title: Investigation of an outbreak of chikungunya in Malegaon Municipal areas of Nasik district, Maharashtra (India) and its control.
abstract: OBJECTIVE
  An outbreak of chikungunya fever occurred in Malegaon town of Nasik district of Maharashtra state, India during February and March 2006. A total of 4530 fever cases were reported during this period including 1781 cases which were admitted in different hospitals of the town. An entomological and epidemiological investigation was carried out in the affected villages during the outbreak to study the possible causes of the outbreak and to isolate the virus responsible.
  
  
  METHODS
  Entomological evaluation was done as per WHO guidelines. Sera samples were collected by venipuncture from clinically suspected chikungunya patients in hospitals and also during house-to-house survey in affected villages. IgM antibodies to dengue virus were detected using IgM capture ELISA (PANBIO) and by "Haemagglutination inhibition test" for detection of antibodies against Chikungunya virus. Acute sera samples were inoculated in cell lines for virus isolation. The isolates were confirmed by RT-PCR.
  
  
  RESULTS
  On investigation, it was found that water storage containers like cement tanks, plastic containers or earthen pots placed in front of the individual houses were the potential breeding sites for Aedes aegypti. Entomological survey carried out in the most affected areas revealed high Aedes indices. House, container and breteau indices were found to be 27.2, 16.19 and 35.1, respectively. Out of the 13 acute sera samples collected, virus was isolated in 10 samples. The isolates were confirmed by RT-PCR and sequencing using primers from nsP1 gene of Chikungunya virus (CHIKV, Accession No. EF077609, EF077610). Of the 17 convalescent sera tested, significant level of HI antibodies to CHIKV was detected in five samples. One sample was positive for IgM antibodies against dengue virus. Based on clinico-epidemiological features and laboratory findings, the illness was confirmed to be of chikungunya viral disease.
  
  
  CONCLUSIONS
  Control measures targeting the vector population and personal protective measures against the mosquito bites were instituted. Extensive IEC campaign with the involvement of community and religious leaders helped in containment of the disease.
authors.affiliation: Centre for Medical Entomology and Vector Management, National Institute of Communicable Diseases, Delhi, India. kaushalmonu@yahoo.com
authors.forename: Kaushal
authors.initials: K
authors.lastname: Kumar
authors.forename: Mala
authors.initials: M
authors.lastname: Chhabra
authors.forename: R
authors.initials: R
authors.lastname: Katyal
authors.forename: P K
authors.initials: PK
authors.lastname: Patnaik
authors.forename: Himani
authors.initials: H
authors.lastname: Kukreti
authors.forename: Arvind
authors.initials: A
authors.lastname: Rai
authors.forename: V K
authors.initials: VK
authors.lastname: Saxena
authors.forename: V
authors.initials: V
authors.lastname: Mittal
authors.forename: Shiv
authors.initials: S
authors.lastname: Lal
mesh_terms: D000293:Adolescent; D000328:Adult; D000330:Aedes / Q000821:virology*; D000368:Aged; D000369:Aged, 80 and over; D018354:Alphavirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D000818:Animals; D002646:Chikungunya virus / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007303:Insect Vectors / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods*; D014881:Water Supply