Chandipura virus: A looming threat to children in India

Dear Editor,

The recent report from Gujarat, where six children succumbed to the suspected Chandipura virus (CHPV) infection since July 10, highlights a growing concern that demands national and even global attention. With twelve suspected cases noted so far, the pattern of this outbreak necessitates a deeper understanding of CHPV, its transmission, symptoms, management, and regional impact [1].

Chandipura virus is a member of the Rhabdoviridae family, closely related to the virus that causes rabies. It primarily transmits through sandflies, including the Phlebotomine sandflies and Phlebotomus papatasi, with some mosquito species like Aedes aegypti also acting as vectors [2]. The virus harbors in the salivary glands of these insects and can transmit to humans or domestic animals through bites. This leads to severe complications, including encephalitis, which is an inflammation of the brain's active tissues. The initial symptoms of CHPV infection mimic those of the flu—fever, body ache, headache—but can quickly escalate to more severe conditions such as altered sensorium, seizures, and encephalitis. The rapid progression from encephalitis to mortality within 24–48 hours’ post-hospitalization underscores the deadly nature of this virus. Historically, the disease has predominantly affected children under 15, making it a significant pediatric concern [3].

Fig. 1 provides a comprehensive overview of the Chandipura Virus, detailing its structure, transmission, symptoms, and epidemiological hotspots. The virus is depicted with a bullet-shaped virion and single-stranded RNA, surrounded by glycoprotein spikes. Transmission occurs through bites from infected vectors such as sandflies, mosquitoes, and ticks, which are particularly active during monsoon seasons and thrive in environments like cow dung. Once the virus enters the body, it rapidly invades and multiplies within the central nervous system (CNS), leading to severe encephalitis and neuronal damage within 28–48 hours. Initial symptoms include headache, fever, and muscle pain, progressing to more severe manifestations such as sensory impairments and seizures. The diagram highlights Gujarat, India, as a current hotspot with recent outbreaks, emphasizing the urgent need for effective treatments, vaccine development, and preventive strategies like insecticide sprays.

Fig. 1.

Transmission, pathogenesis, and epidemiology of chandipura virus infection.

Presently, there is no specific antiretroviral therapy or vaccine available for CHPV. Management strategies are purely symptomatic, focusing mainly on controlling brain inflammation to avert mortality. This reactive approach is less than ideal, as the disease's rapid progression can outpace medical interventions, making it crucial to develop targeted therapies or preventive measures.

First identified during a dengue/chikungunya outbreak in Maharashtra in 1965, CHPV has shown recurrent outbreaks primarily in Maharashtra, northern Gujarat, and Andhra Pradesh. The virus remains endemic to central India, where the vector populations are densest. These regions, often rural and tribal, are particularly vulnerable due to environmental conditions favorable to sandfly proliferation, such as during the monsoon season. The use of cow dung in rural housing for painting or making cakes also attracts sandflies, exacerbating the problem [4].

The recurrent outbreaks and the recent rise in cases call for urgent action. Enhancing public health awareness, improving sanitary conditions, and developing vector control strategies are critical steps. Additionally, the need for a vaccine or specific treatments has never been more pressing. As the vectors thrive under specific environmental conditions, understanding these dynamics can help in deploying targeted interventions, potentially saving many young lives [5].

The fight against Chandipura virus is not just about managing an infection but about addressing broader issues of public health, environmental management, and regional health disparities. As researchers and healthcare providers rally to understand and combat this virus, the support from governmental and international health organizations will be pivotal in containing this deadly disease. The loss of young lives to such preventable conditions is a stark reminder of the gaps in our healthcare system that need bridging.

CRediT authorship contribution statement

Priyanka Mohapatra: Writing – original draft, Data curation, Conceptualization. Ashok Kumar Balaraman: Conceptualization. Rachana Mehta: Writing – review & editing. Pramod Rawat: Writing – review & editing, Validation, Resources. Sanjit Sah: Writing – original draft, Data curation, Conceptualization. Prakasini Satapathy: Writing – review & editing, Software, Resources.

CRediT authorship contribution statement

Priyanka Mohapatra: Writing – original draft, Data curation, Conceptualization. Ashok Kumar Balaraman: Conceptualization. Rachana Mehta: Writing – review & editing. Pramod Rawat: Writing – review & editing, Validation, Resources. Sanjit Sah: Writing – original draft, Data curation, Conceptualization. Prakasini Satapathy: Writing – review & editing, Software, Resources.

Declaration of competing interest

All authors declared, no conflict of interest.

Handling Editor: Patricia Schlagenhauf