Chikungunya

Jan 31, 2015
2015 / January 2015

The chikungunya (pronounced chik-en-gun-ye) virus is transmitted to humans by mosquitoes that become infected when they feed on a person who has the virus, often causing large outbreaks. Originating in East Africa, chikungunya outbreaks commonly occur in Africa, Asia, Europe and the Indian and Pacific ocean regions. In late 2013, the first local transmission in the Americas was reported in the Caribbean.

First identified in southern Tanzania in 1952, the virus caused sporadic cases in Africa and large urban outbreaks in Thailand and India during the 1960s and 1970s. In 2004, a large outbreak on the Kenyan coast further spread throughout the islands of the Indian Ocean, India and parts of Southeast Asia. Traveler-related cases introduced the virus into Italy and France, resulting in local transmission and several hundreds of cases in Europe. Aedes mosquitoes transmit the virus; they are aggressive and bite mostly during the daytime. Chikungunya is a single-strand RNA virus, with humans the primary hosts during epidemics.

The incubation period after exposure is usually three to seven days (the range is one to 12 days). Most people experience an acute onset of fever and pain in several joints. Joint symptoms, often severe and debilitating, are usually symmetrical and often occur in hands and feet. Other symptoms include headache, arthritis, muscle pain, conjunctivitis, nausea and vomiting. A maculopapular rash may appear, characterized by a flat, red area covered with small, closely connected bumps. (It may only appear red in pale-skinned people.) Acute symptoms resolve in seven to 10 days.

Rare complications include uveitis or retinitis (eye infections), myocarditis, hepatitis, nephritis, blistered skin lesions, hemorrhage, meningoencephalitis, myelitis (infection of white or gray matter of the brain), Guillain-Barré syndrome and cranial nerve palsies. Persons at risk for severe disease include newborns exposed during delivery; people older than 65; and those with underlying conditions such as hypertension, diabetes or cardiovascular disease. Some individuals may have a relapse of rheumatologic symptoms in the months following an acute illness or may endure joint pain for months to years. Deaths are rare.

Chikungunya virus infection should be considered in patients with acute onset of fever and joint pain, especially travelers recently returning from areas with known transmission. Diagnosis is based on place of residence, travel history and exposures. Blood testing for chikungunya is performed at the Centers for Disease Control, a few state health departments and one commercial laboratory; test results are usually available four to 14 days after the specimen was received. Health care providers are encouraged to report suspected cases to state and local health departments to facilitate diagnosis and alleviate local transmission.

Health departments should perform surveillance for chikungunya cases in returning travelers and be aware of the risk of local transmission in areas where Aedes mosquitoes are active. State health departments should report confirmed infections to the CDC.

It is important to differentiate chikungunya from dengue virus, which is transmitted by the same mosquitoes and has a similar clinical presentation. The two viruses can circulate in the same area and cause occasional co-infections in the same patient. Chikungunya is more likely to cause high fever, severe joint pain, arthritis, rash and lymphopenia (decreased white blood cells). Dengue more likely causes blood abnormalities such as neutropenia, leading to increased susceptibility to infection; and thrombocytopenia, the inability of the blood to clot, causing hemorrhage, shock and death. Patients with suspected chikungunya should be managed as dengue cases until dengue is ruled out.

Most epidemics in Africa occur in tropical rainy seasons and decline during dry seasons; however, outbreaks can occur after periods of drought when household water containers serve as mosquito breeding grounds.

Caribbean countries are on high alert and travelers to the area are cautioned to take preventative measures. Jamaica strengthened its surveillance and mosquito control measures. Many islands warn residents to remove standing water, use repellents and see a doctor at the first symptoms.

There is no medication for the chikungunya virus. Treatment involves assessing hydration and decreasing symptoms. Get plenty of rest, drink fluids to prevent dehydration and take medications such as ibuprofen, naproxen, acetaminophen or paracetamol to relieve fever and pain. Persistent joint pain may require the use of corticosteroids or physiotherapy. Supportive care may include hospitalization, intravenous therapy and the monitoring of hemodynamic status. Evaluate for other serious conditions such as dengue, malaria and bacterial infections and treat and manage appropriately.

As there is no vaccine for the virus, it is important to prevent and control exposure to mosquitoes using the following measures. Use airconditioning or window/door screens in your home. Use mosquito repellents on exposed skin. The most effective repellents for long-lasting protection contain DEET, picaridin, IR3535, oil of lemon eucalyptus and para-menthane-diol products. Cover exposed skin with long-sleeved shirts, long pants and hats. Consider wearing permethrin-treated clothing as a safeguard against bites. Empty standing water from outdoor containers and support local mosquito control programs.

People at increased risk for severe disease should steer clear of traveling to areas with ongoing chikungunya outbreaks. If you are sick with chikungunya, avoid mosquitoes and mosquito bites to prevent further spread of the virus.

Preparing for possible chikungunya outbreaks in the Americas since 2006, the CDC developed a regional surveillance and response program, diagnostic test training and an evaluation program for regional reference laboratories. They also publish traveler health notices for outbreaks in other regions. The spread of this viral infection into the Caribbean illustrates how quickly diseases can multiply with global travel.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.

Introducing

FX Excursions

FX Excursions offers the chance for once-in-a-lifetime experiences in destinations around the world.

Daily
Sep 20, 2019

Catch Autumn at the Arboretum in Dallas

Attend one of the most acclaimed fall events, Autumn at the Arboretum, in Dallas. In its 14th year, the annual event is known as one of the best pumpkin festivals in the country, with its creative displays featuring more than 90,000 pumpkins, gourds and squash. The event takes place at Dallas Arboretum, Sept. 21 –Oct. 31. Alongside thousands of pumpkins, guests glimpse 150,000 autumn flowers across the 66-acre space.

TAP Air Portugal Adds 15 Flights Each Week From U.S., Canada

TAP Air Portugal is adding 15 new weekly flights from the United States and Canada by summer 2020,  a new record for the carrier of 71 weekly flights between North America and Portugal.

Feature
Sep 19, 2019

Wilderness Safaris Reopens Jao Camp

Following a complete renovation, Wilderness Safaris’ Jao Camp reopened in Botswana’s Okavango Delta.

News
Sep 19, 2019

Best U.S. Cities for Oktoberfest Celebrations

WalletHub compared the 100 largest U.S. cities across 24 key metrics to determine the best destinations for an upcoming Oktoberfest celebration. The brand’s study found the estimated cost for an American to attend Oktoberfest in Munich, Germany, is $5,000. Munich boasts a $1.43 billion annual economic impact on Munich. During Oktoberfest, nearly 2 million gallons of beer are consumed and more than 510,000 whole roast chickens eaten.

To New Heights

United Airlines announces a number of new routes.

Feature
Sep 19, 2019

Qantas Will Start Using a Dreamliner on Santiago–Sydney Route

Qantas will start using a Boeing 787-9 Dreamliner on its Sydney–Santiago route starting in late June 2020.

eFlyer News
Sep 18, 2019

New Luxury Hotel Set to Open in China

A new hotel is slated to open in the capital of China’s Guangxi Province.

The Island of the Knights

Welcome to Rhodes, a medieval treasure beautifully preserved throughout the centuries. Rhodes is the capital of the Dodecanese, an island ideal not only for those who want to relax, but also for those looking for an action-packed holiday! With its bright green hills, rich green valleys and uninterrupted line of golden beaches, Rhodes is truly a blessed place. “The sun island” has more sunshiny days and milder temperatures throughout the year than any other location in Greece. It is, after all, one of the country’s easternmost places and among the first to welcome summer on its impressive beaches. Add in the excellent facilities for tourism, the island’s special blend of cosmopolitan and traditional, and numerous cultural and archaeological sites, the most important being the Medieval (Old) Town, a UNESCO World Heritage site, and you’ve got the perfect holiday destination. While on Rhodes, don’t miss a daytrip to nearby Sými. An island of sponge divers and seamen, Sými used to have 30,000 inhabitants before the Second World War and was the richest island in the Dodecanese, despite its small size. Today, Sými attracts many visitors thanks to its beautifully preserved Neo-Classical buildings and the famous Archangel Michael monastery at Panormitis.

eFlyer News
Sep 18, 2019

LOT Polish Airlines Adds New Route to Delhi

LOT Polish Airlines is offering travellers more options for travel between Asia and Europe.