Chandipura virus: Know all about the infection that has claimed children's lives in Gujarat

The ongoing Chandipura virus outbreak in Gujarat, which has also reached neighbouring states, poses a critical health risk for children below the age of 15 years. As of July 24, 23 cases of Chandipura virus were confirmed out of the total 121 cases reported based on suspected symptoms of the virus, Dr. Nilam Patel, Additional Director (Public Health) of Gujarat Health Department told ANI. Six of these cases are from other states - three from Rajasthan, two from Madhya Pradesh and one from Maharashtra. Total 40 suspected deaths have occurred due to the virus, of which 10 are confirmed cases of Chandipura.

With the surge in Acute Encephalitis Syndrome (AES) cases caused due to Chandipura virus in Gujarat, the Maharashtra Health Department also issued an advisory cautioning officials and citizens to keep a check on symptoms and potential cases.

According to the paper ‘Chandipura virus: an emerging human pathogen?' published in The Lancet in 2004, Chandipura virus was first detected in 1965 in Nagpur, Maharashtra. It is reportedly named after the village where it was first detected. Since then, the virus has been reported in Maharashtra, Madhya Pradesh, Andhra Pradesh and now Gujarat.

Amid this rising health concern, we speak to Mumbai-based health experts to understand the symptoms, causes, effects and possible preventative measures of the virus.

What is the Chandipura virus?

Chandipura is a vector-borne virus that mainly causes encephalitis.

"Chandipura virus is a member of the family Rhabdoviridae, which also contains rabies. First isolated in Maharashtra in 1965 specifically from Chandipura area, this virus mainly causes encephalitis and is infamous for a high mortality rate among its victims," explains Dr Neeraj Tulara, General Medicine and Infectious Disease Specialist, Dr LH Hiranandani Hospital, Powai, Mumbai.

He adds, "This is an emerging pathogen with significant public health risks because it can cause outbreaks of rapidly progressive severe illness."
Dr Kirti Sabnis, Infectious Disease Specialist, Fortis Hospital Mulund and Kalyan, states, "The encephalitis-causing Chandipura virus is mainly transmitted by sandfly bite and leads to an inflammation or swelling of the brain."

Does it affect only children?

All recent cases of Chandipura virus have been reported among children below the age of 15 years.

"The Chandipura virus (CHPV) can affect adults, although it is more commonly reported in children," reveals Dr. Rahul Verma, Director - Neonatology & General Pediatrics, Sir HN Reliance Foundation Hospital, Mumbai.

"Epidemiological studies and outbreak data have shown that children suffer severe courses of disease with higher morbidity and mortality rates compared to adults," Dr. Tulara adds.

Symptoms to look out for

Early detection and intervention are key to navigate the effects of the virus.

"The clinical presentation of Chandipura virus infection is acute and severe. The incubation period is short, typically ranging from 24 to 48 hours," reveals Dr. Verma.

The experts explain some symptoms to look out for.

"Infection usually starts as flu-like illness - cold, sneezing, fever. It further leads to vomiting, headache, abdominal pain and diarrhoea. It can rapidly progress to seizures, confusion, and coma. The rapid progression is likely due to the virus's aggressive attack on nervous system," states Dr. Sabnis.

Dr. Tulara states, "Stiffening, nausea, headache, vomiting which comes with sudden migraines attacks, confusion or altered mental status, attacks by seizures without warning, very high fever, sensitivity to light and drowsiness are some examples of these major symptoms. These signs clearly indicate an encephalitic condition, hence requiring urgent medical attention since their progression is rapid."

If the intervention is not prompt, the progression of these symptoms may result in a coma or even death.

What are the short-term and long-term effects of the virus?

Dr. Tulara reveals that the virus causes acute encephalitis syndrome with severe brain dysfunction, high fever, seizures within few hours leading to coma that may be fatal.

"The long-term survivors of this disease have a range of complications such as cognitive and motor impairments while behavioral changes and neurological deficits are examples. Their quality of life is greatly affected by these lasting impacts, hence there is a need for continued medical care as well as emotional support," he says.

Is there a vaccine or treatment for the Chandipura virus?

"No vaccine is available till now. It's a sporadic disease, hence it is difficult to find a vaccine and have trials," states Dr. Sabnis.

Dr. Verma elaborates, "Supportive care remains the mainstay of treatment, aiming to manage symptoms and prevent complications."

Dr. Tulara states some supportive care measures.

• Fever reduction measures include the administration of antipyretics.
• Control of seizures calls for anticonvulsants.
• The patient also needs respiratory assistance and maintenance of fluid-electrolyte balance.

Immediate medical care remains key to manage symptoms of the virus. One must immediately visit the doctor if such symptoms arise.

Has enough research been done about the virus?

"Unfortunately, no definitive treatment research has been done," remarks Dr. Sabnis.

"This has not been given much attention and comprehensive studies have received less funding because it is relatively unknown outside its endemic areas where sporadic outbreaks have been witnessed. People often mistake Chandipura virus family for rabies simply because they belong to similar families, however, modes of transmission differ widely between them and their disease manifestation are in stark contrast. The main method by which Chandipura is transmitted from one person to another is via sandflies whereas rabies is typically spread through the bites of infected animals," informs Dr. Tulara.

Dr. Verma expresses hope for continued research in the domain. "With the outbreak in the news, new research is bound to happen. It should point to the infection's treatment and the vaccine's genesis to prevent it," he states.

What preventive measures can be taken to stay protected from the virus?

Experts believe that at this point, prevention is the cure when it comes to Chandipura virus. They list down precautions to protect oneself from the infection.

• Remove standing water sources and clean vegetation surrounding habitations to decrease sandfly breeding grounds. Vector control is key in preventing the virus.
• Put on protective clothes, use insect repellants and fix nets or screens on doors and windows to prevent sandfly bites.
• Public health education is also vital to inform communities about the risks and preventive measures.

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