Chikungunya outbreak continues in Lampung

The Jakarta Post | Tue, 02/16/2010 2:03 PM

At least 420 people in Sidomulyo, South Lampung regency, have been infected with the mosquito-borne chikungunya disease since early in the month, prompting local health authorities to declare the outbreak an emergency.

A top official at the local health agency, Kristi Endrawati, told Antara news agency in Kalianda on Tuesday that the disease had spread from one village to another within a relatively short time.

She said the aedes aegypti mosquito, which carries the chikungunya virus and spreads it to humans through its bite, was rapidly reproducing in cacao plantation areas in the regency.

“The cacao pod can hold water and become a mosquito nest which contributes to the spread of the aedes aegypti mosquito. It is impossible to fog all the plantations since they are too big and it is not effective. We only fog residential areas," she said.

Once infected with chikungunya, victims develop a high fever, reddish spots, joint pain, vomiting, flu symptoms and headaches.

Officials from the agency have campaigned to ask local people to cover all water catchments and clean all ponds periodically to reduce the number of mosquitoes in the area especially during the rainy season.

Earlier this year, over 12,000 people in Lampung were recorded to have contracted the disease, the highest recorded number in the last ten years.

Rainy Season Brings Threat Of Diseases

Antara News, Thursday, January 21, 2010 11:02 WIB, Fardah

Jakarta ( ANTARA News) - As Indonesia has entered the rainy season, a number of diseases, such as chikungunya, dengue fever, diarrhea, bird flu and lymphatic filariasis, are threathening people in some areas.

Diseases like chikungunya, dengue fever, and lymphatic filariasis are spread through certain mosquito bites, while bird flu and diarrhea are usually rampant in a cold rainy season.

Rainy season has come in Indonesia since around November 2009. Over the past few months, Chikungunya cases have been reported especially in the provinces of South Sumatra, Bengkulu (Sumatra Island), South Kalimantan, Bangka Belitung, Lampung, Riau, Jambi, East Java, Central Java, and West Java,

Chikungunya (pronounced as chik`-en-GUN-yah) fever is a viral disease spread by mosquitoes - Aedes aegypti mosquito, which is also called yellow fever mosquito. The symptoms include severe and persistent joint pain and fever similar to dengue fever. It is usually not life threatening. But the joint pains can last for a long time and hence full recovery may take months.

Chikungunya disease was first detected in 1952 in Africa at a place called Makonde Plateau located in a border area between Tanzania and Mozambique. The name "chikungunya" is from the Makonde language and its meaning is "that which bends up" as Chikungunya patients walk in a stooped posture due to joint pain. Chikungunya is also known as Chicken guinea, Chicken gunaya and Chickengunya.

The Aedes mosquitoes that transmit chikungunya breed in a wide variety of man-made containers which are common around human dwellings.

In December 2009, over 500 residents of Kayuagung and Tulung Selapan sub districts, Ogan Komering Ilir (OKI) District, South Sumatra Province, were infected with chikungunya virus.

About 50 percent of 1,100 residents or 240 families at Guci village, Ujan Mas sub district, South Sumatra, were believed to be infected with chikungunya. In Tulung Selapan, there were about 500 patients and in Kayuagung around 30.

In last November 2009, chikungunya disease has affected around 500 residents in five sub districts in Rejang Lebong District, Bengkulu Province, Sumatra Island.

The local health service immediately conducted mosquito control fogging activity and distributed abate (potent micro-granule insecticide) to kill mosquito larvae, in the five affected sub districts, he said.

In South Kalimantan, chikungunya has infected a number of residents in 11 districts and cities since late 2009. Some 3,098 people in the 11 districts and cities of South Kalimantan were infected.

In Banjar district alone, some 1,622 residents of 33 villages in four sub districts suffered from chikungunya in early 2010. The local health authorities have declared the chikungunya cases an extraordinary happening.

Almost all districts in South Kalimantan Province, except Banjarmasin and Barito Kuala, were affected by Chikungunya, Rosihan Adhani, head of the South Kalimantan provincial health service, said early January 2010. The disease was predicted to continue affecting the districts until Frebruary 2010, he added.

Another mosquito-borne disease affecting some regions is lymphatic filariasis, known as Elephantiasis. Lymphatic filariasis is infection with the filarial worms, Wuchereria bancrofti, Brugia malayi or B. timori.

These parasites are transmitted to humans through the bite of an infected mosquito and develop into adult worms in the lymphatic vessels, causing severe damage and swelling (lymphoedema).

The infection can be treated with drugs. However, chronic conditions may not be curable by anti-filarial drugs and require other measures, for example surgery for hydrocele, care of the skin and exercise to increase lymphatic drainage in lymphoedema.

Lymphatic Filariasis puts at risk more than a billion people in more than 80 countries. Over 120 million have already been affected by it, over 40 million of them are seriously incapacitated and disfigured by the disease.

In Indonesia, lymphatic filariasis disease has been reportedly endemic in 368 of the country`s 471 districts/cities. The government has launched massive medication in order to completely eradicate the disease by 2018.

In Southeast Sulawesi, for instance, filariasis or elephantiasis cases have been reported occurring in six districts, namely Konawe, Buton, Konawe Utara, Konawe Selatan, Muna, and Baubau City, Abdul Razak, the head of the Southeast Sulawesi provincial health office`s disease control unit, said last December 2009.

Dengue is a mosquito-borne infection which in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.

The Health Ministry has reported that in the current rainy season, the dengue fever cases have increased in the provinces of Riau, Jakarta, West Java, West Kalimantan, Central Kalimantan, South Kalimantan, West Sulawesi, and North Maluku. Dengue cases have also been reported in Bangka Belitung, East Kalimantan, Gorontalo, and Palu.

Seven residents of Bangka Belitung (Babel) died of dengue fever late last year. Fogging had been conducted in 20 houses to prevent the further spread of the disease, Helmi Soefie, head of the Babel health service`s disease control section, said last December 2009.

In Bangkalan, East Java, the number of patients suffering from dengue fever in the current rainy season at Syarifah Ambami Rato Ebu (RSA) hospital was also on the rise, the hospital`s director said last January 11, 2010.

"Since the beginning of this year the number of dengue fever patients treated at this hospital has increased to 22 persons," RSA hospital director Teguh Basukohadi said here on Monday.

Up to November 2009, Indonesia recorded 137,600 dengue cases with 1,170 deaths, while in 2008 there were 126,600 cases with 1,084 fatalities.

"We should be on alert of dengue fever as the country has entered the rainy season,"

Health Minister Endang Rahayu Sedyaningsih said when visiting Matahari community health post (posyandu) in Cilincing, North Jakarta, last January 8, 2010.

As for bird flu or Avian Influenza (AI - H5N1) virus, Indonesia reported fewer deaths from bird flu in 2009, but health specialists warn that the risk to humans remains high.

Over the past two months, pultry deaths due to bird flu virus have been reported among other things in South Sumatra, Lampung (Southern Sumatra), Bangka Belitung,

Central Kalimantan, Riau, South Kalimantan, East Kalimantan, and Central Java.

Late December 2009, South Sumatra`s Metro city animal husbandry culled at least 39 chickens infected with the bird flu virus. Some 320 chickens were dead at South Metro sub district and 323 others in West Metro.

Last January 19, Pamekasan regency (Est Java Province) veterinary office culled 270 bird flu-infected chickens to prevent the spread of this dangerous virus.

Meanwhile, diarrhea killed four persons in Caringin sub district, Sukabumi District, West Java, since September 2009. The health service has recorded a total of 72 diarrhea cases at eight villages, at Caringin sub district so far.

Mosquito-borne African virus a new threat to West

Reuters, by David Morgan, Sat Sep 19, 2009 11:50am EDT

A man walks behind a model of an Anopheles mosquito in the new Darwin Centre at the Natural History Museum, in London September 8, 2009. (REUTERS/Stefan Wermuth)

WASHINGTON (Reuters) - The United States and Europe face a new health threat from a mosquito-borne disease far more unpleasant than the West Nile virus that swept into North America a decade ago, a U.S. expert said on Friday.

Chikungunya virus has spread beyond Africa since 2005, causing outbreaks and scores of fatalities in India and the French island of Reunion. It also has been detected in Italy, where it has begun to spread locally, as well as France.

"We're very worried," Dr. James Diaz of the Louisiana University Health Sciences Center told a meeting on airlines, airports and disease transmission sponsored by the independent U.S. National Research Council.

"Unlike West Nile virus, where nine out of 10 people are going to be totally asymptomatic, or may have a mild headache or a stiff neck, if you get Chikungunya you're going to be sick," he said.

"The disease can be fatal. It's a serious disease," Diaz added. "There is no vaccine."

Chikungunya infection causes fever, headache, fatigue, nausea, vomiting, muscle pain, rash and joint pain. Symptoms can last a few weeks, though some suffers have reported incapacitating joint pain or arthritis lasting months.

The disease was first discovered in Tanzania in 1952. Its name means "that which bends up" in the Makonde language spoken in northern Mozambique and southeastern Tanzania.

The virus could spread globally now because it can be carried by the Asian tiger mosquito, which is found in Asia, Africa, Europe, the Americas, Australia and New Zealand.

In the United States, the mosquito species tends to live in southern regions east of the Mississippi but has been found as far afield as western Texas, Minnesota and New Jersey.

Health officials are greatly concerned about the appearance of Chikungunya in the islands of the Indian Ocean -- Mauritius, Seychelles and Reunion -- which have beach resorts frequented by European tourists.

"It is hyper-endemic in the islands of the Indian Ocean," Diaz told the meeting.

"Travel by air will import the infected mosquitoes and humans," he added. "Chikungunya is coming."

Diaz warned of possible double-infections involving Chikungunya and dengue fever or malaria, which are also carried by the Asian tiger mosquito.

The spread of the disease could be greatest in so-called mega-cities such as Mumbai and Mexico City, which have large and impoverished populations, poor health controls and water systems that provide ready breeding grounds for mosquitoes, Diaz said.

West Nile, spread by a different mosquito species, first appeared in New York in 1999 and now can be found in most of North America.

(Editing by Maggie Fox and Paul Simao)

WHO: Chikungunya could spread across Asia, potentially reaching Europe

The Jakarta Post

GENEVA (AP): A severe achy-joint fever spreading in Asia via mosquitoes could easily reach more countries in the region and potentially take hold in Europe and the United States, World Health Organization experts warn.

The fever, called chikungunya, is ravaging parts of Indonesia, sickening people with rashes, vomiting, headaches and joint pain so intense it is often too painful for victims to sit or stand.

"It's enormously disruptive ... the outbreaks are very abrupt and intense," said Michael Nathan, a mosquito-borne disease expert at the WHO in Geneva.

"Lots and lots of people are seeking help all at the same time and services struggle to cope with that."

Singapore reported eight suspected cases this week, the first time the virus has spread locally, according to a Ministry of Health statement. Officials were scouring the area to destroy mosquito breeding grounds, and tests were conducted to ensure no one else was infected, it said.

Taiwan also detected three cases in travelers from Indonesia, two in December and another earlier last year.

Nearly 300 people in northern Italy were sickened in 2007 after an infected traveler came from India, the first time an imported case of the tropical disease sparked a local outbreak in Europe.

Although rarely fatal, the virus can lead to death in patients with other underlying health conditions and is especially hard on the elderly.

Symptoms are similar to dengue fever, another mosquito-borne disease, but joint and muscle pain is typically more intense and longer lasting with arthritis-like aches reported months or even years after infection. Dengue is considered more dangerous because it can cause internal bleeding that leads to death.

Chikungunya was first identified in Tanzania in the early 1950s and has caused periodic outbreaks in Asia and Africa since the 1960s.

Chikungunya outbreak infects thousands

Oyos Saroso H.N., The Jakarta Post, Bandarlampung

Chikungunya disease has infected thousands of people in Bandarlampung over the last month.

In the worst-hit area, Waydadi subdistrict in Sukarame, the mosquito-borne disease has struck 500 or so residents in three neighborhood units.

"Ninety percent of the residents in our neighborhood have been infected by chikungunya. There are 94 families in our neighborhood, and in each family, two to three members have been infected by the disease. My wife and I also caught it," said RT 13 neighborhood unit chief in Waydadi, Amin Ismail, on Thursday.

The infection rate is similarly high in the RT 10 and RT 12 neighborhood units.

Amin said he had reported the rampant disease to the subdistrict and district chiefs four weeks ago, but had yet to receive a reply.

"Usually, when an outbreak affects many people, the provincial and municipal administrations immediately respond, for example by conducting fumigation around the neighborhood or providing free medication. But the administration has not responded as of yet," said Amin.

According to Amin, residents who fall ill generally go to the community health center because they cannot afford to go to a hospital or doctor.

Waydadi district chief Amil Riadi said he was unaware residents were infected with chikungunya. "There were no reports from the subdistrict office or community health centers," said Amil.

The disease spread to a number of districts in Bandarlampung starting in November, as rainy season approached. Aside from Sukarame district, the disease has also infected residents in North and South Telukbetung, Kemiling, Sukaraja, Panjang and Kedaton districts.

Bandarlampung Health Office deputy head Tri Henny Sukemi said her office was coordinating with the provincial health office to carry out a fumigation drive in a number of subdistricts deemed rife with the disease.

The coordinator of the Coalition for a Healthy Lampung (KULS), Herdimansyah, said provincial and city health officials had been sluggish in responding to the outbreak.

"The number of patients has climbed into the thousands, but there is not yet any concrete action. The disease in Lampung can be categorized as an extraordinary case now due to its vast spread and the huge number of those affected," he said.

Herdimansyah added that the disease had also infected residents in a number of regencies in Lampung, such as Tanggamus and South Lampung.

He said no fatalities had been reported so far in Lampung, but said the disease was very harmful due to its impact on people's productivity.

"Those affected by the disease obviously cannot go to work for at least a week. It might not matter if they were civil servants or private sector employees because they would still get paid, but what about the poor people who work as laborers? They cannot earn a living if they're sick," said Herdimansyah.

He added the number of sufferers in Lampung might be more than 1,000 because community health centers and doctors treating patients generally do not report cases to the health office.

"Many sufferers also do not seek treatment because they cannot afford to," he said.

Bandarlampung Health Office head Reihana said a number of subdistricts in the city were believed to be the breeding grounds of aedes aegypti mosquitoes, the carrier of the disease, due to an unclean environment and poor sanitary habits.

"These mosquitoes like these places to breed," he said.

The aedes aegypti mosquito also carries dengue fever.

Chikungunya, which originated on the African continent, was first detected in Indonesia in 1973. The first cases were reported in Samarinda, East Kalimantan. The disease then spread to Kuala Tungkal, Martapura, Ternate and Yogyakarta, and later reached other areas across the country.