Hospitals in Pakistan’s largest metropolis, Karachi, are brimming with chikungunya virus sufferers.
Main authorities hospitals all through the town are reporting 500 to 750 suspected circumstances of the mosquito-borne illness every single day, as famous by native media earlier this month, additional straining an already struggling public well being system.
However what’s chikungunya, how does it unfold, and why has it hit Pakistan’s most populous metropolis so badly?
What’s chikungunya?
Chikungunya is a viral illness that’s unfold via the chew of contaminated Aedes aegypti mosquitos. These mosquitos additionally carry and unfold dengue and the Zika virus.
The title, chikungunya, derives from a phrase within the Kimakonde language, spoken in Tanzania and Mozambique, which means “to turn into contorted”.
How unhealthy is the chikungunya outbreak in Pakistan?
In latest months, extreme circumstances of chikungunya have been reported in Karachi, significantly amongst aged sufferers and people with diabetes, in keeping with a report from Aga Khan College Hospital.
Issues embrace neurological points like paralysis and coma, in addition to coronary heart and eye issues. These extreme circumstances typically require intensive care and mechanical air flow, with unsure restoration prospects and a danger of extended hospitalisation or demise.
In accordance with authorities information seen by Al Jazeera, 172 folks in Karachi examined constructive for polymerase chain response (PCR) exams between Might and September. Of 956 folks suspected of getting the virus, 713 had been examined. Nevertheless, the precise variety of circumstances is probably going a lot greater.
Many individuals are identified with out the PCR check, relying as a substitute on matching signs and blood exams that present low platelet counts, which will be attributable to chikungunya.
Shoaib Khan, basic doctor at a personal hospital in Karachi’s Nazimabad, advised The Categorical Tribune newspaper that the excessive check value had additionally prevented sufferers from getting a correct prognosis.
The PCR check for the virus is accessible at a couple of personal hospitals and prices 7,000 rupees ($25) to eight,000 rupees ($28) in a rustic the place the per capita month-to-month revenue was $118 again in 2021, in keeping with World Financial institution information, making it unaffordable for many individuals.
One in all Karachi’s authorities hospitals, the Jinnah Postgraduate Medical Centre, gives free exams for chikungunya, Muslim Shah, a metropolis resident who visited the power on Thursday, advised Al Jazeera. Karachi has a inhabitants of round 20 million folks, in keeping with the 2023 census.
Shah advised Al Jazeera that the hospital doesn’t have a separate chikungunya ward, and the sufferers hospitalised with the mosquito-borne virus are usually wards, with out mosquito nets.
Chikungunya and dengue are anticipated to stay extreme till December, Abdul Wahid Rajput, director of the Sindh Infectious Illnesses Hospital and Analysis Centre, advised The Categorical Tribune.
Residents in Karachi and Lahore, the place mosquito-borne viruses are frequent, have blamed the federal government for not frequently finishing up fogging, which includes spraying disinfectant to eradicate mosquitoes.
How does chikungunya unfold?
If an contaminated mosquito bites a wholesome human, it injects the virus into the bloodstream.
If a non-infected mosquito bites an individual who’s already contaminated, it sucks the virus from that particular person’s blood and turns into a service able to transmitting the virus to others via bites.
Well being authorities warn that the danger of the virus spreading from an contaminated particular person – by way of a service mosquito – is the very best throughout the first week of an infection. The virus doesn’t straight unfold from human to human.
This cycle possible started after mosquitos bit contaminated animals. Chikungunya naturally exists in wild animals (like monkeys) that function a virus reservoir.
What are chikungunya signs?
Fever and joint ache are the commonest signs. Whereas deadly circumstances are uncommon, joint ache will be extreme and proceed for months.
Contaminated folks may additionally have complications, nausea, fatigue, muscle ache, joint swelling, or a rash.
“It began off with me feeling ache in my wrist. The sort that you simply get once you sleep in your wrist humorous,” 23-year-old Karachi resident Nawal Malik, who contracted the virus in late September, advised Al Jazeera.
Malik’s mom, colleague, and neighbour additionally contracted the virus across the identical time.
Quickly, all of Malik’s joints had been hurting, together with her fingers and knuckles. Apart from joint ache, she skilled nausea, low blood stress, coronary heart palpitations, ache behind her eyes, chills and high-grade fever.
“For some other an infection, the fever often breaks once you take medicines for it, however for us with chikungunya, the fever would come again shortly after breaking,” she mentioned, speaking in regards to the expertise of herself and her mom.
As of Wednesday, it has been about three weeks since Malik recovered from the virus, however she nonetheless experiences acute ankle ache.
For her mom, 63, the virus was “far more extreme”. She has beforehand been identified with osteoarthritis and diabetes.
“For her, the joint ache was actually horrible; it’s the worst ache I’ve ever seen her in,” she mentioned, including that her mom’s joints proceed to harm weeks after restoration.
Signs often start three to seven days after an contaminated mosquito bites you. Many individuals get well inside per week to some weeks. After that, an individual will possible have life-long immunity from the virus.
Chikungunya signs are much like these of dengue and the Zika virus. In consequence, chikungunya is commonly misdiagnosed, say consultants, together with the World Well being Organisation.
How is chikungunya handled?
Whereas there aren’t any particular medicines to deal with it, relaxation, fluids, and ache relievers could assist alleviate signs, in keeping with the Facilities for Illness Management and Prevention (CDC) in the USA.
Nevertheless, not all ache relievers are secure throughout a suspected an infection. The CDC advises in opposition to taking non-steroidal anti-inflammatory medicine (NSAIDs) till dengue has been dominated out, as they will improve the danger of bleeding. In extreme circumstances, dengue sufferers can have inside or exterior bleeding issues.
Frequent examples of NSAIDs embrace ibuprofen, Advil, and aspirins.
Over-the-counter medicines similar to acetaminophen or paracetamol are acceptable as they scale back ache and fever, however shouldn’t have anti-inflammatory results.
How can one shield in opposition to chikungunya?
Well being authorities help defending oneself in opposition to mosquito bites as the best technique in opposition to the unfold of chikungunya.
This will likely contain carrying lengthy sleeves and pants, making use of mosquito repellants, eradicating standing water, and staying in closed, air-conditioned areas indoors or behind mosquito netting when outdoor.
Is there a vaccine?
A single-dose chikungunya vaccine (IXCHIQ) is accessible in the USA. In accordance with a November 2023 article by the US Meals and Drug Administration (FDA), it’s authorised for people 18 years and older and at a better danger of publicity to the virus. In June 2024, Ixchiq acquired market authorisation in Canada and in July, in Europe.
Nevertheless, Meeran Yousuf, spokesperson for the Sindh Well being Division, mentioned that Pakistan often solely makes use of vaccines authorised by the WHO, which has not authorised a chikungunya vaccine to date.
Individuals at greater danger of extreme signs embrace newborns, seniors and other people with medical situations similar to diabetes or hypertension.
The place has it unfold?
In 2024, some 460,000 Chikungunya virus circumstances have been reported worldwide, together with 170 related deaths, in keeping with the European Centre for Illness Prevention and Management (ECDC).
In accordance with the ECDC, international locations with the very best variety of circumstances in 2024 included Brazil, with 391,754 reported circumstances and India, with 69,439 reported circumstances.
The virus was first recognized in what’s now Tanzania – then often called Tanganyika – in 1952 and has since been reported in 118 international locations, in keeping with the World Well being Group.
In Africa, Southeast Asia, the Indian subcontinent, the Pacific Area and the tropical areas of the Americas, it has turn into endemic.
An endemic virus persistently exists inside a selected geographic space or inhabitants. Outbreaks, on this case, are predictable over time, in contrast to world pandemics, that are extra widespread.
Brazil, Paraguay, Argentina and Bolivia are some international locations with essentially the most circumstances, in keeping with the European CDC.
Sporadic outbreaks have additionally been reported in areas with the Aedes aegypti mosquito, similar to Yemen and Italy. France reported one non-travel-related chikungunya an infection in August.
What’s the authorities doing?
Meeran Yousuf, spokesperson for the Sindh Well being Division, advised Al Jazeera that the federal government is finishing up “a number of spray actions” all through the province of Sindh, the place Karachi is situated.
These efforts intention to eradicate the mosquito accountable for spreading chikungunya.
As well as, the federal government is finishing up consciousness campaigns. “We’re additionally doing larvicidal actions,” Yousuf added. A larvacide is a sort of insecticide that kills mosquitos of their immature larvae and pupae phases, stopping them from growing into biting adults, in keeping with the CDC.