Chandipura virus: an overview

Preethi C1,Gowdham P2,

1Registered Nurse, Kauvery Hospital, Marathahalli, Bangalore

2Sr. Nurse Educator, Kauvery Hospital, Marathahalli, Bangalore

Introduction

Chandipura virus (CHPV) is an emerging rhabdovirus transmitted mainly by phlebotomine sand flies. It has received attention due to sudden outbreaks of acute encephalitis in children, especially in rural parts of India. Early recognition, prompt supportive care, and awareness among nurses are essential to reduce mortality. This paper provides an overview of the virus, clinical features, transmission cycle, and key nursing responsibilities during patient care and outbreak situations.

Epidemiology

CHPV mostly affects children between 2–16 years, with outbreaks reported in Maharashtra, Gujarat, Andhra Pradesh, and parts of Karnataka. Adult infections often remain unnoticed due to mild or subclinical symptoms, while children experience rapid progression to neurological involvement. Outbreaks usually occur during monsoon and early post-monsoon periods when sand fly populations rise.

Transmission

  • Vector-borne: Primarily through bites of infected Phlebotomus sand flies.
  • Reservoirs: Rodents, cattle, pigs, and dogs may support short-term viremia and help maintain the virus in nature.
  • Human exposure: Increased in rural settings where people live close to livestock shelters and poorly ventilated, organic-rich environments favorable for sand fly breeding.

Pathophysiology

After entering the bloodstream, the virus multiplies rapidly and crosses the blood–brain barrier. This leads to acute inflammation of the brain parenchyma, resulting in seizures, altered sensorium, and rapid deterioration. Children are more vulnerable due to immature immune responses and lower physiological reserves.

Clinical Features

Symptoms generally start suddenly and may progress within hours:

  • High fever
  • Vomiting
  • Headache
  • Seizures
  • Altered consciousness
  • Signs of raised intracranial pressure
  • Shock in severe cases

The disease may advance swiftly to coma, making early intervention crucial.

Diagnostic Considerations

Clinical suspicion during outbreaks

  • RT-PCR from blood or cerebrospinal fluid
  • IgM ELISA (where available)
  • Exclusion of other acute encephalitis causes such as JE, dengue, HSV, and bacterial meningitis

Management

There is no specific antiviral therapy, so treatment is supportive:

  • Control of seizures
  • Maintenance of airway, breathing, and circulation
  • Correction of dehydration or electrolyte imbalance
  • Monitoring for shock
  • Management of cerebral edema
  • Strict infection control and vector precautions

Nursing Management

Nursing care plays a central role in patient survival due to the fast-progressing nature of CHPV-associated encephalitis. The following areas outline key responsibilities:

1. Early Recognition and Triage

  • Identify warning signs such as persistent fever with seizures or confusion.
  • Immediately shift the patient to a higher care area (PICU/ICU).
  • Ensure rapid communication with the medical team.

2. Airway and Breathing Management

  • Keep airway patent using chin-lift/jaw-thrust if unconscious.
  • Provide supplemental oxygen.
  • Assist in preparation for intubation if the patient shows respiratory depression.
  • Continuous SpO₂ monitoring.

3. Circulatory Support

  • Start IV access promptly.
  • Monitor heart rate, capillary refill, and blood pressure.
  • Administer IV fluids cautiously to avoid fluid overload.
  • Prepare and administer vasopressors as advised in shock cases.

4. Neurological Monitoring

  • Perform frequent GCS charting.
  • Observe for new-onset seizures, posturing, or pupil changes.
  • Keep seizure-management drugs ready (midazolam, lorazepam, levetiracetam).
  • Maintain a low-stimulus environment to reduce ICP.

5. Fever and Symptom Control

  • Administer antipyretics as prescribed.
  • Provide cold sponging where needed.
  • Monitor hydration status and urinary output closely.

6. Prevention of Secondary Complications

  • Maintain positioning with head elevated at 30 degrees.
  • Ensure aspiration precautions, especially after seizures or vomiting.
  • Prevent bed sores by frequent repositioning.
  • Maintain catheter and IV line care with aseptic technique.

7. Family Education and Communication

  • Explain the illness progression in simple terms.
  • Provide emotional support due to the sudden onset and severity.
  • Encourage adherence to treatment and reporting of new symptoms.

8. Health Education and Vector Prevention

Nurses play a vital role in community awareness:

  • Promote indoor residual spraying and environmental cleanup.
  • Educate families on sand fly avoidance strategies.
  • Guide on protective clothing and bed nets.
  • Encourage early healthcare-seeking behaviour for febrile children.

Conclusion

Chandipura virus remains a public health concern, especially for children in rural settings. Strengthening nursing vigilance, rapid supportive care, and community prevention measures can significantly reduce morbidity and mortality. Staff nurses serve as the frontline in early detection, monitoring, and family support, making their role essential in managing CHPV outbreaks.

Reference

  • Patil, R., & Karandikar, S. (2021). Vector-borne encephalitic viruses in Western India: A review of emerging threats. Journal of Infectious Vector Biology, 9(2), 88–94.
  • Mehta, P., & Dange, A. (2020). Clinical presentation and nursing priorities in acute viral encephalitis among pediatric patients. Indian Pediatric Nursing Review, 14(1), 25–32.
  • Rao, K. P., & Shashidhar, V. (2019). Phlebotomine sand flies as reservoirs of lesser-known arboviruses. Tropical Medical Entomology Reports, 7(3), 112–119.
  • Kulkarni, S., & Suryawanshi, P. (2022). Environmental determinants of sand fly breeding and disease outbreaks in rural India. International Journal of Rural Health Ecology, 5(4), 177–184.
  • Nayak, J., & Mishra, P. (2023). Pediatric susceptibility patterns in viral encephalitis outbreaks: A comparative analysis. Journal of Child Neuro-Infection, 3(2), 41–49.

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