LESSON PLAN ON

CHIKUNGUNYA AND ITS

PREVENTION

SUBMITTED TO SUBMITTED BY

RAJ

2 ND YEAR M.SC (N)

VARADAN COLLEGE OF NURSING

OBJECTIVES

GENERAL OBJECTIVES
 At the end of the class the participants will be able to gain knowledge regarding chikungunya fever and its
prevention and will be able to apply that knowledge in their practical life situation.

SPECIFIC OBJECTIVES

At the end of the class participants will be able to:

• To define the chikungunya fever
• To know the historical epidemiology

• To identify the causes of chikungunya fever

• To list out the classification of chikungunya

• To know about the mode of transmission of chikungunya fever

• To discuss about the clinical manifestations of chikungunya

• To diagnose the chikungunya fever

• To enumerate the treatment of chikungunyafever

• To explain about the complications of chikungunyafever

• To discuss about the prevention of chikungunya fever

STUDENT PROFILE
NAME OF THE INSTITUTION : institute of nursing
COURSE : M.Sc. nursing 2nd year
 SUBJECT : Nursing
TOPIC : chikungunya fever and its prevention

NAME OF THE RESEARCH GUIDE : Mrs.

: Associate Professor

NAME OF THE CO-GUIDE :Mrs.

Associ
ate
Profess
or

NAME OF THE RESEARCHER : Mr.

PARTICIPANTS OF THE STUDY : junior students
DURATION : 1hour
METHOD OF TEACHING : Lecture cum discussion
MEDIA OF TEACHING : Power point, Black board. Chart
,model,handout.

S.NO TIME OBJECTIVES CONTENT TEACHING LEARNING A.V EVALUATION

ACTIVITY ACTIVITY AIDS
1. 1min To introduce INTRODUCTION Teaching Learning Black
the topic activity activity board
Chikungunya is a mosquito-borne viral disease
first described during an outbreak in southern
Tanzania in 1952. It is an RNA virus that belongs
to the alpha virus genus of the family Togaviridae.
The name “chikungunya” derives from a word in
the Kimakonde language, meaning “to become
contorted”, and “that which bends up” describes
the stooped appearance of sufferers with joint pain
(arthralgia).The fever is locally also named as
“Langrajor”

DEFINITION
2. 2min To define the Teaching Learning Ohp What is the
chikungunya activity activity definition of
“ It is spread by bite of “Aedes aegypti” mosquito
chikungunya?
which usually bite during day light hours. The
name is derived from Swahili word meaning “that
which bends up” .Describes that posture patient
assume to relieve the severe joint pains.
Or
 “Chikungunya is caused by the chikungunya virus
(CHIKV), an arthropod-borne virus (arbovirus).
Chikungunya fever is one of the most
important mosquito-borne viral diseases”.

3. 2min To know the Teaching Learning Black When

epidemiology HISTORY OF EPIDEMIOLOGY activity activity board chikungunya
identified in
Epidemiological criteria: residing or having visited India?
epidemic areas, having reported transmission
within 15 days prior to the onset of symptoms. In
late 2013, the first local (autochthonous)
transmission in the Americas was documented. In
India it was first reported in 1963 at Calcutta. Its
recent epidemic which started in December 2005,
involving southern and central India has grabbed
much attention. Chikungunya is not considered to
 be fatal. However, in 2005 - 2006, 200 deaths have
been associated with chikungunya of Reunion
Island and widespread outbreak in southern India.
A recent report of large scale outbreaks of
chikungunya virus in southern India has confirmed
the re-emergence of this virus. The precise reasons
for the re-emergence in the Indian sub-continent as
well as in southern India, of this viral infection, are
due to a variety of social, environmental,
behavioral and biological changes.

4. 2min To identify the

 etiology of ETIOOLOGY OF CHICKEN GUNYA FEVER Teaching Learning Chart What are the
chikungunya activity activity causes of
fever chikungunya
Causative organism – Chikungunya virus fever?
Alternate name – Buggy Creek virus
ICTV acronym – CHIKV
Humans and other primates are the natural hosts
for the chikungunya virus. The virus is spread to
humans by the bite of an infected female, Aedes
species mosquito – Aedes aegypti or Aedes
albopictus.

5. 1min To describe the Teaching Learning Chart Who are the

RISK FACTORS OF CHIKUNGUNYA FEVER
risk factors activity activity risk factors of
chikungunya?
People of all ages can become infected with
CHIKV and suffer a debilitating illness, but only
20% of the people that are infected will suffer any
illness symptoms. Infants, senior citizens, and
people already suffering from other underlying
illnesses are at greater risk of a severe illness. To
date no locally-acquired cases have been reported
among Virginia residents. T here is a risk of
infected travelers transmitting CHIKV to local
 Asian tiger mosquitoes which are the most
common nuisance mosquito in urban areas of
Virginia.

Teaching Learning Chart What is the

6. 1min To list out the VIRUS CLASSIFICATION activity activity classification of
classification chikungunya ?
Group: Group IV [(+) SS RNA]
of
chikungunya Family: Togaviridae
Genus: Alphavirus
Species: Chikungunya virus

7. 2min To enumerate MODE OF TRANSMISSION Teaching Learning Chart What is the

the mode of activity activity mode of
 Chikungunya is spread by the bite of an
transmission transmission of
infected Aedes mosquito, primarily Aedes chikungunya?
aegypti.
 Recently, research by the Pasteur Institute
in Paris has found a mutation that enables
it to be transmitted by Aedes albopitcus
(Tiger mosquito), which appears to be the
cause of the recent epidemic in Asia.
 Few cases of mother to foetus infection
have been reported from Asia, which
occurs between 3 and 4 months of
 pregnancy.
RESERVOIR
 Humans are the major source of reservoir
of chikungunya virus for mosquitoes.
 Some non human primates like monkeys
are the reservoir in Africa, in which it is
transmitted by Aedes fureifer and Africans.

Teaching Learning Ppt What are the

8. 3min To identify the CLINICAL MANIFESTATIONS OF activity activity symptoms of
signs and CHIKUNGUNYA FEVER chikungunya ?
symptoms of
chicken gunya
 Full-blown disease is most common among
adults in whom the clinical picture may be
 dramatic.
 The abrupt onset of clinical manifestations
follows an incubation period of 2 to 3 days.
 Silent CHIKV infections do occur, but the
number and incidence is not yet known.
Fever is sudden onset, high grade (> 40° C,
104° F) with chills and rigors; fever is
biphasic or saddle back (fever subsides in 2
to 3 days and than comes back after 1 day);
the second phase of fever is usually
associated with bradycardia.
 Fever is associated with constitutional
symptoms such as headache, photophobia,
conjunctivitis, anorexia, nausea, and
abdominal pain.
 Arthralgia/arthritis in chikungunya has
been quite crippling in recent outbreaks in
southern India. Migratory polyarthritis
mainly affects the small joints of hands,
wrists, ankles, and feet. Rash may appear
at the outset or several days after the illness
i.e., in the convalescence phase.
 Dermatological manifestations observed in a
recent outbreak of chikungunya fever in southern
India include the following4:
1. Maculopapular rash.
2. Blotchy, nasal erythema.
3. Freckle-like pigmentation over centro-facial
area.
4. Flagellate pigmentation on face and extremities.
5. Lichenoid eruption and hyperpigmentation in
photo distributed areas.
6. Multiple aphthous–like ulcers over the scrotum,
crural areas, and axilla.
7. Lymphoedema in acral distribution (bilateral/
unilateral).
8. Multiple ecchymotic spots (children).
9. Vesiculobullous lesions (infants).
10. Subungual haemorrhage.
11. Photourticaria.
12. Acralurticaria.
Fever typically last for two days and then abruptly
comes down. However, joint pain, headache,
insomnia, and various degrees of prostration last
for a variable period, usually for about 5 to 7 days.
Chikungunya is a self-limiting disease, and
recovery is the rule, but little mortality has been
reported in the recent outbreaks in southern India.
In July 2006, a team analysed the virus RNA and
determined the genetic changes that have occurred
in various strains of the virus and identified the
genetic sequence which led to the increased
virulence of the recent strains
 The symptoms are most often clinically
indistinguishable from those observed in
dengue fever.
 Indeed, simultaneous isolation of both
 dengue and chikungunya from the sera of
some patients has been reported earlier,
indicating the presence of dual infections
 Therefore, it is very important to clinically
distinguish dengue from chikungunya virus
infection.
 Unlike dengue, haemorrhagic
manifestations are relatively rare, and as a
rule, shock is not observed in chikungunya
virus infection.
 Other important clinical conditions for
differential diagnosis are West Nile fever,
O’nyong-nyong fever.
9. 2min To diagnose Teaching Learning What are the
the activity activity Ppt diagnostic
chikungunya DAIGNOSTIC INVESTIGATIONS OF investigations?
fever
CHIKUNGUNYA FEVER

Diagnosis The tests available are:– Detection of

antigen and antibody in serum by ELISA test.
 IgM capture ELISA is necessary to
distinguish the disease from dengue fever.
 These tests are available at National
 Institute of Virology at Pune, Maharashtra.
 Chikungunya virus infection should be
considered in patients with acute onset of
fever and polyarthralgia, especially
travelers who recently returned from areas
with known virus transmission.

 Laboratory diagnosis is generally

accomplished by testing serum or plasma
to detect virus, viral nucleic acid, or virus-
specific immunoglobulin (Ig) M and
neutralizing antibodies.

 Viral culture may detect virus in the first 3

days of illness; however, chikungunya
virus should be handled under biosafety
level (BSL) 3 conditions.

 During the first 8 days of illness,

chikungunya viral RNA can often be
identified in serum.

 Chikungunya virus antibodies normally

develop toward the end of the first week of
 illness. Therefore, to definitively rule out
the diagnosis, convalescent-phase samples
should be obtained from patients whose
acute-phase samples test negative.

 Common laboratory tests for

chikungunya include for instance RT-PCR
and serological tests

10. 2min To understand Teaching Learning Mode How you will

the treatment activity activity l treat the
of chikungunya
chikungunya fever ?

TREATMENT OF CHIKUNGUNYA FEVER

There is no specific treatment for

chikungunya. The illness is usually self-
limiting and will resolve with time.
Supportive care with rest is indicated
during the acute joint symptoms.
Ibuprofen, paracetamol relieve symptoms
of fever and aching.

Movement and mild exercise tend to

improve stiffness and morning arthralgia,
but heavy exercise may exacerbate
rheumatic symptoms.
In unresolved arthritis refractory to
NSAIDs, chloroquine phosphate (250
mg/day for several weeks) has given good
results.
Vaccine for commercial purpose is not
available and is under trial.
11. 2min To know the Teaching Learning Mode What are the
complications activity activity l complications ?
COMPLICATIONS OF CHIKUNGUNYA
FEVER
Chikungunya is a self-limiting illness. The major
causes for morbidity are severe dehydration,
electrolyte imbalance, and hypoglycaemia.
Recovery is the rule, but 10 - 15% patients had
chronic joint pain and stiffness.
Major complications, though rare, are:–
1. Bleeding disorder (epistaxis, UGI bleed) as it
causes thrombocytopenia, superadded by
injudicious use of NSAIDs.
2. Neurological complications: a.
Meningoencephalitis. b. Paresis of limbs.
c. Slurring of speech.
3. Cardiovascular decompensation.
 4. Pneumonia and respiratory failure.
5. Deaths – Few deaths have been reported in the
recent epidemic in Reunion Island and in southern
12. 5min To explain Teaching Learning Flash How to prevent
India.
about the activity activity cards the
prevention PREVENTION OF CHIKUNGUNYA FEVER chikungunya
fever?
As there is no vaccine available yet, the only way
to prevent it is to eliminate mosquito breeding
sites and to prevent mosquito bites.
 Aedes mosquito vector for this disease
breeds in artificial accumulations of water
in and around human dwellings, such as
water found in disused wares, broken
bowls, flower pots, earthen pots. Therefore,
these sites should be eliminated by
responsible human behaviour and social
education.
 Aerosol spray of ultra low volume
quantities of malathion or sumithion (230
ml/litre) has been found to be effective.

 Mosquito net and repellents which contain

20 - 50% DEET (N, N-diethyl-meta-
tolnamido) should be used to prevent
mosquito bites.
  As mosquito bites during daytime,
mosquito repellants should be used during
daytime also and, not only during the night.

 Use of full sleeve clothing is effective in

13. 2min To discuss preventing mosquito bites.
about the Teaching Learning Hand What are the
 chikungunya activity activity out transmission of
infant ?
CHIKUNGUNYA FEVER ABOUT MOTHER

 Chikungunya fever with pregnancy There

have been cases of mother-to-infant
infection which have occurred between 3
and 4 months into pregnancy.
 Before and after that period in pregnancy,
cases have not been recorded.
 IgG that is produced around day 15, passes
through the placenta and confers immunity
to the foetus.
 However, there is a 48 per cent risk of
infection at birth if the virus is present in
the mother’s blood.
 Such an infection in the foetus is rarely
serious, and more than 90 per cent of the
infected newborns recover quickly without
sequelae.
14. 1min To summaraise
the topic
SUMMARY
I summaraise my topic with the
 definition ,epidemiology,etiology,classification,mo
de of transmission,reserviour,clinical
manifestations, diagnostic investigations,treatment
and prention of chikungunya fever.
15. 1min To conclude
the topic
CONCLUSION
I conclude my topic with providing information to
control over the chikungunya in infant from
mother and mother will conclude to get complete
information on chikungunya fever about
prevention methods
16. 1min To give
assignment
ASSIGNMENT

How to prevent the chukungunya fever in infant?

17.
BIBLIOGRAPHY

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disease in southern province, Tanganyika territory,
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Society Trop Med Hyg 1955; 49: 28-32. 2. Shah
KV, Gibbs CJ Jr, Banerjee G. Virological
investigation of the epidemic of haemorrhagic
fever in Calcutta: isolation of three strains of
Chikungunya virus. Indian J Med Res 1964; 52:
676-83. 3. http://www.medindia.netChikungunya
Affects Eight state.htm. 4.
http://en.wikipedia.org/wiki/Chikungunya. 5.
http://timesofindia.indiatimes.com. 6.
Chikungunya and Dengue in the south west Indian
Ocean. Epidemic and Pandemic Alert and
Response (EPR). http://
www.who.int/csr/don/2006. 7. Parik.
Disappearance of chikungunya virus from India
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1986; 80: 491. 8. Yergolkar PN, Tandale BV,
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/entity/csr/don 2006_02_17/es. 10. Powers AM,
Branlt AC, Jesh RB, Weaver SC. Re-emergence of
chikungunya and O’nyong-nyong viruses:
evidence for distinct geographical lineage and
distant evolutionary relationship. J Gen Virol
2000; 81: 471-9. 11. Neogi DK, Bhattacharya N,
Mukherjee KK et al. Sero survey of chikungunya
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