VZCZCXRO6942
OO RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHNE #1098/01 0651305
ZNR UUUUU ZZH
O 061305Z MAR 07
FM AMEMBASSY NEW DELHI
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3657
INFO RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 5548
RUEHLM/AMEMBASSY COLOMBO 9057
RUEHKA/AMEMBASSY DHAKA 9163
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RUEHSH/AMCONSUL SHENYANG 0187
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UNCLAS SECTION 01 OF 05 NEW DELHI 001098 
 
SIPDIS 
 
SIPDIS 
 
DEPT FOR SCA/INS, HHS FOR OGHA STEIGER/BHAT, CDC FOR 
BLOUNT/COX, NIH FOR GLASS/HILEMAN, OES/PCI FOR STEWART, 
OES/IHA FOR SINGER, GENEVA FOR WHO, APHIS/KOREA FOR ANDY 
BALL 
 
E.O. 12958: N/A 
TAGS: PGOV AMED EAGR IN KFLU ECON PREL SENV TBIO PTER
SUBJECT: CHIKUNGUNYA VIRUS RE-EMERGES IN INDIA - MAN VS. 
MOSQUITO FIGHT CONTINUES 
 
NEW DELHI 00001098  001.2 OF 005 
 
 
 
¶1. (U) Summary: After a 32 year hiatus, the chikungunya virus 
is making a comeback in India.  While the Government of India 
(GOI) estimates over 180,000 cases of chikungunya infection 
since December 2005, the actual number of cases is difficult 
to assess.  The GOI,s lack of transparency in reporting, 
problems with effective diagnosis, and the states' seeming 
inability to track the virus make chikungunya a very serious 
public health problem.  This time the virus has spread 
widely, with infections cropping up in rural and urban areas, 
as well as areas that attract mass tourism.  Previous 
outbreaks were limited.  One of our Mission officers 
contracted chikungunya, putting a personal face on this 
horrid disease.  This cable looks at the state of the public 
health system for diagnosis and reporting, and speculates on 
chikungunya as a possible bioterrorism agent.  End Summary 
 
WHAT IS CHIKUNGUNYA? 
------ 
 
¶2. (U) The chikungunya virus was first recognized in epidemic 
form in Tanzania, East Africa in 1952.  This virus is spread 
from the bite of an infected mosquito.  In Asia, (including 
India) the main vector is the mosquito species, Aedes 
Aegypti.  In other parts of the world, chikungunya is 
transmitted through the Aedes Albopictus species.  Kolkata 
reported India,s first chikungunya virus outbreak in 1963. 
At that time, scientists identified the virus as being of 
Asian origin.  For the current outbreak, scientists from the 
Indian Council of Medical Research,s (ICMR) premier virology 
laboratory, the National Institute of Virology (NIV) in Pune 
determined the virus is of African origin. 
 
¶3. (U) The disease, first described after the outbreak on the 
Makonde Plateau, along the border between Tanganyika and 
Mozambique, is derived from a Makonde word meaning &that 
which bends up.8  Victims of the viral disease abruptly 
manifest symptoms--acute onset of moderate-to-high fever 
accompanied with body ache, backache, and joint pain 
affecting primarily the knees, ankles, wrists, hands and 
feet.  Joint pain is severe and incapacitating, causing the 
infected individual to &bend8 or hunch over from the pain, 
hence its name.  According to the Centers for Disease Control 
(CDC), the incubation period (time from infection to illness) 
is anywhere from 3-7 days. 
 
¶4. (U) Symptoms and incubation period were directly 
experienced by New Delhi Poloff, bitten by a mosquito 
 
NEW DELHI 00001098  002.2 OF 005 
 
 
infected with the virus, after arriving in Chennai on 
November 28, 2006.  A mosquito infected with the virus bit 
Poloff Saturday, December 2, 2006 and she began manifesting 
symptoms 3-4 days later on Tuesday, December 5. Symptoms 
included excruciating and incapacitating muscle and joint 
pain, high fever (reaching 105 degrees Fahrenheit), nausea, 
headache, vomiting, swelling of the muscles and joints, 
general fatigue, and a full body rash.  The joint pain and 
fatigue has been prolonged, lasting several months.  The 
joint pain subsided only after 3-4 months. 
 
MISSION IMPACT 
------ 
 
¶5. (U) New Delhi PolOff is among one of three confirmed 
chikungunya infections among the staff of Mission India. 
Embassy New Delhi has documented three confirmed cases among 
EFMs and Mission personnel; Consulate Chennai has also 
documented 4 suspected cases among FSNs; there are no 
reported cases among Mission Personnel in Kolkata or Mumbai. 
 
DIAGNOSIS, TREATMENT, AND PREVENTION 
------ 
 
¶6. (U) There are critical problems with diagnosis due to poor 
infrastructure at labs in India and chikungunya,s 
similarities with dengue.  Typically, diagnosis is based on a 
process of elimination.  Once typhoid, malaria, and dengue 
are ruled out, the assumption is then that the symptoms are a 
result of chikungunya.  In India both the National Institute 
for Communicable Diseases in Delhi (NICD) and the NIV at Pune 
provide testing facilities which take 3-4 weeks for a result. 
 This process is long, frustrating, not widely accessible, 
and often inaccurate.  In the case of our PolOff, it took 5 
weeks to return a negative result for chikungunya from NICD. 
New Delhi Health Unit resent PolOff,s blood sample to the 
Armed Forces Research Institute of Medical Services (AFRIMS) 
lab in Thailand, which returns the most reliable results. Two 
months after being infected, PolOff finally got a positive 
diagnosis of the virus.  Consulate Chennai also reports no 
accurate, quality testing lab there for chikungunya. 
Additionally, the virus is often misdiagnosed as dengue due 
to the similar co-circulation, antibodies, and manifestation 
of symptoms.  On the positive side, infection of chikungunya 
is thought to confer lifelong immunity to the individual 
infected. 
 
¶7. (U) CDC,s Outbreak Notice and information to travelers is 
 
NEW DELHI 00001098  003.2 OF 005 
 
 
available at webaddress: 
http://www.cdc.gov/travel/other/2006/chikungu nya india.htm. 
Present treatment includes rest, fluids, and drugs such as 
ibuprofen, naproxen, acetaminophen, or paracetamol to relieve 
symptoms of fever and joint pain.  Infected Poloff took 
approximately 1200 mg of ibuprofen (anti-inflammatory) and 
2000-3000 mg of acetaminophen and Tramadol daily, which only 
helped to take the edge off the pain.  The best way to avoid 
infection is to prevent mosquito bites, including wearing 
long sleeves and pants and wearing mosquito repellent. 
Additionally, a person with chikungunya should limit exposure 
to mosquito bites to avoid further spread of the mosquito 
borne infection. 
 
WHERE DID INDIA,S 2005-2006 OUTBREAKS OCCUR? 
------ 
 
¶8. (U) In India, the first documented recent report of 
chikungunya came in December 2005, in Andhra Pradesh.  By 
mid-April of 2006, the suspected cases numbered over 25,000 
in Andhra Pradesh, over 36,000 in Karnataka, and over 65,000 
in Maharashtra.  Families reported multiple cases across all 
age groups.  Eventually, chikungunya found its way to Kerala, 
where the press reported Kerala,s Chief Minister V.S. 
Achuthanandan as saying that deaths due to chikungunya had 
occurred in Kerala.  In 2006, after the floods and heavy 
rains in the north, cases of chikungunya were reported all 
over Rajasthan, Gujarat, and Madhya Pradesh. 
 
¶9. (U) The re-emergence of the virus is a cause for concern 
as it could become a major public health problem.  Its 
re-emergence could be linked to a variety of social, 
environmental, behavioral, and biological changes.  It may 
also indicate the existence of a low-level, asymptomatic, 
persistent infection in India which was not being documented. 
 The current outbreak is different than previous ones, which 
predominantly affected urban areas.  Now chikungunya 
outbreaks are found in both urban and rural areas.  It is 
important to note that active surveillance for chikungunya 
has not occurred during lulls in major outbreaks and that the 
virus is spreading throughout India. 
 
DEADLY VIRUS COULD KILL TOURISM 
------ 
 
¶10. (U) In 2006, GOI pulled together a team of experts to 
probe the cause of reported chikungunya-related mortalities 
in Kerala.  The team had officials from the NICD, NIV, World 
 
NEW DELHI 00001098  004.2 OF 005 
 
 
Health Organization (WHO), and the National Vector Borne 
Disease Control Program (NVBDCP).  This team submitted a 
report to the Ministry of Health (MOH) which ruled out 
chikungunya as a cause for death.  NVBDCP Chief P.L. Joshi 
said &There is no death due to chikungunya in the country 
and the deaths in Kerala and other places are due to other 
related diseases such as TB, cancer and cardiac problems.8 
WHO,s India Representative, Salim Habayeb, and GOI Health 
Minister Anbumani Ramadoss both corroborated this statement. 
 
¶11. (SBU) ICMR,s NIV director, however, shared the results 
of its epidemiological, clinical, and laboratory 
investigations of the chikungunya outbreak with a visiting 
Centers for Disease Control and Prevention (CDC) delegation. 
These results showed at least a ten fold increase in the 
number of chikungunya cases over what the GOI reported and a 
correlation of death with infection.  Although the State 
Governments of Andhra Pradesh, Karnataka, and Maharashtra 
declared deaths and high numbers of infections, a senior MOH 
official told Health Attach, "Kerala is our tourism 
destination, and it would be a disaster if this state was 
labeled as a place of infection."  For its own political and 
economic reasons, it seems the GOI is playing down the rate 
of infection and deaths associated with the virus. 
 
HUNT FOR CHIKUNGUNYA VACCINE ON 
------ 
 
¶12. (U) In the late 1970s, US Army scientists at the Walter 
Reed Army Institute of Research and the US Army Medical 
Research Institute of Infectious Disease (USAMRIID) developed 
the only known chikungunya vaccine tested on humans from a 
live attenuated vaccine developed from a patient in Thailand. 
 The research stopped in 1997 due to difficulties with 
funding and a &difficulty envisioning how final field 
efficacy trials would be conducted due to the unpredictable 
nature of chikungunya outbreaks.8  In September 2006, US 
Embassy Paris announced a USG agreement to transfer research 
records, vaccine supplies and seed stocks to the French, so 
they could resume vaccine development.  Scientists in France 
have started laboratory safety testing of a chikungunya 
vaccine.  According to press reports, French scientists plan 
to start clinical trials in September 2007. 
 
¶13. (SBU) Hyderabad based Bharat Biotech India Ltd (BBIL), a 
premier Indian biotech industry innovator, also has 
development of a chikungunya vaccine in the pipeline.  Though 
BBIL met with a French delegation regarding a potential 
 
NEW DELHI 00001098  005.2 OF 005 
 
 
partnership at the end of 2006, nothing was agreed to.  In 
the end they realized they are working on different 
methodologies for developing a vaccine. 
 
COMMENT: A GLOBAL PROBLEM AND POTENTIAL BIOTERRORISM AGENT 
------ 
 
14.(SBU) The CDC already lists chikungunya (viral 
encephalitis and alphaviruses) as a Category B Biological 
Weapons Agent.  Category B is the second highest priority for 
defense because it is composed of agents that are easy to 
disseminate, cause moderate morbidity, low mortality, and 
would require enhancements of the US surveillance and 
diagnostic capacity if there were an outbreak.  In India, the 
lack of disease surveillance and transparency in reporting 
infections, insufficient testing laboratories, and the 
dichotomy of statements between scientists, state authorities 
and the policy makers in Delhi make India,s national health 
structure particularly vulnerable. 
 
¶15. (U) Mission will continue watching and reporting on 
chikungunya and other emerging and reemerging infectious 
diseases.  HHS/CDC is engaged with the MOH on emerging and 
re-emerging infectious diseases under the auspices of an 
Indo-US bilateral agreement on Emerging and Reemerging 
Infectious Diseases and Disease Surveillance (ERIDDS). This 
interaction provides HHS staff at the Mission access to 
unpublished data on disease surveillance and disease burden. 
End Comment. 
MULFORD