Chikungunya: A Comprehensive Narrative Review on Epidemiology, Pathogenesis and Management

Abstract

The virus that causes Chikungunya fever (CHIKF), the Chikungunya virus (CHIKV), is carried by arthropods, primarily Aedes mosquitoes. A major global health concern since its initial discovery in Tanzania in 1952, CHIKF is most prevalent in tropical and subtropical regions. The virus, which belongs to the Togaviridae family, causes acute febrile disease that can last for months or years and is marked by fever, rash, and incapacitating arthralgia. Urban and sylvatic cycles are the means of transmission, and ecological and environmental factors impact epidemics. The disease's potential for epidemics and protracted joint-related symptoms results in significant socioeconomic costs. RT-PCR, immunofluorescence tests, and serology are diagnostic methods that differentiate CHIKV from related diseases such as dengue fever. Although supportive care is still the cornerstone of treatment, current studies examine the effectiveness of conventional treatments such as Nilavembu Kudineer, vaccine development, and antiviral medicines. The approval of the first CHIKV vaccine in 2023 marked an important turning point in disease prevention. By providing an overview of the epidemiology, etiology, clinical symptoms, and developments in diagnosis, treatment, and prevention of CHIKV, this study emphasizes the critical need for concerted efforts to lessen the disease's impact on public health.

Keywords

Introduction

The alphavirus known as the Chikungunya virus (CHIKV) is transmitted by mosquitoes. In 1952, amid a massive outbreak of a debilitating arthritic illness in Tanzania, the virus was first isolated from the serum of an afflicted patient (1). Since its reappearance in 2006, An arthropod-borne viral (arbovirus) illness known as chikungunya fever (CHIKF) has emerged as a major worldwide health concern. Similar to CHIKF today, fever and arthralgia epidemics have been documented historically(2). Over the past 15 years, chikungunya, a spread by mosquitoes and native to tropical areashas seriously threatened public health. It causes crippling joint pain and infects more than one million people annually (3). CHIKV is a member of the genus Alphavirus, which is a subfamily of the Togaviridae. Three structural proteins (C, E1-2) and four non-structural proteins (nsP1–4) are encoded by the message-sense RNA genome of alphaviruses, which are tiny (60 nm in diameter), enclosed viruses. CHIKV is maintained in the wild by continuous cycles of transmission between vertebrate hosts and Aedes mosquito vectors (4).  A self-limiting acute sickness that includes fever, rash, arthralgia, and myalgia is caused by the virus. Although they have been reported, other problems such as neurological symptoms and multi-organ failure are extremely uncommon (5). During the CHIKV outbreak, which afflicted around one-third of Reunion Island's population between March 2005 and July 2006, In June 2005, vertical transmission was first identified. In mice models without placental infection, it has been demonstrated that maternal viremia and fetal or neonatal sensitivity to a particular arbovirus directly promote intrapartum transmission of CHIKV (6).  Initially, it was only described as a severe fever and persistent peripheral polyarthritis that was sometimes accompanied by a rash. The disease's name, "chikungunya," which translates to "that which bends up" in Makonde, was inspired by the severity of the pain and disability. (7). According to recent studies, the chikungunya sickness has an extraordinarily high impact, resulting in economic losses and absenteeism. This is primarily because of its unique propensity for epidemics and the intense and incapacitating joint pain that it causes.(8). Since there are currently no approved medications for these infections in contemporary medicine, doctors treat them by treating their symptoms. However, in Siddha, a certain course of medication known as a regimen efficiently treats both of these infections. There is a single formulation, Nilavembu Kudineer (NVK), that is used in the early stages of infection to treat both dengue fever (DF) and chikungunya fever (CF). Andrographis paniculata is the main element in NVK, a polyherbal mixture that regulates all fevers linked to body aches. This herb, which is Indigenous to India and Sri Lanka, is also referred to as the King of Bitters, Bile of the Earth, and Neem of the Ground (9).

REVIEW POINT

Epidemiology:

The virus likely originated in Central and East Africa because CHIKV is spread by a sylvatic cycle between nonhuman primates and Aedes species mosquitoes that live in forests. Although human instances do occasionally occur, large-scale outbreaks are uncommon in these areas. However, in Asian and African cities, the virus can be transmitted from mosquitoes to unsuspecting human hosts, just like dengue viruses do. Aedes Egyptian and Aedes albopictus mosquitoes are the main vectors of CHIKV in urban areas (10).

CHIKV was introduced to Asia from Africa over 500 years ago. Three genotypes of the virus were identified based on the preliminary genetic investigation of the common CHIKV African ancestry: Asian, East/Central/South African (ECSA), and West African (WA). The Indian Ocean lineage (IOL) sublineage is likewise included in the ECSA. The most common of these genotypes, which are currently widely distributed, are Asian and ECSA (1). According to a genetic study of the virus that produced the outbreak, the CHIKV isolates obtained during the 2006 outbreak maintained a high degree of similarity and had over 99% identity at the nucleic acid level, indicating a single clade within the Central/East African genotype. The virus was first discovered in Kenya's coastal region in 2004 (1). The first reports of a chikungunya-like illness in Zanzibar appear to have been in 1823 and were referred to as kidinga pepo, a Swahili term for a condition characterized by an abrupt cramp-like seizure. Christie only mentioned an outbreak of this illness in Zanzibar a few years later, in an 1872 issue of the British Medical Journal. at 1827 and 1828, reports of a chikungunya-like sickness were first made at St. Thomas Island in the Caribbean. In the United States, it subsequently extended to New Orleans, Louisiana, and parts of South Carolina (11). The International Society for Infectious Diseases sponsors the Program for Monitoring Emerging Diseases (ProMED), which offers a distributed worldwide system for reporting infectious disease outbreaks. Reports on chikungunya cases in the local news were frequently reflected in ProMED records. Every item connected to chikungunya was examined, and case information was taken out. If there is a disagreement between ProMED data and public health data, the figure given by national or regional authorities is taken into consideration. India was the only high-incidence country to make state or provincial-level chikungunya case data publicly available between 2015 and 2020 (12).

PATHOPHYSIOLOGY:

Transmission:

CHIKV transmission occurs in two different cycles: sylvatic and urban. While animal-to-mosquito transmission is referred to as "sylvatic transmission," human-to-mosquito transmission is known as the "urban cycle". The sylvatic cycle is the major maintenance technique used in Africa. In areas with higher population densities, CHIKV is primarily sustained by an urban cycle in which Aedes mosquitoes act as the vectors and people as the major hosts (3). Following the discovery of the first neonatal case suggestive of mother-to-child CHIKV transmission in La Réunion island in 2005, a multidisciplinary prospective study was started to characterize the epidemiological, clinical, biological, and radiological features and outcomes of all neonatal CHIKV infections recorded at the Groupe Hospitalier Sud-Réunion during this outbreak, as well as to ascertain the frequency and timing of vertical transmission of CHIKV. This study showed that mother-to-child transmission of the virus did occur, resulting in an overall prevalence of maternal-fetal infections of 0.25 percent at 22 weeks, even though only 2.5% of exposed neonates develop CHIKV, despite 10% of them being exposed during pregnancy (4).

approximately the past 20 years, the mosquito-borne alphavirus known as the Chikungunya virus (CHIKV) has infected approximately 10 million people in over 125 nations or territories. 1.3 billion people currently reside in tropical and subtropical regions where CHIKV can spread. Recent outbreaks throughout South America's southern cone, including Uruguay, Argentina, and Paraguay corroborate estimates that the CHIKV range is probably being expanded by climate change, increasing the likelihood of epidemic transmission in more densely populated temperate regions, such as China, continental Europe, and the United States of America.5. The U.S. Food and Drug Administration authorized the first chikungunya (CHIK) vaccine in November 2023 (13). Between 15 and 47 percent of patients experience digestive symptoms such as diarrhea, vomiting, nausea, or abdominal discomfort during the acute phase of the illness. Consequently, during the acute phase of the illness, chikungunya fever significantly affects quality of life. Over 60% of instances involve incapacitation or limitation of usual activity, whereas 47% of cases have fatigue that is either considerable or very significant. Some patients experienced psychological effects, such as depression or demoralization. In a more recent investigation, the primary symptoms of a cohort of outpatients infected with CHIKV during the Reunion island outbreak were described, together with their classical and daily course (until day 14 after beginning)(14). According to a recent study on the Reunion Island CHIKV outbreak, symptoms in afflicted individuals may not show up for up to 14 days after the virus first manifests. Two phases were identified over these 14 days: the "convalescent stages," which lasted from days 5 to 14 without any discernible viremia, and the "viral stage," which lasted from days 1 to 4 with declining viremia. Compared to the first stage, the second stage had a slower rate of clinical improvement (15).

The Infection Route: Humans can contract CHIKV in a known manner, and certain cell types are more susceptible than others. Human epithelial and endothelial cells, primary fibroblasts, and monocyte-derived macrophages are among the cells that are vulnerable to infection and viral production, whereas lymphoid and monocytoid cells, primary lymphocytes and monocytes, and monocyte-derived dendritic cells did not demonstrate CHIKV replication. Replication at other tissues triggers the disease's viremic phase, which is also when mosquitoes can transmit it (3).

VIROLOGY

Transmission effect of virology: One of the best-established instances of a particular viral component influencing epidemiology was the discovery of a CHIKV mutant that was preferentially spread by Aedes albopictus, a non-traditional vector. Nearby La Reunion seems to be experiencing relatively little disease in 2005 as a result of the CHIKV outbreak that was raging in Comoros. But when the island's A. albopictus populations grew and the rainy season began in early 2006, the number of human illnesses skyrocketed to almost 40,000 cases per week during the height of the outbreak.

Impact of virology on vaccine development: Many CHIKV vaccine candidates have been under development, especially in light of the virus's quick spread throughout the world. These strategies include subunit vaccines, DNA vaccines, virus-vectored strategies, virus-like particles, and live-attenuated choices. Although each method has pros and cons, their efficacy must be based on particular virological traits.

Impact of virology on therapeutic development: Perhaps even more crucial than the creation of vaccinations is the need to understand specific genetic and antigenic characteristics of viruses to develop therapeutics. One therapeutic strategy where particular viral sequences are crucial is the use of short hairpins or tiny interfering RNA elements to restrict viral replication.

Impact of virology on Diagnosis: It has been demonstrated that CHIKV causes a high-titered viremia that can persist for extended periods. Research on afflicted persons has revealed that RNA has been discovered in serum 13 days after illness, and viremia can be identified as early as 7 days before the beginning of symptoms. At their apex, the titers also achieve levels of more than 108 particle forming units/ml. The molecular or antigenic identification of infection in diagnostic samples may be impacted by these elevated viremia levels and prolonged intervals (16).

Neurological and clinical signs: The symptoms of CHIKV include high fever, exanthema, myalgia, headaches, and arthralgia after an incubation period of one to twelve days. This final symptom typically affects multiple joints and is symmetrical. Even though the initial symptoms go away within a week or two, arthralgia can linger for months or even years. Between 3% and 25% of cases had asymptomatic infections. Atypical signs, like neurological problems, have been documented in addition to the typical clinical picture of CHIKV. The clinical range in these cases has been comparable for children and adults. Following mother-to-child transmission, encephalopathy was the most frequent consequence among newborns infected with CHIKV. The transmission rate for viremic women during the delivery period was nearly (17). CHIK neurological disorder is usually treated with symptoms. Although the majority of people with neurological diseases recover without any aftereffects, the prognosis varies. Multiple organ systems may be concurrently affected by neurological disease after CHIK infection; for this reason, a multidisciplinary approach is essential (18). More than 90% of adult patients have been reported to experience acute phase arthritis, which is characterized by a polyarticular and symmetrical pattern and primarily affects the hands, wrists, shoulders, knees, ankles, and feet. Patients may find it difficult to move, wash their teeth, or pick up objects because of the discomfort, which can be incapacitating. At this stage, tenosynovitis, joint stiffness, and edema (periarticular and/or articular) are commonly seen (19).

MUCOCUTANEOUS MANIFESTATIONS

It has been reported that CF is associated with a wide range of skin and mucous membrane lesions, some of which have not been seen in other viral exanthems. About 40–50% of instances may result in the disease's dermatological symptoms. The most prevalent pattern of cutaneous lesions observed is morbilliform eruption. It often manifests three to five days after the onset of fever and goes away three to four days later, usually without any aftereffects. About 80% of individuals have no symptoms at all, while the remaining patients may experience minor pruritus. Although it may occur concurrently with the fever or after defervescence, the eruption usually occurs within the first two days after the fever's commencement (20). The study included patients who attended Calicut Medical College's outpatient department of dermatology and pediatrics as well as those who attended camps set up in Calicut's suburbs during the most current CKG outbreak, which lasted from July 2009 to the end of September. The study was descriptive and prospective. The criteria established by the National Institute of Communicable Diseases, Directorate General Health Services, India, were used to make the diagnosis of CKG (21).

Ocular Manifestation: Each participant underwent a comprehensive ophthalmologic examination that included a dilated fundoscopy examination using a 78D fundus lens (Volk, Mentor, OH, USA), gonioscopy, slit-lamp biomicroscopy, Goldmann applanation tonometry, pupillary reflex testing, best-corrected visual acuity (BCVA), manifest refraction, and more. Those who had a history of corneal diseases, eye injuries, or an unwillingness to cooperate during exams were excluded. The infection phase was categorized based on the dates of the serologic and ophthalmological examinations. A recent infection was defined as one that had been identified within a year of the date of the ophthalmological examination, and a chronic infection as one that had been diagnosed for more than a year.

The lacrimal function: After using the blue cobalt filter to infuse 1.0% fluorescein sodium, the tear film break-up time (TBUT) was measured; a TBUT of less than 10 seconds was deemed abnormal. The dry eye workshop recommendations were followed when doing the Schirmer test (ST) without anesthesia (ST type I). The lissamine green test was used to evaluate the ocular surface, and the Copenhagen criteria were used to rate the corneal and conjunctival staining. Notably, when TBUT or ST were positive, the diagnosis of dry eye was taken into consideration (22).

DIAGNOSTICS

Both CHIKV-specific IgM in an IgM/IgG indirect immunofluorescence assay (IFA) (Anti-CHIKV IIFT IgM/IgG, Euroimmun, Lubeck, Germany) and CHIKV-specific real-time reverse-transcription polymerase chain reaction (RT-PCR), as instructed by the manufacturer, were considered positive results for acute CHIKV infection. IFA and negative RT-PCR results for serous with positive IgG but negative IgM were not regarded as acute infections. There were no convalescent sera available to measure seroconversion. The only diagnostic center on the island that used IFA to test for CHIKV was the Landslaboratorium. Prior to being shipped to the Institute of Tropical Medicine (ITM, Antwerp, Belgium), where CHIKV-specific RT-PCR was carried out as previously mentioned, all sera were kept at -80 ?C at the Landslaboratorium. In short, using primers and probes that could identify the African and Asian CHIKV strains, a particular region of the nonstructural protein 1 (NSP-1) gene was amplified on the LightCycler 96 (Roche) in accordance with the procedure outlined by Van den Bossche et al. After 50 cycles of real-time RT-PCR, any Ct-value less than 50 was regarded as positive. An attempt was made to isolate CHIKV from samples with Ct-values less than 30 by inoculating Vero cells (ATCC1 CCL-81TM). The isolates' E1-region was genotyped using the Sanger sequencing technique (23).

Diagnosis of CHIKV using IgG and IgM assay: The IgM and IgG capture ELISA kit (IBL International, Hamburg, Germany) was used to measure CHIKV-specific IgM/IgG antibodies in compliance with the manufacturer's instructions. The diagnostic specificity and sensitivity were both above 90%.  Quick diagnostic procedure for the diagnosis of CHIK To diagnose CHIKV quickly, the STANDARD F Chikungunya IgM/IgG FIA kit (SDBIOSENSOR, Gyeonggi-do, Republic of Korea) was utilized. It qualitatively examines CHIKV-specific IgM and IgG antibodies using fluorescence immunoassay (sensitivity 94.3% and specificity 97%) (24).

Using CHIKV real-time RT-PCR, the CDC arbovirus diagnostic laboratory developed the CHIKV testing methodology, which assesses samples obtained less than six days after the onset of sickness. The broadly reactive 3855 primer/probe pair can be used to identify both Asian and East Central South African (ECSA) genotypes. The purpose of its development was to identify the ECSA genotypes of visitors returning from India. Specifically designed for the Asian genotype CHIKV strain currently seen in the Caribbean, the 856 primer/probe combination is marginally more sensitive for the Asian genotype than the 3855 set. The 856 set's increased sensitivity makes it helpful for verifying positive results for samples with low amounts of CHIKV RNA (25). Because the clinical signs of dengue and CHIKV are similar, laboratory confirmation of CHIKV infection is essential, particularly in dengue endemic locations. Nonetheless, the two viruses might be spread by distinct vectors (Ae. aegypti and Ae. albopictus), necessitating distinct approaches to control. For the early phase confirmation of CHIKV infections, RT-PCR is a great technique, and numerous procedures have been developed specifically for this use. Unfortunately, the viraemic period, which typically lasts one to five days following fever onset, is the only time this viral detection method is effective. Serological testing is therefore necessary to verify CHIKV infection. A small number of commercial CHIKV diagnostic tests have recently hit the market, but few studies have compared and assessed these instruments in a methodical manner (26). Laboratory techniques like the precipitin test, enzyme linked serological assays (ELISA), and polymerase chain reaction (PCR) have been used to study the host choice and feeding habits of Culicoides midges. Laboratory techniques like the precipitin test, enzyme linked serological assays (ELISA), and polymerase chain reaction (PCR) have been used to study the host choice and feeding habits of Culicoides midges. As an alternative, observational studies have been carried out, which entail the collection of adult female midges through the use of direct aspiration from animals, which is the most dependable study technique, or light, sticky, or animal-baited traps (27). Given the limitations of ELISA-based methods for CHIKV detection, this study examined ELISA, rapid diagnostic tests (RDT), and nucleic acid assays based on real-time PCR. Additionally, the levels of inflammatory cytokines that influence immune responses were assessed in 102 patients who had both an acute CHIKV infection and a malaria coinfection. These cytokines include TNF-α, IFN-γ, interleukins (IL), IL-4, IL-10, IL-12, IL-13, IL-16, and others. Supplies and Methods Ethics-based endorsement This work was approved by the independent and institutional authorities (1). Numerous techniques, such as virus isolation, serological techniques, and RNA detection using real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), can be used in laboratories to assess CHIKV infection. In the past, serological techniques to identify the existence of certain antibodies against CHIKV served as the primary basis for diagnosis. As molecular techniques have advanced, qRT-PCR has gained popularity as a means of identifying viral RNA, especially during the acute phase of infection. Above all, when choosing the testing method, the examination's goal and the schedule for specimen collection should be taken into account (28).

SEROLOGIC EXAMINATION

Out of 296 patients, 65 came in for follow-up. Using an in-house dipstick ELISA kit, serum samples from these 65 individuals were examined for the presence of IgM and IgG antibodies specific to the CHIK virus. A panel of 107 out of 296 serum samples taken from individuals exhibiting clinical characteristics resembling those of either dengue fever or CHIK fever was included in the study because the symptoms of both illnesses can be confused. Additionally, as a negative control, a panel of 20 serum samples from healthy people who showed no symptoms of dengue fever or CHIK was included (29).

RT-PCR: Two previously published PCR methods were examined in order to ascertain their sensitivities. The first was a one-step RT-PCR based on SYBR Green, which was developed by Hasebe et al. (2002) to identify a fragment of the CHIKV non-structural protein 1 (nsP1) gene. Hapuarachchi et al. (2010) provided a description of the PCR conditions. The other test was an RT-PCR procedure based on Taqman probes that was modified from Pastorino et al. 2005. It contained the following PCR assay modifications and minor adjustments to the primers that target the E1 region: The Qiagen QuantiTect Probe RT-PCR kit was used for the PCR experiment (26).

PATHOGENESIS

History of nature and transfer: Epidemics of chikungunya fever exhibit seasonal, cyclical, and secular patterns. These epidemics are distinguished by explosive breakouts that are punctuated by years or even decades of disappearance. The precise cause of this phenomenon is still unknown. Many mechanisms are thought to be at play, including a complex interaction between various elements such as the virus's susceptibility in humans and mosquito vectors, the conditions that promote mosquito reproduction and lead to a high vector density, and the vector's ability to effectively spread the virus. Traveling abroad has made it easier for the virus to spread from endemic regions to other regions, leading to outbreaks and imported cases (30). Both "classical" and "new" clinical patterns of the illness are currently acknowledged. Life-threatening cases and neurological variants of the disease were described during the Reunion outbreak, as well as later in India, especially in young children and the elderly. Since both "classical" and "new" clinical patterns of the sickness are now recognized, such rare but severe cases still represent an important study topic even though the prevalence of life-threatening disorders has since been determined to be quite low (below 1%). During the Reunion outbreak and later in India, cases of the disease that were life-threatening and had neurological variations were reported, particularly in small children and the elderly. Such rare but severe instances nevertheless represent an important research concern since infection rates for a naive population may be as high as 30%, even if the prevalence of life-threatening infections has since been determined to be quite low (below 1%). A naive population may have up to 30% infection rates (31). Several publications claim that CCA is "post-chikungunya chronic inflammatory rheumatism." According to these reports, patients infected with CHIKV may also develop arthritis that mimics psoriatic arthritis (PsA), seronegative spondyloarthritis (SpA), rheumatoid arthritis (RA), or undifferentiated polyarthritis (UP), which is characterized by inflammatory arthritis affecting more than four joints for more than six weeks without a different indication (32). In the acute phase, supportive care is employed as treatment because no specific antiviral medication is effective against CHIKV. Among the goals of CCA treatment are pain management and preventing joint deterioration. Leflunomide, methotrexate (MTX), hydroxychloroquine (HCQ), sulfasalazine (SSZ), corticosteroids, biologic therapies, and nonsteroidal anti-inflammatory drugs (NSAIDs) have all been investigated as potential treatments, either separately or in combination (32).

TREATMENT

The course of treatment for a patient with CHIKF may vary according to the disease's stage. Depending on the severity of the pain, opioids and conventional analgesics (such as paracetamol) are frequently recommended during the acute period. Despite their widespread use in the subacute and chronic phases of the disease, corticosteroids and non-steroidal anti-inflammatory medications (NSAIDs) are avoided at this point. Despite not having undergone clinical testing, certain antivirals exhibit both in vitro and in vivo action. Due to the lack of compelling evidence against CHIKF musculoskeletal symptoms, most recommendations have adopted therapies utilized for more common inflammatory arthropathies, such as disease-modifying anti-rheumatic drugs (DMARDs) and chloroquine derivatives (33).  Although there is an initial pattern of acute febrile illness from the standpoint of clinical presentation, the majority of the disease's symptoms are caused by musculoskeletal manifestations, which occur during the acute phase and continue for months or even years after the fever has subsided. Patients' quality of life is impacted by the severe physical incapacity brought on by the pain and suffering associated with joint manifestations in their various stages. A considerable percentage of patients experience discomfort and mental, psychological, and sleep difficulties as a result of the illness (19).  Treatment for CV involvement is still debatable, and there is no specific vaccine or treatment for chikungunya. Everyone agrees that treatments should be carried out early in the illness to prevent cardiogenic shock and heart failure. It is strongly advised to take supportive measures like oxygenation, close cardiac monitoring, and inotropic medication as needed (34). Typically, arthritis does not have a clear progression; instead, it is more severe in the morning and gets worse with more strenuous exercise. The symmetrical involvement of the joints is one of the symptoms that are similar to those of the acute phase in the chronic phase. This phase is characterized by joint pain that doesn't go away after healing. Polyarthralgia typically lasts for two weeks, although it can also linger for weeks or even years. Consequently, CHIKV can cause significant arthralgia and/or arthritis during the chronic phase, which can interfere with a person's quality of life and linger for months to years after the original infection (35).

Impact of magnesium and zinc salts on the percentage of CHIKV-infected cells that survive:

To determine whether treatment with zinc and magnesium salts could stop virus-induced cytopathic effects, the antiviral activity of the salts was further verified using the MTT assay. The MTT test was used to compare infected cells treated with and without zinc and magnesium salts (2.5, 5, 10, 20, 40, 60, 80, and 100 mM concentrations) to uninfected and untreated cells to determine the percentage of cells that survived (36).

Natural Remedies: It is easy to divide the many forms of natural treatments utilized for CHIKV into four categories: homeopathy, physiotherapy, preventive, and home remedies. In the endemic areas where CHIKV is present, each of these treatments has a part in reducing its effects. This section will demonstrate how natural remedies can effectively help persons with chronic CHIKV-associated arthralgia or arthritis, even though pharmaceutical therapy is typically considered first when considering treatment alternatives in Western countries (37).

PREVENTION AND CONTROL:

To lessen the spread of CHIKV, environmental management to stop mosquito breeding and integrated control of epidemiological surveillance are crucial. Prevention is the best line of protection against environmental mosquito vectors. To lessen the amount of skin exposed to mosquito bites, apply pesticides, put window and door screens in dwellings, remove standing water and other mosquito breeding grounds, use mosquito nets, and wear long sleeves. However, total avoidance of transmission from environmental management is not possible due to CHIKV's disproportionate effects in low-resource areas and its widespread misdiagnosis and underdiagnosis (37).

Homeopathy: For thousands of years, traditional medicine has included the use of medicinal plants, herbal preparations, and medicines from both natural and manmade sources to cure and prevent ailments. This practice is still widely used today. Since plants have evolved multilayered defenses against all diseases and are constantly being challenged by viruses to defend themselves, they can be used to protect people from disease. Research on plants as possible sources of natural antiviral medications that might be useful in treating the chronic symptoms of CHIKV has increased. Homeopathy is the most effective treatment for CHIKV because it can prevent viral multiplication, boost the host immune system, lower mortality, and alleviate symptoms with little harm (37).

Vaccine and Treatment: Immunizations and Therapy Even though CHIKV is already common in many areas, there are currently no vaccinations for the virus, and anti-inflammatory medications remain the primary treatment for CHIKV-infected people to alleviate their symptoms. For developing nations to finance a widespread immunization program, a CHIKV vaccine must be affordable, manageable, and portable. There are now several preclinical vaccines under development and a limited number of clinical studies being carried out globally. Since CHIKV persistent arthralgia shares some clinical characteristics with rheumatoid arthritis (RA), some commonly used disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine, have been used to treat it, though their efficacy has been limited (1).

RESULT AND CONCLUSION

The chikungunya virus (CHIKV) continues to be a major concern to world health due to its widespread spread by Aedes mosquitoes and its ability to induce persistent and incapacitating symptoms, particularly arthralgia and arthritis. Urbanization and climate change raise the risk of an epidemic, and the disease poses economic and social challenges, especially in tropical and subtropical regions. Effective therapy choices are still restricted to managing symptoms, even with advancements in diagnostics, such as sophisticated molecular and serological approaches. There has been promise in using antiviral substances like zinc and magnesium salts as well as traditional treatments like Nilavembu Kudineer. A significant step toward illness prevention has been taken with recent developments in vaccine development, which culminated in the first CHIK vaccine being approved in 2023.

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