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 instances of the mosquito-borne illness each 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 chunk of contaminated Aedes aegypti mosquitos. These mosquitos additionally carry and unfold dengue and the Zika virus.
The identify, chikungunya, derives from a phrase within the Kimakonde language, spoken in Tanzania and Mozambique, that means “to turn into contorted”.
How dangerous is the chikungunya outbreak in Pakistan?
In latest months, extreme instances of chikungunya have been reported in Karachi, significantly amongst aged sufferers and people with diabetes, in response to a report from Aga Khan College Hospital.
Problems embrace neurological points like paralysis and coma, in addition to coronary heart and eye issues. These extreme instances typically require intensive care and mechanical air flow, with unsure restoration prospects and a danger of extended hospitalisation or dying.
In line with authorities information seen by Al Jazeera, 172 folks in Karachi examined constructive for polymerase chain response (PCR) checks between Might and September. Of 956 folks suspected of getting the virus, 713 have been examined. Nonetheless, the precise variety of instances is probably going a lot increased.
Many individuals are recognized with out the PCR take a look at, relying as an alternative on matching signs and blood checks that present low platelet counts, which could be attributable to chikungunya.
Shoaib Khan, normal doctor at a non-public hospital in Karachi’s Nazimabad, informed The Specific Tribune newspaper that the excessive take a look at price had additionally prevented sufferers from getting a correct prognosis.
The PCR take a look at for the virus is on the market at a number of non-public 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 response to World Financial institution information, making it unaffordable for many individuals.
One among Karachi’s authorities hospitals, the Jinnah Postgraduate Medical Centre, gives free checks for chikungunya, Muslim Shah, a metropolis resident who visited the ability on Thursday, informed Al Jazeera. Karachi has a inhabitants of round 20 million folks, in response to the 2023 census.
Shah informed Al Jazeera that the hospital doesn’t have a separate chikungunya ward, and the sufferers hospitalised with the mosquito-borne virus are normally wards, with out mosquito nets.
Chikungunya and dengue are anticipated to stay extreme till December, Abdul Wahid Rajput, director of the Sindh Infectious Ailments Hospital and Analysis Centre, informed The Specific Tribune.
Residents in Karachi and Lahore, the place mosquito-borne viruses are frequent, have blamed the federal government for not commonly finishing up fogging, which entails 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 – through a service mosquito – is the best throughout the first week of an infection. The virus doesn’t instantly unfold from human to human.
This cycle seemingly 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 most typical signs. Whereas deadly instances are uncommon, joint ache could 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 type that you simply get while you sleep in your wrist humorous,” 23-year-old Karachi resident Nawal Malik, who contracted the virus in late September, informed Al Jazeera.
Malik’s mom, colleague, and neighbour additionally contracted the virus across the similar time.
Quickly, all of Malik’s joints have been hurting, together with her fingers and knuckles. Moreover joint ache, she skilled nausea, low blood strain, coronary heart palpitations, ache behind her eyes, chills and high-grade fever.
“For some other an infection, the fever often breaks while you take medicines for it, however for us with chikungunya, the fever would come again rapidly 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 “way more extreme”. She has beforehand been recognized 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 a couple weeks. After that, an individual will seemingly have life-long immunity from the virus.
Chikungunya signs are much like these of dengue and the Zika virus. Because of this, chikungunya is usually 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 response to the Facilities for Illness Management and Prevention (CDC) in the US.
Nonetheless, not all ache relievers are secure throughout a suspected an infection. The CDC advises in opposition to taking non-steroidal anti-inflammatory medication (NSAIDs) till dengue has been dominated out, as they’ll enhance the danger of bleeding. In extreme instances, dengue sufferers can have inside or exterior bleeding issues.
Frequent examples of NSAIDs embrace ibuprofen, Advil, and aspirins.
Over-the-counter medicines reminiscent of acetaminophen or paracetamol are acceptable as they cut back ache and fever, however do not need anti-inflammatory results.
How can one shield in opposition to chikungunya?
Well being authorities help defending oneself in opposition to mosquito bites as the simplest technique in opposition to the unfold of chikungunya.
This may occasionally contain sporting 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 open air.
Is there a vaccine?
A single-dose chikungunya vaccine (IXCHIQ) is on the market in the US. In line with a November 2023 article by the US Meals and Drug Administration (FDA), it’s accredited for people 18 years and older and at a better danger of publicity to the virus. In June 2024, Ixchiq obtained market authorisation in Canada and in July, in Europe.
Nonetheless, 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 approved a chikungunya vaccine thus far.
Individuals at increased danger of extreme signs embrace newborns, seniors and other people with medical situations reminiscent of diabetes or hypertension.
The place has it unfold?
In 2024, some 460,000 Chikungunya virus instances have been reported worldwide, together with 170 related deaths, in response to the European Centre for Illness Prevention and Management (ECDC).
In line with the ECDC, international locations with the best variety of instances in 2024 included Brazil, with 391,754 reported instances and India, with 69,439 reported instances.
The virus was first recognized in what’s now Tanzania – then referred to as Tanganyika – in 1952 and has since been reported in 118 international locations, in response to 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, not like world pandemics, that are extra widespread.
Brazil, Paraguay, Argentina and Bolivia are some international locations with probably the most instances, in response to the European CDC.
Sporadic outbreaks have additionally been reported in areas with the Aedes aegypti mosquito, reminiscent of 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, informed 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 kind of insecticide that kills mosquitos of their immature larvae and pupae phases, stopping them from growing into biting adults, in response to the CDC.
