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M. P. Ravindra Nathan

The new spin on the health issues for travelers to India is making everybody shiver, literally, thanks to a new viral fever, which has suddenly popped up.

The name is �Chikungunya� and it is creating panic amongst the public. While I was visiting Kerala in August 2006, the newspapers carried headliners about this infection almost daily. Till now, we only had to fight malaria, dengue, hepatitis and a few non-specific �viral fevers,� which wreaked the most havoc but currently, Chikungunya is getting all the attention. Many of my friends who recently returned from India had come down with it.


You may wonder what a strange name �Chikungunya� is. It has nothing to do with chicken and not to be confused with any kind of bird flu. Actually, the name comes from Africa and is Swahili for "that which bends up," referring to the stooped-up position of the patient hit with the virus. It is caused by an alpha virus that is spread by bites from the Aedes Aegypti mosquito (the kind with bands on its belly and bites you during day time; it spreads dengue fever too), freely roaming around all over India. Its symptoms include high fever, marked chills, joint pains with swelling, headache, weakness and sometimes nausea, as well.

Medical scientists haven�t discovered a cure for this infection yet. There is no vaccine or preventive drugs. Prevention tips are similar to those for any other mosquito-borne disease: limit your exposure to mosquitoes. That is easily said than done in India! �Some of those mosquitoes are so big they can pick you up and eat you alive� as my sister puts it. �Nowadays, they are doing shifts to bite us � day and night and have holding patterns like airplanes!� one of my friends joked. Applying mosquito repellants (yes, cover yourself with Off, Cutter�s, Deet, Premethrin or whatever you can get your hands on, when you are going out; also, there are mosquito magnets, mosquito traps, coils, mosquito netting for your use � all freely available).

Staying indoors as much as possible, having secure screens on windows and doors to keep mosquitoes out and using a mosquito net are a few measures you can adopt to ward off the infection. Also, get rid of mosquito breeding grounds if possible or at least spray or fumigate the areas. Did you know that mosquitoes do not travel more than 90 meters from their breeding site. So, clean up the gutters, stagnant waters and all those heaps of waste in and around the house. We hunkered down inside our house most days instead of traveling at night. To think that man is afraid of this little pest in the 21st century!

Once you get the infection, the standard symptomatic and supportive self-care principles are the only salvation. There is no specific antiviral drug. Drink plenty of fluids since dehydration is common with fever and most infections. Intravenous fluids may be required in many cases. The fluids prevent blood becoming too thick, resulting in bleeding and coagulation problems, one reason for fatality.

Bed rest and anti-inflammatory drugs such as ibuprofen or acetaminophen as needed also are recommended. Aspirin should be avoided. No, a shot of brandy won�t cure your viral fever. Avoid alcohol since it dehydrates you and impairs your immune system. If you are diabetic or immuno-suppressed in any way, be extremely careful and inform your doctor immediately. Insulin requirements are higher during infections. Infected persons should be protected from further exposure to mosquito bites to prevent transmission to another person.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

Payal Patel

Influenza A and B are types of viruses that cause the flu. The usual time frame is from November to April with the peak months usually being January and February.

The flu is an upper respiratory infection of the nose and throat and sometimes the trachea and bronchi. Most people usually have a bad cold that consists of nasal congestion, sore throat, cough, along with headache, fever of 102-103 degrees for 2-3 days, body aches and general tiredness.

It generally lasts for about 10-14 days. More severe symptoms are associated with babies usually less than 6 months and the elderly. The complications of the flu are usually a result of secondary bacterial infections that can lead to pneumonia, ear infections, sinusitis and bronchitis. The flu is usually spread via air through sneezing, and coughing, along with indirect contact with secretions on a person�s hand or objects such as toys, door handles, etc., and then touching your own mouth or nose.


Children more than 1 year of age, who come to the office before 48 hours from the start of flu symptoms, can receive a medicine called Tamiflu. This does not completely cure the flu, but it shortens the flu symptoms by 1-2 days and prevents the complications that can occur with the flu. Otherwise, the treatment is generally supportive with fever and body ache reducers such as Tylenol and Motrin, saline suctioning, over-the-counter cough and cold medicines, and plenty of liquids.


Prevention consists of vaccination, limited contact with a sick person, limit group settings such as a daycare, birthday parties, etc. Proper hygiene such as hand washing, and covering the mouth and nose when sneezing or coughing also decreases the risk of infection.

The flu vaccine

There are two types of vaccines available at this time. The flu shot is recommended for all children ages 6-23 months old, and children more than 6 months old with chronic heart or lung conditions or those on long-term aspirin therapy, pregnant women, household contacts and caregivers of children less than 6 months of age. The other form of vaccine is called Flumist, which is delivered via the nose and is recommended for healthy persons 5-49 yrs of age. Both the vaccines have to be taken every year. Side effects of the vaccine include mild flu-like symptoms and egg protein sensitivity.

Why vaccinate?

Vaccination is highly recommended for those with chronic condition such as asthma, sickle cell disease and other immunodeficient and chronic heart and lung conditions. If we also vaccinate healthy children, especially the school-age group, there is reduced transmission in the community. It also prevents disease in high-risk elderly, and reduces the cost of acquiring the actual disease and its complications. It also interrupts influenza outbreaks in the community.

The best time to get vaccinated is starting late October to early January while the vaccines are available. Some pediatricians may have a limited supply of the flu vaccine and may reserve them for those with chronic illnesses, but there are plenty of flu vaccine clinics held each year, and flu vaccines also are available at walk-in clinics.


Bronchiolitis is a viral infection of the nose and throat, and sometimes the lungs. Most common virus is the RSV but can occur due to other viruses. Unfortunately, In Florida RSV is present for the longest time frame each year from October to April with cases occurring throughout the year.

Infections are usually present in approximately 60 percent of infants less than 6 months and about 80 percent less than 1 year of age. For most people, the virus causes the common cold, but for children less than 1 year and those with prematurity, chronic lung disease such as asthma, chronic heart disease, and immunodeficiency and exposure to smoke, it can be associated with more severe symptoms.

True bronchiolitis consists of difficulty breathing with rapid rate of breathing, coughing, wheezing and shortness of breath. The bronchiolitis symptoms are worse for 2-3 days with gradual improvement over a week with cough and nasal secretions lasting about two weeks. During this time, the virus is shed and therefore can spread to others. This again can be prevented by hand washing, limited contact with a sick person and avoiding group settings. The treatment is usually supportive with saline suctioning of the nose, warm humidified air, and encouraging liquids. Some children with bronchioltits may get a trial of asthma medicines by your doctor at the sick evaluation in the office.

Dr Payal Patel , a board-certified pediatrician in Tampa, can be reached at [email protected]

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