On Wednesday, July 17, 2024, the National Institute of Virology (NIV) in Pune, confirmed the death of a four-year-old girl in Gujarat, as caused by the Chandipura virus. Meanwhile, the death toll of suspected cases of the virus has touched 15, while a total of 133 cases of viral encephalitis , including 47 cases caused by the Chandipura virus, have been registered in Gujarat in a month, the State government said in a statement.
Of the 15 deaths, 13 are from the State while one each are from neighbouring Madhya Pradesh and Rajasthan.
Gujarat Health Commissioner Harshad Patel said almost all the patients are children. Local health authorities have been monitoring encephalitis cases and would continue to keep a close eye on infections in the general population, stepping up surveillance in areas which have reported cases, he said.
This is not the first outbreak of Chandipura virus in the country: there were outbreaks in 2003-04 in parts of central India including Maharashtra, Gujarat and Andhra Pradesh that caused the deaths of over 300 children.
What is the Chandipura virus?
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 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.
How is it transmitted?
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, 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 then.
What are the symptoms of the disease?
The Chandipura infection is an encephalitis-causing virus, which means the infection leads to an inflammation or swelling of the brain tissue. Another Lancet paper, ‘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
- the fever is 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).
Whom does it affect?
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. 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.
How is it treated?
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 Farenheit), raised intracranial pressure and seizures and prevention of secondary bacterial infections are also detailed.
How is it prevented?
Prevention, the document says, includes vector control: identifying sandfly breeding sites, spraying insecticides, 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 is also important, through the use of protective clothing, repellants and nets.
