Chikungunya Virus - Coming to a City Near You

• Publish Date: 2015/03/27 - (Rev. 2016/11/07)
• Author: University of Texas Medical Branch at Galveston
• Contact : Donna Ramirez - donna.ramirez@utmb.edu

Outline: Mosquito-borne chikungunya virus, a painful and potentially debilitating disease, predicted to soon spread to the U.S..

Main Digest

The mosquito-borne chikungunya virus has been the subject of increasing attention as it spreads throughout South America, Central America, the Caribbean and Mexico. This painful and potentially debilitating disease is predicted to soon spread to the U.S.

Chikungunya is an infection caused by the chikungunya virus. It features sudden onset fever usually lasting two to seven days, and joint pains typically lasting weeks or months but sometimes years. The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Chikungunya was one of more than a dozen agents researched as potential biological weapons. The mortality rate is a little less than 1 in 1000, with the elderly most likely to die.

The University of Texas Medical Branch at Galveston's Scott Weaver, globally recognized for his expertise in mosquito-borne diseases, has been studying chikungunya for more than 15 years. Weaver and fellow infectious disease expert Marc Lecuit of the Institut Pasteur have summarized currently available information on this disease in the March 26 edition of the New England Journal of Medicine.

Since chikungunya was first identified in1952 in present-day Tanzania, the virus has been confirmed in other African countries, Asia, The South Pacific and Europe. In Dec. 2013, the first locally acquired case of chikungunya in the Americas was reported in the Caribbean.

Since then, chikungunya has been identified in 44 countries or territories throughout the Americas with more than 1.3 million suspected cases reported to the Pan American Health Organization from affected areas.

Symptoms appear about three days after being bitten by an infected mosquito.

The most common symptoms and signs are fever and severe joint pain and may include headache, arthritis, muscle pain, weakness and rash.

Some patients will feel better within a week but others develop longer-term joint pain that can last weeks to years.

Death is rare but can occur.

People at increased risk for severe disease include young children, older adults and people with medical conditions such as diabetes or heart disease.

Other than anti-inflammatory drugs to control symptoms and joint swelling, there are no specific therapies to treat infected persons and no licensed vaccines to prevent chikungunya fever.

"Chikungunya continues to be a major threat to public health around the world," said Weaver. "Until there is a treatment or vaccine, the control of chikungunya fever will rely on mosquito reduction and limiting the contact between humans and the two virus-carrying mosquitoes, Aedes aegypti and Aedes albopictus."

These efforts generally focus on reducing or treating standing water and water storage containers where eggs are laid and larvae develop as well as wearing protective clothing and/or insect repellent.

Current research is focused on better understanding how exactly the virus enters and multiplies within the human and mosquito body.

Researchers are also learning more about why some people develop long-term chronic joint pain after the initial chikungunya fever while others do not.

Several promising chikungunya vaccine candidates have reached late preclinical or phase one clinical testing, but final development will require major commercial investments.

Another challenge to vaccine development lies in targeting locations where there will be many cases of chikungunya fever to set up and conduct clinical trials.

Weaver is the director of the UTMB Institute for Human Infections and Immunity, scientific director of the Galveston National Laboratory and leads the Global Virus Network's Chikungunya Task Force.

Quick Facts:

• Joint pain is often debilitating and can vary in duration.
• There is no cure for the disease. Treatment is focused on relieving the symptoms.
• The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.
• The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.
• Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.
• The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in a localized outbreak in north-eastern Italy. Outbreaks have since been recorded in France and Croatia.

Statistics

• January 2014, the Public Health Agency of Canada reported that cases were confirmed on the British Virgin Islands, Saint-Barthelemy, Guadeloupe, Dominica, Martinique, and French Guyana.
• In April 2014, chikungunya was also confirmed in the Dominican Republic by the Centers for Disease Control and Prevention (CDC). By the end of April, it had spread to 14 countries in all, including Jamaica, St. Lucia, St. Kitts and Nevis, and Haiti where an epidemic was declared.
• By the end of May 2014, over ten imported cases of the virus had been reported in the United States by people traveling to Florida from areas where the virus is endemic.
• On January 2015 there were 90,481 reported cases of chikungunya in Colombia.