CHIKUNGUNYA IN INDONESIA

Ministry of Health, Republic of Indonesia

Chikungunya Fever:
An Acute viral infection of abrupt
p onset,, heralded by
y

fever and severe arthralgia, followed by other

constitutional symptoms ,e.g. headache, nausea,
vomiting, coryza,conjunctivitis, photophobia and
retro-orbital
retro
orbital pain and rash.
Fever rises abruptly 39-40C, and accompanied
by intermittent shaking chills
chills.
The name Chickungunya is derived from the Swahili
word indicating that
that which bends up
up in reference
to the temporarily disabling joint symptoms

CLINICAL FEATURES
Incubation period is 2
2-4
4 days
Duration of acute illness 3-5 days quite sick
Recovery : 5
5-7
7 days
Most common complaint is joint pain (70%)
Persistent or recurrent joint pain & stiffness for 1 year

or more

CLINICAL FEATURES
1. Fever
2 Pain
2.
P i in
i one or more joints.
j i t especially
i ll on kknee
joints, metacarpal/ tarsal, finger and vertebra
3 Myalgia,
3.
Myalgia headache and back pain
pain.
4. Maculo-papular rash may be onset of 1st day
of fever but usually on 4th 5th days of fever
Usually available on face, body, hand and foot

Other clinical signs and symptoms:

Hemorrhage manifestation such as: petechiae,

echimosis, gum bleeding, haematemesis and
melena.
One attack of Chikungunya will give life-long
i
immunity.
it

The Distinguishing Features

DHF and Chikungunya
Sign and Symptom
Pharyng Hyperemis
Vomit
Constipation
Abdominal pain
Headache
Lymphadenopathy
Conjuctiva Hyperemis
Cough
Restlessness, Iritability
Rhinitis
Maculo papular rash
Myalgia/Joint Pain
Enantema
Abnormal Reflex
Diarrhea
Splenomegali (Infant > 6
months)
Coma

DHF
(%)

Signs & Symptom

Chikungunya
(%)

98,9
57,9
53,3
50,0
44,6
40,5
32,8
21,5
21,5
12,8
12,1
12,0
8,3
6,7
6,4
6,3

90,3
59,4
40,0
31,6
68,4
30,8
55,6
23,3
33,3
6,5
59,6
40,0
11,1
0
15,6
3,1

3,0

Epidemiology
First case was reported
p
in 1973 in East

Kalimantan and DKI Jakarta

1982 in Jambi and Sumatera Utara, Java, West
Kalimantan
1983 : South Kalimantan , East Kalimantan,
Central Kalimantan, South Sulawesi.
2003 : Java, NTB, Central Kalimantan.
2006-2007 : Java, South Sumatera.
2000-2008: Total cases are 19.238

Chikungunya,
I d
Indonesia,
i 2001-2008
2001 2008
Year

Cases

Death

SubDistr Villages

2001

539

2002

1818

16

2003

8732

68

87

2004

1266

11

2005

340

14

2006

1401

18

18

2007

1111

23

23

2008

1925

15

70

CHIKUNGUNYA, Indonesia, 2001-2008

10000
C
Cases
and
d number
b off SSubDistrics
bDi i

100

8000

80

6000

60

4000

40

2000

20

0
SubDistr
Cases

0
2001 2002 2003 2004 2005 2006 2007 2008

Subdit. Arbo : Outbreak Report

Chikungunya Outbreak
Indonesia, 2001-2007
15.209 cases
68 Districts
7 Provincies

S
#

S
#
#S
S
#

#
S
#S
#S
S
#
S
##
S
#
S
#
S
SS
#
#S
S
##
#
S
S
#
#
S
##
S#
#
S
##S
S
#
S#
S#
#
S
S#
#S
S
SS
#
S#
S #
S#
#
S
S
S
#
S
S
#S
S #
#
S#
S
#
#S
S
#
S
#
#
S
S
##
# S
SS
#
# S
##
S

1 outbreak

Chikungunya Outbreak
Indonesia, 2001-2008

Chikungunya Outbreak,
Sungai Dua Village, Banyuasin, Sumatera Selatan, 2006
(case=fever or joint pain)

Sign

Total

Present of Sign

Fever

25

22

88%

Rash

25

14

56%

Pains of one/
more joints
Perdarahan

25

25

100%

25

0%

Death

25

0%

Subdit. Arbo : Outbreak Investigtion Report, Juzi and Iriani, 2006

Chikungunya Outbreak,
Sungai Dua Village, Banyuasin, Sumatera Selatan, 2006

A
Age

P
Pop

C
Cases

AR/100

CFR

0-11 mt

96

2,08

0%

1-5 yr

96

21

21,9

0%

6-14
6
14 yr

565

51

90
9,0

0%

15-44 yr

1611

286

17,8

0%

>45 yr

986

141

14,3

0%

Total

3354

501

14,9

0%

Subdit. Arbo : Outbreak Investigtion Report, Juzi and Iriani, 2006

Chikungunya
g y Outbreak,,
Sungai Dua Village, Banyuasin, Sumatera Selatan, 2006
160
140

C
Cases

120
100
80
60
40
20
0

19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Week
Subdit. Arbo : Outbreak Investigtion Report, Juzi and Iriani, 2006

L b
Laboratory
t
Diagnosis
Di
i
Three main laboratory tests are used for
Diagnosing Chikungunya virus e.g: :
Virus isolation
Serological test using ELISA method
Molecular technique of PCR

Transmission cycle
Chikungunya is caused by

a virus of Togaviridae
g
family, genus Alphavirus

It is transmitted by the

Aedes mosquito.

Aedes mosquitoes bites in

day time.

It breeds
b d in
i domestic
d
ti

containers

 Mosquito life cycle

ONE GENERATION IS BORN ROUGHLY EVERY WEEK

Treatment
Supportive and symptomatic
Antipyretics
Non steroid anti inflammation non steroid
(NSAID)
Threat underlying diseases
Physical
Ph i l therapy
th
& rehabilitation
h bilit ti

O tb k response
Outbreak
Outbreak criteria :
One or more cases in one area where is no
case was reported before.
Outbreak response
p
include 3 activities:
a. Outbreak Investigation
p Treatment
b. Prompt
c. Prevention of the outbreak and close
surveillance

Outbreak Prevention and Close

S
Surveillance
ill
Intensify weekly report (PWS-KLB Mingguan)
Intensifiy daily report (PWS-KLB Harian)
Early Warning System of Chikungunya Outbreak:

Based on the increasing of the outbreak event in

one area
area. The data was collected from PHC
PHC,
Hospital, Laboratory and Monthly report from
Health Districts Services (STP)
(
)
Intensify Epidemiological Surveillance and
Entomology

P
Prevention
ti
Since no vaccine and no preventive drug --

The best way is to prevent mosquito bite and

mosquito breeding
PSN/ Mosquito Source Reduction
Larvaciding
L
idi
Fogging is use to reduce Infected adult

mosquito and controlling the transmission and

to prevent outbreak spread widely.

Mosquito Breeding Places