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“Four of these 12 patients are from Sabarkantha district, three from Aravalli and one each from Mahisagar and Kheda. Two patients are from Rajasthan and one from Madhya Pradesh. They were treated in Gujarat,” Gujarat Health Minister Rushikesh Patel said.
Below we explain what CHPV infection is and who it affects.
What is CPHV infection and how is it transmitted?
CHPV is a virus from the Rhabdoviridae family, which also includes other members such as the rabies-causing lyssavirus. Several species of sandflies such as Sandfly sand duck Phlebotomus papatasiand some species of mosquitoes such as Aedes aegypti (which is also the vector of dengue) are considered vectors of CPHV. The virus resides in the salivary gland of these insects and can be transmitted to humans or other vertebrates such as domestic animals through bites. The infection caused by the virus can then reach the central nervous system, which can lead to encephalitis, an inflammation of the active tissues of the brain.
What are the symptoms of CHPV infection?
CPHV infection initially presents with flu-like symptoms such as acute onset fever, body aches and headache. It may then progress to altered sensorium or seizures and encephalitis.
Retrospective studies in India have also reported other symptoms such as respiratory distress, bleeding tendency or anemia.
Infection often progresses rapidly after encephalitis, which can lead to mortality within 24 to 48 hours of hospitalization, according to studies.
How can the infection be controlled?
The infection can only be controlled symptomatically, as there is currently no specific antiretroviral therapy or vaccine for its treatment. Therefore, controlling brain inflammation is crucial to prevent mortality.
The progression of the disease can be as rapid as the patient having a high fever in the morning and having kidney or liver problems at night. This makes it difficult to manage the symptoms, according to several pediatricians.
Which are the most affected regions in India?
CHPV infection was first isolated in 1965 during the investigation of a dengue/chikungunya outbreak in Maharashtra. However, one of the largest outbreaks of the disease in India was observed in 2003–2004 in states such as Maharashtra, northern Gujarat and Andhra Pradesh, where more than 300 child deaths were recorded.
Gujarat, during the 2004 outbreak, recorded a case fatality rate of around 78%, while in Andhra Pradesh, during the 2003 outbreak, the rate stood at around 55%.
The infection has remained largely endemic in central India, where the population of sandflies and mosquitoes transmitting CHPV infection is highest.
Dr Rakesh Joshi, medical superintendent of Civil Hospital, Ahmedabad and a paediatric surgeon, said outbreaks are usually reported in rural, tribal and peripheral areas and this may be linked to the prevalence of sandflies in these areas. He added that the infection also has a seasonal aspect as more outbreaks are reported when the sandfly population increases.
According to Dr Rajesh Jeswani, a paediatrician in Gujarat, “Many kutcha households also use cow dung paint or perhaps make cow dung cakes, which in turn attracts sandflies. Moreover, the outbreaks are more pronounced because sandflies multiply more during the monsoon season.”
Has the pattern of the disease changed over the years?
Yes, according to Dr Sandipkumar Trivedi, former executive board member of the Indian Pediatric Association. He said that changes are being reported in the patterns, both in the manifestation of the disease and the vector.
“Sandflies usually do not fly more than a metre above the ground, but this time, during surveillance, sandflies have been found on terraces and higher ground. Also, out of the six suspected deaths so far, two had brain haemorrhages, which is a new presentation. We are also seeing new clusters of outbreaks, for example in Gujarat, and there are also suspected cases in other tribal areas like Pavagadh, Khedbrahma and Godhra,” said Dr Trivedi.
