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Deepu Philip Mathew,  

CIRCULAR ON KYASANUR FOREST DISEASE

Kyasanur forest disease is an arthropod borne viral disease discovered in shimoga district of Karnataka state during March-1957. ETIOLOGY:- The disease is caused by " B"  group Arbo Virus. The agent KFD Virus is a RNA Genome Virus of the genus flavi virus, Family flavi viride. It is antigenicaly related to  Langat, DHF and westnile viruses.
GEOGRAPHICAL DISTRIBUTION;-
    KFD was persisting only in 5 Districts of Karnataka namely Shimoga, Chickmagalur, Dakshina Kannada, Uttara Kannada and Udupi till 2012. In December -2012 incidences of KFD  was confirmed in monkeys, Ticks and Human in Chamarajanagara District. Incidence of KFD in Monkey was confirmed in Mysore distri ct in January-2013. Later incidences of KFD in monkey was also confirmed in Nilgiris district of Tamilnadu. One incidence of Human was confirmed In Kerala State also.
EPIDEMIOLOGY:- The disease affects all ages in both sexes .  But it is common in young people who are more exposed to forest. This is a seasonal disease usually from December to May. During this period, nymphal stage of Tick is very active, the exposure of Human is also more in the forest.

MODE OF TRANSMISSION;- The disease is transmitted by the bite of infected ticks. The nymphal  stage of tick is primarily responsible for the transmission of the disease. The ticks once infected remains infective through out their life. The tick belongs to genus Heamophysalis and speices spinigera which is the commonest vector. Incubation period is 3 - 8 days.
CLINICAL SIGNS AND SYMPTOMS:-  The onset is sudden with high fever, severe headache, Nausea and Severe bodypain more in back and legs. The viremia is upto 12 days maximum between 3 - 6 days. Persons with above symptoms may be treated in the nearest Primary Health Centre. I E C activities to be carried out for the local people.
HAEMATOLOGICAL MANIFESTATION:- There may be bleeding from nose, gums, rectum, urethra person may become hypotensive leading to shock.
NEUROLOGICAL SYMPTOMS;- Drowsiness, twitching of muscles, tremors, convulsions and neck stiffness.
TREATMENT FOR THE KFD PATIENTS;- There is no specific treatment for KFD. Hence, all the  patients are treated symptomatically. Correction severe dehydration by infusion of I.V.  Fluids, use of antipyretics to control fever help in recovery of patients. There is no special drug for KFD, therefore following steps are adopted for treating the patients.
a)    Early hospitalization.
b)    Absolute bedrest.
c)    Administration of oral and I.V.Fluids.
d)    Vitamin C and K.
e)    Antibiotics.
f)    Eye ointment.
g)    Injection perinorm.
h)    If there is cerebral edema 10% Dextrose I.V or Manitol should be
administered.
i)    Inj. Batrophase and blood transfusion in case of haemorraghic symptoms.

SURVEILLANCE PROGRAMME;-  Active and intensive surveillance should be carried out. The following preventive measures are to be taken in KFD epidemic area.
1)    People should be advised not  to go to the forest where monkey deaths are reported.
2)    Persons whose visit to the forest is inevitable should be advised to cover the body with thick cloths and Gum boots.
3)    Application of D.M.P Oil (Insect repellent) to expose parts before going to forest.
4)    Washing clothes and body with hotwater and soap, after returning from the forest.
5)    Incidences of human fever cases and unnatural monkey deaths occurred KFD epidemic area to be monitored and detail information be communicated to health authorities.
6)    Monkey death should be reported to the nearest PHC/PHU/CSC/GH. Samples of brain, Lungs, Heart, Kidney and Lever may be collected from dead monkey (Fresh) in Sterile plastic vials by Health workers with the co-operation of local Veterinarians and transported in cold chain to VDL, Shimoga. Carcass of the dead monkey should be burnt after collection of samples. Hot spot dusting with Malathion powder in the areas were monkey death have been reported with in 50 meter radius around the spot of monkey death besides the endemic foci.
7)    Haemaphysalis spinigera, H.Turturis, H.Kinneri and H.Kyasanurensis, are the commonest vector of KFD. Collection of ticks, larvae, nymphs are carriedout by flag dragging method. Some of the ticks are collected from domestic animals and body of the forest workers and arround Hot spots where unnatural monkey deaths have occurred by plucking method. Ticks samples are labled and sent in cold-chain to VDL.Shimoga.
8)    The surveillance programme includes detection of Human fever cases. Collection of suspected human blood samples for diagnosis is necessary.  3 - 5 ml of serum is to be collected aseptically labled and sent in cold-chain to VDL Shimoga.
KFD VACCINATION PROGRAMME;- KFD vaccination is the Key for the whole programme. The timing of vaccination should be linked to the transmission cycle so that people can be protected. Population at risk should immunized.
a)    Population at risk
1)    Previously affected villages.
2)    Surrounding villages of 5 kms radius around monkey deaths, Tick positives and Human positives.
b)    Planning of vaccination:-
1)    Population at risk are to be identified.
2)    Estimation of doses of vaccine required.
3)    Emphasis should be on I.E.C. activities to create awareness about vaccination in the community.
    C) Vaccination schedule:-
          1) Two doses at an interval of one month.
          2) Age group  6 - 14 years -  0.5 ml S C route.
                                  15 - 65 years - 1.0 ml S C route.
4)    Booster dose is administered after  6 - 9 months.
            Warning: Vaccine should not be administered to pregnant women, person allergic to Gentamycin, Crystaline pencilin and Egg protein, and also to person with symptoms of  Jaundice and Cardiac complaints.
            There will be irritation at the site of inoculation for 2 - 8 minutes.
  D) Storage of Vaccine:-
        1) Vaccine should be stored at + 2 C to + 4 C temperature. Vaccine should not be frozen at any cost, if frozen discard.

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