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The scars of the Covid-19 pandemic still vivid, children and their parents in Gujarat are yet again petrified about the threat to their health, this time from the ubiquitous mosquitoes and sand flies.38 children under the age of 15 years in Gujarat have died after being infected by the Chandipura virus, and the suspected number of infected cases is around 101. A member of the menacing rabies virus family, Chandipura Virus (CHPV) is a member of Rhabdoviridae family known to cause sporadic cases and outbreaks in western, central, and southern parts of India , especially during the monsoon season.The virus is a member of the Vesiculovirus genus of the family Rhabdoviridae. It is transmitted by vectors like mosquitoes, ticks and sandflies.
•Historical account:
It was first identified in 1965 after isolation from the blood of two patients from Chandipura village in Maharashtra state hence called Chandipura virus.It was named after the village it was first identified in, Chandipura village in Maharashtra, India during an outbreak of encephalitis in 1965.
India has been associated with a number of otherwise unexplained outbreaks of encephalitic illness in central India. Between June and August 2003, 329 children contracted the virus, and 183 died in Andhra Pradesh and Maharashtra states of India. Further sporadic cases and deaths in children were observed in Gujarat state in 2004.
According to an article, ‘Chandipura virus: an emerging human pathogen’published in The Lancet in 2004, the virus is a member of the Vesiculovirus genus of the family Rhabdoviridae. Incidentally this family also includes the rabies virus. The Chandipura virus, the paper states, was first isolated in 1965, from the blood of two adults with a febrile illness in a Chandipura village in Nagpur, Maharashtra. The virus is reportedly named after the village it was isolated from. The other instance when the virus was isolated in human beings was in 1980, in Madhya Pradesh from a patient with acute encephalitis, the article says.
Mode of transmission:
The virus is vector-borne, with the likely vector believed to be the female Phlebotomine sandfly, insects that are prevalent in the early monsoon period. A 2016 paper, ‘Changing clinical scenario in Chandipura virus infection’, published in The Indian Journal of Medical Research, also pointed to the role of Sergentomyia sandflies. It said several species of mosquitoes replicated and transmitted the virus experimentally, and among the different mosquito species studied, The female Aedes aegypti, (which also transmits dengue), was found to be highly susceptible and could transmit the virus more efficiently than others, under laboratory conditions. However it said no isolation of the virus from the mosquito had been reported as of the later.
Symptoms of infection:
Chandipura virus causes high grade fever, with symptoms similar to flu, and acute encephalitis (inflammation of the brain). Gujarat's health department reported 13 new suspected cases of the Chandipura virus and five fatalities on July 21 2024
With the latest additions, the tally of the confirmed and suspected infections in the state has gone up to 101 so far, while the death toll climbed to 32.The positive cases are confirmed at Pune based National Institute of Virology (NIV)
Chandipura vesiculovirus (CHPV) is a member of the Rhabdoviridae family that is associated with an encephalitic illness, Chandipura encephalitis or Chandipura viral encephalitis, in humans.
It is an Arbovirus that is arthropod borne virus
Chandipura vesiculovirus is an enveloped RNA virus with an approximate genome length of ~11 kb. Viral genome codes for five polypeptides, namely, nucleocapsid protein N, phosphoprotein P, matrix protein M, glycoprotein G and large protein L in five monocistronic mRNAs.
Signs and symptoms
of Chandipura virus infection:
Symptoms of Chandipura virus infection typically include high grade fever, headache, abdominal pain vomitting, stiff neck, convulsions, seizures and unconsciousness, progressing rapidly to coma and death in severe cases within 48 to 72 hours of infection
The Chandipura infection is an encephalitis-causing virus, which means the infection leads to an inflammation or swelling of the brain tissue.
Encephalitis is inflammation of the active tissues of the brain caused by an infection.. The inflammation causes the brain to swell, which can lead to headache, stiff neck, sensitivity to light, mental confusion and seizures.
Another Lancet paper entitled, ‘A large outbreak of acute encephalitis with high fatality rate in children in Andhra Pradesh, India, in 2003, associated with Chandipura virus’, said the typical clinical manifestations included:
rapid onset of fever
followed by vomiting
altered sensorium (a change in mental status or consciousness)
convulsions, diarrhoea
neurological deficit (examples include an inability to speak, loss of balance, vision changes)
meningeal irritation (signs may include headaches, neck stiffness, photophobia and seizures).
It affects children:
Mortality rate is very high that is 50 to 85%
Death of child occurs in 48 to 72 hours after infection.
The Chandipura virus has been found to mostly affect children under the age of 15, predominantly in rural locations. In the 2003 outbreak, the age of the affected children in Andhra Pradesh was between 9 months and 14 years. The children below age of 14 years have low level of immunity and hence susceptible to infection .Most deaths occurred within 48 hours of admission to the hospital. In the current outbreak in Gujarat, all of the suspected deaths so far have been of children.
.Treatment
There is no specific antiviral agent to treat Chandipura virus and there is no vaccine available as of yet. Early diagnosis and treatment are key. A document by the Gujarat government on ‘Epidemiology & Management of Chandipura Encephalitis’ in 2014, says management of the disease includes managing airways, breathing and circulation through oxygen therapy and ventilation if required. Management of fluid and electrolyte balance, hyperprexia (a condition where the body temperature goes above 106.7 degrees Fahrenheit), raised intracranial pressure and seizures and prevention of secondary bacterial infections are also detailed.
There is no specific treatment or vaccine available for Chandipura virus infection, so management focuses on supportive care and prevention measures such as mosquito and sand fly control.
About sand fly:
Phlebotomus is a genus of "sand flies" in the Diptera family Psychodidae.
The adult flies are nocturnal, spending the day sheltering in dark humid places such as on bark, among foliage, among leaf litter, in animal burrows, in termite mounds, and in cracks and crevices. At nightfall they emerge to feed on sugary secretions and plant sap. The female needs a blood meal before it can reproduce; some species feed on mammals including humans, while others also feed on birds, reptiles and amphibians. The fly is a weak flier and takes short flights to find a victim, adopting a "hopping" style of flight when close to a host. Some sandflies are "exophagic", living entirely out of doors, while others are "endophagic" and invade houses. In the tropics, adults may breed all year round, but in temperate climates the adults die off in the autumn and new adults emerge in the spring. The adults have short mouthparts and are unable to bite through clothing.
Recent cases:
In July 2024, Sabarkantha district of Gujarat in India experienced a suspected outbreak particularly in children. This suspected outbreak has raised significant public health concerns due to the rapid spread and the severity of symptoms observed in the affected children.
Steps should be taken to protect insects, and to protect different vertebrates like domestic animals from bites.
Preventive measures:
Preventing the Chandipura Virus infection revolves ar around several key practices: Hygiene practices: Washing hands regularly with soap and water, especially after handling animals or being in potentially contaminated environments.
Although there is no specific treatment available for CHPV and management is symptomatic, timely referral of suspected AES cases to designated facilities can improve outcomes. Since early June 2024, cases of Acute Encephalitis Syndrome have been reported in children under 14 years of age in Gujarat.
The Chandipura virus cases have seen a notable increase, particularly in villages identified as sensitive to the outbreak. The virus is spread by the female phlebotomine sandfly, which is particularly abundant during the early monsoon season in humid weather
Prevention, the document says, includes vector control: identifying sandfly breeding sites, spraying insecticides, pesticides ,sanitation, environmental control, including the proper storage and disposal of waste and refuse, stopping open air defecation, and the use of fly paper. Breeding sites include holes and crevices in walls, holes in trees, dark rooms, stables and storerooms. Prevention of bites of sandfly is also important, through the use of protective clothing, repellants and nets.
Wearing full sleeve shirt and full length pant.
Prevention is better than the cure
Information compiled by:
Dr Bhairavsinh Raol
