Answer 1 of 3: Have recently read that in and this year there were several outbreaks of Chikungunya fever in India including seems there is no. PDF | India was affected by a major outbreak of chikungunya fever caused by Chikungunya virus (CHIKV) during Kerala was the. Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that is emerging as a .. One lac people were again infected with CHIKV in in Kerala.
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To assess the effect of this epidemic, mortality rates in were compared with those in — for Ahmedabad population 3. A total of 2, excess deaths occurred during the chikungunya epidemic August—November when compared with the average number of deaths in the same months during the previous 4 years. These excess deaths may be attributable to this epidemic.
However, a hidden or unexplained cause of death is also possible.
Public health authorities should thoroughly investigate this increase in deaths associated with this epidemic and implement measures to prevent further epidemics of chikungunya. Chikungunya virusan alphavirus of the family Togaviridaeis native to tropical Africa and Asia.
This virus is transmitted to gunja by mosquitoes. Aedes aegypti and Ae.
The first reported chikungunya outbreak occurred in Tanganyika now Tanzania in — 2. Symptoms of chikungunya include sudden onset of fever, severe arthralgia, and maculopapular rash. A specific symptom is severe incapacitating arthralgia, often persistent, which can result in long-lasting disability 3. Historically, chikungunya was considered self-limiting and nonfatal.
India reported a massive chikungunya epidemic in Chikungunya has reemerged in India sincewhen the attack rate was The dominant vectors are Ae. Studies have indicated that the recent outbreak in the Indian Ocean islands was initiated by a strain related to East African isolates, from which viral variants have evolved with a traceable history of microevolution. This history could provide information for understanding the unusual magnitude and virulence of this chikungunya epidemic 8.
The purpose of this study was to analyze the association between the chikungunya epidemic in India and the mortality rate in the city of Ahmedabad. Such findings could show correlations between reported genomic mutations in chikungunya virus and its increased virulence.
Such information is valuable for public health systems in developing countries that frequently underreport or misreport epidemics. The registrar of births and deaths RBD of Ahmedabad, who is a subordinate officer to the medical officer of health, registers all births and deaths within the city limits under the Registration of Births and Deaths Act. Deaths are registered in 2 ways. Deaths that occur in a hospital are reported by hospital authorities, who provide a medical certificate of death that is sent to the RBD officer in the city ward in which the hospital is located.
Deaths that occur at home are reported by the family to the local RBD officer of the ward in which their home is located. Deaths are compiled and sent from the RBD ward office to the RBD central office and subsequently communicated to the state level registrar of birth and death. Death data used in this study were provided by the medical officer of health of the city. Data include monthly total deaths registered in Ahmedabad during — During the chikungunya epidemic, the city health department collected, compiled, and reported data on suspected cases of chikungunya from municipal hospitals and health centers.
Data include monthly reported cases of chikungunya, blood samples sent for testing, and samples positive for chikungunya virus infection in Ahmedabad starting in April Few data were reported by private hospitals, dispensaries, and private practitioners in the city, who treat many patients.
Average mortality rate for each month during — years before the epidemic was calculated by dividing the average number of deaths for each month by the average population. Average mortality rate for each month in was calculated by dividing the number of registered deaths for each month by the monthly population. The expected number of monthly deaths for each month in was calculated by multiplying the average mortality rate for each month — by the monthly population in Because there were 12 estimates of expected deaths 1 for each monthwe used the more conservative simultaneous confidence interval CI and the Bonferroni method 9 instead of a simple CI for each month separately.
Excess deaths for each month in were the difference between actual observed number of deaths and expected number of deaths. Average monthly mortality rates for — were then compared with the mortality rate for epidemic year.
The medical officer o fhealth in Ahmabadad reported 60, suspected chikungunya cases in The peak of the epidemic occurred kerla August and September when guny, A total of 84 Of these 84 confirmed chikungunya cases, 10 were fatal case-fatality rate A monthly distribution of cases of chikungunya, actual and expected number of deaths inand monthly average mortality rates for — and per 10, persons are shown in the Table.
The number of deaths and mortality rates increased substantially from August through November compared with values for — for the same months. The highest numbers of chikungunya cases were also reported during these months. A comparison of the monthly distribution of actual deaths in with expected deaths showed a rapid increase in deaths registered from August through November In these 5 months, 2, additional deaths Excess number of deaths peaked in Septemberwhen 1, additional deaths Monthly chikungunya cases, expected deaths, and reported deaths, Ahmedabad, India, Jul—Dec, differences were statistically significant.
The temporal gnuya between chikungunya cases and expected mortality kerlaa and actual mortality rates in is shown in the Figure. The peak in chikungunya cases in August—September coincides with the peak in actual deaths in Analysis of our data shows that the mortality rate in Chikuj increased hunya in when compared with rates for the previous 4 years. A total of 3, excess deaths occurred in the epidemic year when compared with the expected number of deaths for that year.
A substantial increase in deaths reported was observed from August through November 2, excess deaths in these months. The number of reported chikungunya cases also showed a peak in August and Septemberwhich coincided temporally with the peak in number of deaths in Ahmedabad Figure.
Chikungunya virus out break in Kerala
The main issues of contention are whether these excess deaths were caused by chikungunya and whether such excess deaths will occur in future years without chikungunya epidemics. No major adverse event or other epidemic occurred in Ahmebabad in August—November other than the chikungunya epidemic.
Our epidemiologic evidence shows that the epidemic is the most plausible explanation for the large increase in deaths in Ahmedabad in August—November However, other unidentified causes cannot be ruled out.
Similar data from other cities and areas affected by the chikungunya epidemic may help establish the link between chikungunya and excess deaths. There cchikun 2 major problems with reporting of deaths in Ahmedabad. The cause of death is poorly reported, and the RBD does not separate death data for residents and nonresidents.
Inclusion of patients from surrounding rural areas who died in city hospitals could have resulted in excess deaths being reported during the epidemic. However, this was a problem chijun years before the epidemic — as well. A review of deaths registered in rural areas outside the city limits of Ahmedabad showed no chilun decrease during the epidemic months of over previous years. Thus, the increase in number of deaths caused by migration of sick patients cannot explain this major increase in deaths inalthough this factor may have contributed to it.
The excess number of deaths observed during the epidemic in Chiun suggests that estimates of deaths caused by chikungunya in India need to be revised. Chiiun the increase in deaths in Ahmedabad and reports of suspected deaths caused by chikungunya in Kerala State, India 13no systematic and comprehensive investigation of deaths in relation to this epidemic has been conducted by government authorities at the national or state level in India.
Further investigations on the cause of excess deaths are urgently needed to conclusively establish that chikungunya was the cause of excess chikkun in Ahmedabad. Given the possible association of deaths with the chikungunya fever epidemic in Ahmedabad, public health authorities should investigate such epidemics in other countries.
These investigations will help determine whether the virus has increased in virulence, which may also pose a greater threat outside the Indian Ocean region. Such studies would help detect and control similar epidemics and help governments to provide adequate warnings to travelers to chikungunya-endemic countries.
We report an increase in mortality rates in Ahmedabad during August—November when a chikungunya epidemic occurred chikn this city compared with previous months in and the same months in the past 4 years. The highest number of chikungunya cases was also reported in August and September. Epidemiologic evidence shows that the chiiun in deaths in Ahmedabad was largely attributable to the chikungunya epidemic. Given poor reporting of deaths, an gjnya cause of death cannot be ruled out.
Mortality rate data for Ahmedabad are consistent with observations of gunyz researchers that the virus may have mutated and become more dangerous than reported 8. Public health authorities must investigate recent epidemics. Otherwise, developing countries may not be able to detect and combat severe future epidemics of other reemerging diseases such as avian influenza and severe acute respiratory syndrome. If our findings are validated by studies in other regions of India and elsewhere, it would assist the yunya health community to be better prepared in dealing with future epidemics of emerging infectious diseases and reduce associated deaths.
Increased Mortality Rate Associated with Chikungunya Epidemic, Ahmedabad, India
We thank Yousuf Saiyed for providing mortality data and S. Kulkarni for providing data on monthly chikungunya cases. His primary research interests include management of primary health care, family planning programs, quality of care, reproductive healthcare, and maternal health programs. Suggested citation for this article: Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India.
Emerg Infect Dis [serial on the Internet]. National Center for Biotechnology InformationU. Journal List Emerg Infect Dis v. Author information Copyright and License information Disclaimer.
This article has been cited by other articles in PMC. Methods Collection of Death Data The registrar of births and deaths RBD of Ahmedabad, who is a subordinate officer to the medical officer of health, registers all births and deaths within the city limits under the Registration of Births and Deaths Act. Collection of Chikungunya Case Data During the chikungunya epidemic, the hunya health department collected, compiled, and reported data on suspected cases of chikungunya from municipal hospitals and health centers.
Statistical Analysis Average mortality rate for each month during — years before the epidemic was calculated by dividing the average number of deaths for each month by the average population. Results The medical officer o fhealth in Ahmabadad reported 60, suspected chikungunya cases in Chioun in a separate window. Discussion Analysis of our data shows that the mortality rate in Ahmedabad increased substantially in when compared with rates for the previous 4 years. Acknowledgments We thank Yousuf Saiyed for providing mortality data and S.
Footnotes Suggested citation for this article: Characterization of reemerging chikungunya virus. Reemergence of endemic chikungunya, Malaysia.