Symptoms of infection, which generally come on three to seven days after being bitten, include the sudden onset of fever, chills, headache, nausea, vomiting, severe joint pain (arthralgias) and rash. Some symptoms typically last several weeks.
The illness is usually self limiting. Although rare, the infection can result in meningoencephalitis, especially in newborns and those with pre-existing medical conditions. Pregnant women can pass the virus to their fetus. Residual arthritis, with morning stiffness, swelling, and pain on movement, may persist for weeks or months after recovery. Severe cases of Chikungunya can occur in the elderly, in the very young (newborns), and in those who are immunocompromised. Chikungunya outbreaks typically result in several hundreds or thousands of cases but deaths are rarely encountered.
Recent outbreaks have occurred in islands in the Indian Ocean, Sub-Saharan Africa, India, South-east Asia, and the Philippines. A 2007 outbreak occurred in the the province of Ravenna in the Emilia-Romagna region of north-east Italy.
There is no vaccine that protects against chikungunya virus.
Using protective measures to prevent being bitten by an infected mosquito is currently the only means available to an individual to reduce the risk of exposure.
The usual public health measures such as minimising open water are going to have to be revisited for a number of insect vectors that are extending their range very successfully including Aedes albopictus the vector of the recent outbreak strains.
Preventive treatments including vaccination
Potential preventive treatments include vaccination and the use of monoclonal antibodies.
Treatment for chikungunya typically involves treating the symptoms and includes bed-rest, fluids and the use of non-aspirin analgesics during the phase of illness where the symptoms are most severe. Avoiding confusing it with early Rheumatoid arthritis and treating it with immunosupressives medicines is desirable.
As a relatively recently emerged pathogen it is the subject of much research.
The latest outbreak has been associated with:
- Genetic mutation of the viral genome
- Aedes albopictus which worryingly has internationalised its distribution since 1980
- Formerly found in Indian Ocean around southern Eastern Africa and Madagascar, South East Asia in a belt from India through Burma to Philippines and Borneo and in Japan and Manchuria
- Now through out North Americia, Central Americia, much of South Americia, Southern Europe, Equatorial West Africa, China and Mongolia, Australia and New Guinea.
Essentially now worldwide, with outbreaks in Brazil, Caribbean and Polynesia as of 2014. It started in Africa and is now endemic in the Indic ocean basin, the Indian subcontinent and the southeast of Asia. Outbreaks have occurred in Southern Europe. Its high attack rate and morbidity, despite low mortality can stretch any healthcare system.
A catch is that because of cross reactivity on immunology O’nyong-nyong virus, less likely to be tested for in travellers, may be missed.
- ↑ Halstead SB. Reappearance of chikungunya, formerly called dengue, in the Americas. Emerg Infect Dis. 2015 Apr DOI: 10.3201/eid2104.141723
- ↑ ECDC Chickungunya fever
- ↑ ProMED report. Chikungunya - outbreak overview. Published 28 Nov 2007. Archive Number 20071128.3838 (Based on report N. Gopal Raj. Chikungunya: Where did the virus really come from? The Hindu. Last viewed 30 Nov 07)
- ↑ DeZure AD, Berkowitz NM, Graham BS, Ledgerwood JE. Whole-Inactivated and Virus-Like Particle Vaccine Strategies for Chikungunya Virus. J Infect Dis 2016;214(suppl 5):S497-S499.
- ↑ Ramsauer K, Tangy F. Chikungunya Virus Vaccines: Viral Vector–Based Approaches. J Infect Dis 2016;214(suppl 5):S500-S505.
- ↑ BMJ 2017;356:j250
- ↑ Graham BS, Repik PM, Yactayo S. Chikungunya in the Americas: Recommendations and Conclusions. J Infect Dis 2016;214(suppl 5):S510-S513.
- ↑ Parola P, de Lamballerie X, Jourdan J, Rovery C, Vaillant V, Minodier P, Brouqui P, Flahault A, Raoult D, Charrel RN. Novel chikungunya virus variant in travelers returning from Indian Ocean islands. Emerg Infect Dis. 2006;12(10):1493-9.
- Health Protection Agency on 2006 Reunion Island and India outbreak
- Eurosurveillance, Institut de veille sanitaire (France); firstname.lastname@example.org list http://www.promedmail.org
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