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Why publish technical guidelines for the prevention and treatment of chikungunya fever?

Francisco Espinosa-Larrañaga,^a Manuel Ramiro-H.^a

^aRevista Médica del Instituto Mexicano del Seguro Social, División de Innovación Educativa, Coordinación de Educación en Salud, Instituto Mexicano del Seguro Social, Distrito Federal, México

Communication with: Francisco Espinosa-Larrañaga

Email: francisco.espinosal@imss.gob.mx

Most of the times, in the presence of emerging diseases health authorities in the involved countries act in a reactive way. When the health problem becomes an inconvenient situation, authorities join experts to establish emergency plans, organize a protocol of specific attention and develop educational strategies to operative personnel. The Instituto Mexicano del Seguro Social with the publishing of the “Technical guidelines for the prevention and treatment of chikungunya fever” is acting cautiously with the development of strategies and a protocol to treat patients and at the same time it is offering the theoretical grounds to operative health personnel. There is no doubt that it is a suitable way to face the chikungunya fever and other emerging diseases.

Keywords: Emerging diseases; Chikungunya fever; Technical procedures in health; Viral diseases; Vectors transmission.

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Malaria, dengue, and chikungunya fever are diseases transmitted by mosquitoes affecting the population of the tropics. The first confirmed case of chikungunya fever virus in the Latin American continent was reported in December 2013 and it has since spread throughout the Caribbean and Latin America.
Chikungunya fever was first described in Tanzania. The mosquitoes that transmit dengue (Aedes aegypti and Aedes albopictus) are the viral vectors of chikungunya fever, which has as its most prominent symptoms high fever, headache, severe muscle weakness, arthralgia, and skin manifestations such as erythema.
At present there is no vaccine, but because of its highly infectious and contagious nature it is spreading rapidly. The Pan American Health Organization (PAHO) through August 29, 2014 has recorded 659,367 cases in 33 countries, of which only 37 patients died (0.0056%). In Central American countries they have identified 1700 cases. In our country the first confirmed case occurred in a child in November in the state of Chiapas, where in addition there were 13 more confirmed cases. The areas most at risk in our country correspond to the tropics, which are mainly located in the states of Campeche, Chiapas, Oaxaca, Quintana Roo, Yucatan, and Tabasco.
The first confirmed cases in the state of Chiapas are connected to its location adjacent to the Guatemala border. The vectors (Aedes aegypti) are widely scattered in this state and in our tropical zones. Mosquitoes acquire the virus from a viremic host. If confirmed cases in our country acquired chikungunya fever on Mexican soil, it was from mosquitoes crossing the southern border and transmitting the virus. If the confirmed cases arrived during the incubation period, they could be the source of a wide spread from these first cases. 
Institutional health authorities, including the Instituto Mexicano del Seguro Social, are responding proactively with the development of “Lineamientos técnicos para la prevención y tratamiento de la fiebre chikunguña” ("Technical guidelines for the prevention and treatment of chikungunya fever"), which are published in this issue of the Revista Médica del Instituto Mexicano del Seguro Social. Many health professionals may consider these guidelines unnecessary, and might think that the number of confirmed cases is minimal; others find that is a great success, as the authorities are acting early based on the facts, rather than reacting.   
The “Lineamientos técnicos para la prevención y tratamiento de la fiebre chikunguña” have as primary goals: that doctors should know, what is chikungunya fever? What is the clinical picture presented by patients? How should we handle it? And, finally, what are the complications and prognosis? This last is in order to care for patients with suspected or confirmed chikungunya fever.
A strength of the published guidelines is in terms of prevention and control to prevent the development of the environment in which the vectors breed and thus to avoid wherever possible the acquisition of the disease through personal protection by using repellents on skin and clothing, using mosquito nets and screens on windows and doors of homes, preventing the accumulation of water in outdoor containers or recipients, and other measures with which they have experience and which are used to prevent dengue.
It is hoped that these guidelines will contribute to the timely detection of cases and rapid response in order to minimize the risk of sustained and progressive chikungunya fever transmission.
In the case of emerging diseases, most of the time health authorities of the countries involved act reactively. When the health problem has become inconvenient, they gather qualified personnel to establish contingency plans, institute specific care protocols, and prepare the relevant operational staff. The Instituto Mexicano del Seguro Social with the publication of the “Lineamientos técnicos para la prevención y atención de la fiebre de chikunguña” acts proactively in developing a strategy, a care protocol, and at the same time providing the theoretical basis for operating personnel to be instructed on their use. Clearly, this is an appropriate way of dealing with chikungunya fever and other emerging diseases.  

Recommended reading

1. Morens MD, Fauci SA. Chikungunya at the door- Déjàvu all over again? N Eng J Med. 2014;371(10):885-7.
2. Pialoux G, Gauzere BA, Jaureguiberry S, Strobel M. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis. 2007;7(5):319-27.
3. Bettadapura J, Herrero LJ, Taylor A, Mahalimgam S. Approaches to the treatment of disease induced by chikungunya virus. Indian J Med Res. 2013(5); 138:762-5.
4. Bajak A. US assesses virus of the Caribbean. Nature. 2014; 512(7513):124-5.
5. Barrera-Cruz A, Diaz-Ramos RD, Viniegra-Osorio A, Grajales-Muñoz C, Davila-Torres J. Lineamientos técnicos para la prevención y tratamiento de la fiebre de chikunguña, Rev Med Inst Mex Seguro Soc: 2015;53(1):102-19.

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