in the Comoros islands in 2004,

caused significant epidemics in Southeast Asia and India. Due to the global

distribution of the vectors Aegypti and Albopictus. Scientists have found that

the mutations E1-A226V and E2-L210Q make CHIKV much more likely to

spread. As a result, CHIKV transmission has now reached Europe and the

Americas. According to numerous studies, the 2005–2006 outbreak of

Chikungunya on the island of La Réunion was caused by the incredibly

competent vector Albopictus. Several techniques, including viral culture,

reverse transcriptase PCR (RT-PCR), hemagglutination inhibition test (HAI),

and ELISA, can detect CHIKV quickly. The epidemiology pattern of CHIKV

includes sporadic and epidemic incidence throughout West Africa, from

Cameroon to Senegal, and in many additional African countries (Central

the Congo, South Africa, Malawi, Guinea, and Uganda). In the 1960s and

1990s, several epidemics were followed by significant outbreaks sporadically

during intervals of 7 to 20 years. Because the vectors are common and

effective at spreading the virus, CHIKV is now found worldwide. Travel could

be another contributing factor to the CHIKV outbreak. Travel patterns have

improved the virus's ability to enter new geographic areas through the

movement of viremic individuals (Wahid et al., 2017).

Chikungunya virus (CHIKV) is a resurgent mosquito-borne human

infection that causes chikungunya fever, which is characterized by severe

joint pain. Serological findings in Asia suggested that CHIKV initially appeared

in 1954. From the 1950s through 2005, the Asian genotype was responsible

for irregular CHIKV infections. Symptoms generally emerge 4-7 days after

CHIKV exposure. Although Chikungunya fever is a self-limiting virus with a

low mortality rate, deaths from the disease have occurred in newborns, the

elderly, and people with preexisting diseases such as cardiovascular disease,

diabetes, renal disease, and chronic diseases of liver disease. Since its

mutation, the virus has threatened endemic and epidemic growth throughout

Africa, Asia, Europe, and America. After ten years, it was discovered that new

CHIKV mutations contributed to the second major epidemic in South and

Southeast Asia. Like other arbovirus infections, Chikungunya can cause

various symptoms, including high fever, headache, skin rash, myalgia,

arthralgia, and neurological issues. Depending on the symptoms, chikungunya

viral exposure to the end of day 21), post-acute (after the first three weeks

until the third month after illness onset), and chronic (from 3 months after

disease onset). Most CHIKV infections become symptomatic 3-7 days after

being bitten by a CHIKV-infected mosquito, with the most frequent symptoms

being acute fever sickness (>38.9 °C), arthralgia, rash, and headache

(Khongwichit et al., 2021).

Outbreaks of CHIKV were stated from Bangladesh, Bhutan, India,

Pakistan, Sri Lanka, Nepal, and the Maldives in South Asia from 2007–2020.

Three lineages-Asian, East/Central/South African (ECSA), and Indian Ocean

Lineage (IOL), are circulating in South Asia. Lineage, ECSA, and IOL have

become most important over Asian lineage in South Asian international

locations throughout the 2011–2020 epidemics. Further, the mutant E1-

A226V is circulating in abundance with Aedes albopictus in India, Bangladesh,

Nepal, and Bhutan. CHIKV is underestimated as the clinical signs of CHIKV

infection mix with the symptoms of dengue fever in South Asia. Failure to

prevent vector-mediated transmission and predict CHIKV epidemics increase

the risk of more significant global epidemics in the future (Sharif et al., 2021).

Africa was the first continent to have the first incidence of

Chikungunya, which occurred in Tanzania in 1952. The very first outbreak of

Chikungunya occurred in Tanzania in 1953. Several country communities were

impacted by the outbreak, with 60%-80% of persons in each community

affected by the chikungunya virus. South Africa had another outbreak of

Chikungunya in 1956 and still suffers the disease's burden today. From the

1960s until the 1990s, the Central African Republic, Uganda, Nigeria, and the

Democratic Republic of the Congo saw a series of epidemics. In 2004, the

Kenyan island of Lamu saw a massive outbreak of Chikungunya, infecting

almost 70% of the population. The capacity to disseminate viruses has spread

across the globe. Viremic persons moving are primarily responsible for the

spread of CHIKV into the new geographic regions. The Chikungunya virus has

spread to over 40 nations. Millions of individuals have been impacted globally,

although antipyretic and analgesic medications are used to reduce fever and

inflammation (Saxena et al., 2021).

The first local epidemic of Chikungunya in Europe was reported in 2007

in Italy (Emilia-Romagna area), with 205 cases (either confirmed in the

laboratory or defined clinically). Chikungunya epidemics have happened on a

local scale several times since then. In France, two verified instances were

registered in 2010 (Var department), and another 12 cases were confirmed in

2014. (Montpellier). The first confirmed transmissions of the chikungunya

virus in central and southern Italy (regions Lazio and Calabria) were reported

in 2017, with 270 confirmed and 229 suspected cases. Climate change has an

impact on mosquito dispersion. For instance, when minimum temperatures

rise or warm seasons lengthen, certain unfavorable places may become

acceptable climatic conditions for mosquitoes. These three worldwide models

the tropics. Consequently, it is not unexpected that it did not function poorly

in temperate or Mediterranean climates because seasonal dynamics differ

significantly, with tropical climates driven by precipitation patterns rather than

temperature seasonality. Extreme frost episodes, which might impair the

survival of mosquito eggs, play little role in the tropics. In order to make

usable chikungunya risk maps for non-tropical countries such as Europe,

models must be calibrated using data from places with comparable climates

to the target area (Tjaden et al., 2021).

In a country like India, where Chikungunya, dengue fever, and malaria

are widespread, the cycle of these infections overlaps. Because Chikungunya

and Dengue share a vector and have similar clinical presentations, multiple

investigations have observed coinfections (Saswat et al., 2015; Kaur et al.,

2017). Although these two viruses exhibit similar symptoms, their results and

therapeutic approaches differ dramatically. Clinicians must assess based on

numerous clinical manifestations and laboratory tests to begin appropriate

therapy and prevent complications such as hemorrhages, Acute respiratory

distress syndrome (ARDS), renal failure, and arthritis (Kaur et al., 2018). It

has been demonstrated that essential clinical and laboratory characteristics

may predict such infections and categorize them into indications and

laboratory tests for optimal care (Lee et al., 2012). Acute arthritis, shorter

duration of fever, rash, myalgia/arthralgia, and conjunctivitis are more

common in CHIKF, but stomach discomfort, leukopenia, neutropenia, and

is a considerable variation in platelet level cut-offs between D.F. and CHIKF,

as well as patient bleeding. Since roughly 50 years ago, CHIKV outbreaks

have been consistently reported in Indonesia. In Samarinda, East Kalimantan,

in 1973, the first epidemic formally acknowledged in the nation occurred.

Since then, reports of isolated CHIKV outbreaks in Indonesia have increased.

These reports peaked during a national pandemic between 2009 and 2010,

resulting in 137,655 cases and dwarfing earlier case numbers that had never

exceeded 10,000 per year. Official CHIKV case rates in Indonesia have

reverted to comparable levels recorded before the pandemic in 2011. On

occasion, epidemics have nonetheless persisted across the archipelago.

Notably, persons returning from Indonesia were identified as the most

frequent source of imported cases of CHIKV in two investigations screening

symptomatic travelers returning to Taiwan (2006-2009) and Japan (2006-

2016). Both Taiwan and Japan have competent vector species, which

emphasizes Indonesia's potential to be a source of CHIKV transmission in the

area. It raises the possibility that an imported case of CHIKV might result in

local transmission, as was observed in Italy in 2007 (Stubbs et al., 2020).

Although the Chikungunya virus (CHIKV) has been causing sporadic

outbreaks in the Philippines since the 1960s, it is still classified as a novel

infection. Due to its shared infection vectors, the Aedes aegypti and Aedes

albopictus mosquitoes, this virus is sometimes mistaken for dengue due to

the similarity in symptoms. Compared to dengue, this virus is a resurgent

these are common in tropical places. In 2012, there were 777 confirmed

cases of Chikungunya. Five hundred sixty-two (562) confirmed cases of

Chikungunya were totaled as of July 2013. Additionally, compared to areas

where the number of CHIKV infections decreased, more areas have seen a

rise in CHIKV infections over a year and a half. For the years 2012 and 2013,

only ARMM was immune to the CHIKV virus. The prevalence was 0.61 in 2012

and rose to 0.84 in 2013—a 37% rise (until July). The three regions with the

most excellent incidence rates for 2012 were Region XI, Region V, and Region

X, Region VI, Region IV-B, and the CARAGA Region topped the list for 2013.

Furthermore, the number of confirmed CHIKV infections per area and

prevalence rates increased significantly from 2012 to 2013 (Cueva et al.,

2018).

As cited by Cueva (2018), in the Philippines, the re-emerging

chikungunya virus has been causing concern, especially given how common

arboviral infections like this are in tropical regions. According to the National

Epidemiological Center (NEC) of the Department of Health, the first formal

reports of Chikungunya virus (CHIKV) infection in the Philippines were made

in 2012. However, the virus has been sporadically causing outbreaks in the

nation since the 1960s. Consequently, nothing is known about the behavior

and epidemiology of CHIKV in the nation. Pulmanausahakul et al. claim that

CHIKV has been present in the Philippines since the late 1960s. In 1968,

Macasaet investigated the virus in Dumaguete City and wrote about his

findings. In 1996, the CHIKV resurfaced in a rural village in the province of

have not been many efforts to track down infections there or record data.

Records of recent outbreaks are available from the Department of Health's

NEC (from 2012 to 2013). According to DOH, routine surveillance reports for

CHIKV were not conducted on the same scale as those for leptospirosis

outbreaks, dengue fever, and other recurring illnesses. Consequently, not

much is known about its prevalence, which will help evaluate the impact of

CHIKV. Incidence solely considers new cases. However, prevalence

encompasses both new and old, making it the preferred assessment method.

After a three-decade hiatus, the first cases were recorded in Sindh

Province and the Federal Capital, with infections spreading to three provinces

by mid-2017. After the arrival of winter, there was a significant decline in

cases by the end of 2017, resulting in decreased vector activity. Researchers

identified Chikungunya and dengue disease in 776 (50%) and 109 (7%),

respectively, of the 1,549 samples studied till the 31st of July, 2018, with no

patient testing positive for Zika virus. The data also reveal that population

mobility and the number of potential mosquito vectors (Aedes aegypti and

Aedes albopictus) are critical determinants enabling efficient viral transmission

in Pakistan. Similarly, while this is the first CHIKV epidemic documented on a

large geographical scale in Pakistan, the identification of simultaneous cases

in all four provinces suggests that the incidence of mosquito-borne illnesses

will rise in the future years. Comprehensive research of disease determinants

cannot be conducted without installing a countrywide functioning monitoring

affect large populations. A long-term monitoring program with possible

epidemic indicators is also necessary to lower the risk of viral transmission by

producing early warnings, which is one of the most well-known treatments

given the impossibility of perfect vector control. The current CHIKV outbreak,

which was first regarded as a "mystery" disease, provides evidence of

weakened local and regional contingency strategies. Given that humans are

the only amplifying host for such observing pathogens, the most effective

interventions, such as vector control and patient isolation and restriction to

prevent further transmission, may be challenging to implement in resource-

constrained countries such as Pakistan; therefore, it is essential to identify

areas with the highest risk of infection in order to inform and implement

control priority measures. The team's findings emphasize the importance of

enhancing laboratory services in provincial and high-risk regions to create

reliable information for patient care and wise resource allocation (Badar et al.,

2019).