An Epidemiological Portrait
"That which bends up" — a mysterious illness emerges in the City of Gold.
In 2016, the ancient city of Amritsar, renowned for the Golden Temple, faced a modern health crisis. Chikungunya, a viral disease whose name derives from the Makonde language meaning "that which bends up" due to the stooped posture it causes, made its presence known in Punjab. While India had witnessed chikungunya outbreaks before, 2016 marked a dramatic surge in Punjab, with reported cases exploding from just one in 2010 to 2,4721 .
Amritsar, Punjab
Known as the "City of Gold" for the Golden Temple
Aedes Mosquitoes
Primary carriers: Aedes aegypti and Aedes albopictus
Chikungunya is a mosquito-borne viral disease caused by the chikungunya virus (CHIKV), an RNA virus belonging to the alphavirus genus1 . The virus is transmitted to humans through the bites of infected female Aedes mosquitoes, primarily Aedes aegypti and Aedes albopictus.
The name "chikungunya" derives from the Makonde language meaning "that which bends up" due to the stooped posture of sufferers caused by severe joint pain.
In 2016, Department of Community Medicine researchers conducted a detailed investigation into the chikungunya cases reported in District Amritsar. Their findings, published in a 2018 study, painted a detailed epidemiological profile of the outbreak1 .
The research team collected blood samples from patients with suspected chikungunya infections from various hospitals across Amritsar district. These samples were tested at Government Medical College, Amritsar, using the MAC ELISA test, which detects specific antibodies the body produces to fight the chikungunya virus1 .
Blood samples collected from patients with suspected chikungunya infections
Samples tested using MAC ELISA test at Government Medical College, Amritsar
Epidemiological patterns analyzed including age, gender, location, and seasonality
A separate hospital-based study conducted at Government Medical College, Amritsar, during the same outbreak period revealed an additional layer of complexity—co-infections with other viruses5 .
Between June and December 2016, researchers tested 283 suspected cases for both dengue and chikungunya viruses. They discovered that 9.54% (27 patients) were infected with both viruses simultaneously5 . This co-infection presented particular challenges for clinicians due to overlapping symptoms.
The similarity of chikungunya symptoms to other mosquito-borne diseases like dengue and Zika often leads to misdiagnosis in areas where these diseases are common1 .
Understanding how researchers detect and analyze chikungunya outbreaks reveals the science behind the statistics.
| Research Tool | Primary Function | Application in Chikungunya Research |
|---|---|---|
| MAC ELISA Test | Detects IgM antibodies against CHIKV | Confirms recent infection; used for diagnosis after first week of symptoms1 5 |
| RT-PCR | Detects viral RNA in blood samples | Identifies active infection during first week of illness |
| Viral Culture | Grows virus in controlled conditions | Allows for detailed study of viral characteristics and behavior3 |
| IgG Antibody Test | Detects past infection | Identifies individuals with previous exposure to CHIKV |
Samples are processed using appropriate diagnostic tests based on timing since symptom onset.
Epidemiological data including age, gender, location, and symptom profiles are analyzed to identify patterns and risk factors1 .
Mosquito collection and testing helps identify breeding sites and implement targeted control measures1 .
With no specific antiviral treatment or widely available vaccine at the time of the outbreak, control efforts focused primarily on interrupting the transmission cycle1 .
Since Aedes mosquitoes breed in standing water, eliminating water-filled containers around homes was crucial. This included covering water storage containers, removing discarded tires, and cleaning outdoor pots.
A significant finding relevant to North India was that 60-70% of Aedes mosquito breeding in urban areas occurs in desert coolers1 . The National Centre for Disease Control developed a special "NICD cooler" designed to prevent mosquito breeding1 .
During outbreaks, health authorities implemented insecticide spraying to kill adult mosquitoes and treat water containers to kill larvae1 .
The 2016 chikungunya outbreak in Amritsar provided valuable insights into the behavior of this re-emerging disease in North India. The epidemiological profile revealed a virus that predominantly affected urban adults, with a distinct seasonal pattern tied to the monsoon cycle. The discovery of significant dengue-chikungunya co-infections highlighted the complex challenges facing clinicians in regions where multiple arboviruses coexist.
While the Amritsar outbreak resulted in no reported fatalities, the debilitating nature of chikungunya and its potential to cause chronic joint pain created significant morbidity and economic impact through lost productivity1 .
The outbreak underscored the importance of sustained surveillance, prompt diagnosis, and community engagement in mosquito control activities—especially before and during the monsoon season.
As climate change expands the geographical range of Aedes mosquitoes, the lessons from Amritsar's 2016 outbreak remain relevant for public health planning across India and other regions at risk for arboviral diseases7 .