Chikungunya primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Alonso Alvarado, M.D. [3]; Vendhan Ramanujam M.B.B.S [4]

Overview

In the absence of an effective vaccine to prevent chikungunya virus infection, the only available tool to prevent the infection is by reducing the human-vector contact.

Integrated Vector Management Program to Reduce the Risk of Chikungunya Virus Infection

The primary vectors of chikungunya virus infection are Aedes aegypti or Aedes albopictus. Therefore, vector control planning efforts should focus on suppression of both the mosquito populations in order to prevent the likelihood of chikungunya virus infection establishment and to lay the foundation for emergency interventions in the event of an outbreak. Since the biology and control procedures for Aedes aegypti are similar to those for Aedes albopictus, surveillance and control recommendations developed for dengue management as a component of the Integrated Management Strategy for Dengue Prevention and Control (IMS-Dengue) may be utilized and intensified in order to respond to a chikungunya virus infection introduction. Successful Integrated Vector Management (IVM) for chikungunya virus infection requires trained experts in medical entomology and vector control, sufficient resources, and a sustained commitment.

Vector Surveillance and Identification of High Risk Areas

  • Given the similarity in transmission cycles of both Dengue and Chikungunya viruses, in areas where dengue is endemic, a retrospective analysis of Dengue virus transmission during previous years should be conducted during the chikungunya virus infection planning phase to indicate the areas where chikungunya virus infection is expected to circulate.
  • Depending on the risk of transmission, stratification is done and it is used to assign resources and priorities.
  • Surveillance methods for Aedes aegypti and Aedes albopictus are varied and include methods to monitor egg production, larval sites, pupal abundance, and adult abundance.
  • It must also be able to detect and identify hidden and difficult to control larval sites (e.g., cryptic locations such as septic tanks, storm drains, sump pumps, and vacant lots) and other productive sites, as well as the readily identified and commonly found larval habitats.

Personal Protection

  • The likelihood of the infection can be reduced by the use of personal repellents on skin or clothing. DEET (N,N-diethyl-m-toluamide) and picaridin (also known as KBR3023 or Bayrepel™) are effective repellents widely available in the America.
  • Infants and others sleeping or resting during the day should use bednets to avoid infection. It is of particular importance that individuals who are potentially infected with Chikungunya virus during an outbreak rest beneath an IT bednet to avoid mosquito bites and further spread of infection.
  • Use of IT bednets has an additional benefit of killing mosquitoes that come into contact with the net, which may reduce vector-human contact for other household members.
  • A number of pesticide products may be used to safely treat bednets, or long-lasting pretreated nets can be obtained commercially.

Household Prevention

  • The use of intact screens on windows and doors will reduce entry of vectors into the home.
  • Mosquito proofing water storage vessels will reduce oviposition sites and local production.
  • Within a household, use of IT bednets72 and IT curtains73 also reduce vector-human contact.
  • The number of adult mosquitoes in a home may be reduced by using commercially available pyrethroid-based aerosol sprays and other products designed for the home, such as mosquito coils and electronic mat vaporizers. Aerosol sprays may be applied throughout the home, but areas where adult mosquitoes rest (dark, cooler areas) must be targeted, including bedrooms, closets, clothing hampers, etc. Care should be taken to emphasize proper use of these products when advocating their application to the public, in order to reduce unnecessary exposure to pesticides.

Neighborhood and Community Prevention

  • Neighborhood and community prevention for a Chikungunya virus introduction in the Americas should be based on methods developed for dengue control that will reduce the probability that a viremic human arriving in the Americas will be fed upon by Aedes aegypti or Aedes albopictus mosquitoes, thereby leading to secondary transmission and potential establishment of the virus.
  • Dengue programs for controlling Aedes aegypti have traditionally focused on control of immature mosquitoes, often through the community’s involvement in environmental management and source reduction thereby stressing on the importance of incorporating community involvement into an IVM program.

Response to Chikungunya Virus Infection Introduction

  • Immediately upon confirmation of the first autochthonous Chikungunya virus case, the health department should inform the IVM program regarding the onset date and location of the case. Vector control procedures must be intensified to effectively reduce the abundance of infected vectors in order to halt transmission in the areas of the case(s).
  • Simultaneously, emergency response committees at local and national levels should be informed of the situation and activated. Initial efforts should focus on containing virus transmission and preventing expansion. If virus containment fails, or if cases are not detected until the outbreak has spread over a large geographic area, intensive vector control efforts will need to be expanded to a larger scale program.

Risk and Outbreak Communication

  • Communications are an integrated, coordinated effort involving all disciplines and components for preparation and response.
  • Timely communication with stakeholders is crucial for enlisting the community’s participation and to avoid confusion and misinformation.
  • As Chikungunya virus is novel in the Americas, the media, the public and many officials will need to be educated about the disease, the mode of transmission, the lack of specific therapeutic treatment, means of symptomatic and supportive treatment, and effective control measures.

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