Health Alert: September 12, 2014 (Chikungunya)

September 12, 2014

From: Donald T. Allegra, MD, ID Consultant

Re: Chikungunya (CHIKV) Virus Alert

With all the headline news about the deadly Ebola virus in West Africa, there has been very little press about a virus called Chikungunya (CHIKV) which is currently causing epidemics in many Caribbean countries. The virus first appeared in the French area of St. Martin in December 2013. Since then, there have been over 500,000 suspected or confirmed cases including 221 cases in Puerto Rico and the US Virgin Islands and even locally transmitted cases in Florida. 95% of the cases have been reported from the Dominican Republic, Haiti, Martinique, Guadeloupe and St. Martin but the outbreak has yet to peak in the Dominican Republic, Haiti, El Salvador, Venezuela, and Puerto Rico. The virus is spread by the mosquitoes Aedes aegypti and Aedes albopictus (the Asian tiger mosquito), which are also present in the USA and bite during daytime hours in urban areas. The reporting of CHIKV is encouraged but not mandatory and despite this, the number of cases in the US confirmed and reported to the CDC has gone from 138 cases as of 7/14/2014 to 635 cases as of 8/25/14.

Chikungunya is derived from an African word “kungunyala” which translates literally as “that which bends up”, an indication of the severe joint pains which characterize this disease. Symptom appear after a period of 3-7 days (range 1-12), there is a sudden onset of high fever to >102 F with muscle aches and multiple joint involvement but most common in the hands and feet. It is sometimes associated with headache, rash, nausea, and vomiting. Initial symptoms last 7-10 days but joint pains can persist for months with relapses possible and some patients can have joint pains for years. There is no specific vaccine or treatment but the disease is rarely fatal.

As we enter into the high season for Caribbean tourism, some things to remember:

  1. High fever and joint aches in returning travelers from the Caribbean should trigger concern for both CHIKV and Dengue since both diseases are carried by the same mosquitoes and have similar symptoms.
  2. Those at highest risk for disease complications are the elderly, those with underlying medical conditions, and women in the late stages of pregnancy. These groups should be cautioned about travel to high risk areas and all travelers should be advised to use insect repellent in these areas.
  3. Testing for CHIKV can be done through commercial labs or at CDC.
  4. Treatment is supportive and symptomatic but would avoid aspirin and ibuprofen until Dengue is ruled out, since these drugs can increase the risk of bleeding in patients with Dengue.

Although Ebola is certainly a much deadlier disease, we are far more likely for Americans to develop CHIKV in the coming months, and US travelers should be aware of the high risk of CHIKV in vacationing in the Caribbean Basin.