ORANJESTAD, Aruba, Thursday May 1, 2014, CMC – The head of the Caribbean Public Health Authority (CARPHA), Dr James Hospedales, has declared the Chikungunya virus has reached epidemic proportions in the Caribbean. “By definition this is an epidemic since it represents an unusual number of cases of this problem where we would never have it before,” Dr Hospedales told the Caribbean Media Corporation (CMC).
The mosquito-borne illness was first detected in the Caribbean in December 2013, in St Martin, and last week Antigua and St Vincent and the Grenadines became the latest countries to declare an outbreak.
Dr. John Carroll writes from Haiti in his column in the Peoria Journal Star, May 8, 2014:
Based on the patients I have examined in Port-au-Prince today and listening to the Haitian doctors I work with, I think Chikungunya virus will strike Haiti hard. I am no public health expert but I think that this is the beginning of another epidemic by a nasty pathogen. This virus is carried by the same mosquito that spreads dengue. We will all learn about this virus once it hits the U.S.
St Lucia’s Chief Epidemiologist says the focus is on surveillance to stave off a potential Chikungunya virus outbreak. According to Dr Hospedales, as of April 28, there were 4,108 probable cases in 14 countries across the region. He also stated that Caribbean countries have been putting measures in place to address the spread of the virus.
“PAHO (the Pan American Health Organisation) since 2012 had done a preparatory briefing, in July of last year we convened a Caribbean-wide virtual meeting of the chief officers in the countries in the labs, to highlight this emerging threat and to adjust our surveillance protocols and laboratory testing to have early detection.
“In December, once it came into the region we established an incident management team, and that has regular contact with the countries, with PAHO, with the French and so on,” Hospedales said.
Chikungunya is spread by the Aedes Egypti mosquito, which also spreads dengue fever.
Hospedales noted there are steps that can be taken to contain the disease. “Our main recommendations are to continue to educate members of the public on the current situation, and get accurate information to avoid confusion.
“It is very important to inspect homes and communities to eliminate potential vector breeding sites for the Aedes Egypti mosquito,” he said.
He also advised that people who are sick with fever and suspect they may be suffering from dengue or Chikungunya, should use an insect repellant and sleep under a mosquito net. “This is not a severe disease, in that people don’t die from it, whereas dengue can kill you, but Chikungunya has more long term a significant percent of people will have joint pains one year, two years afterwards,” Hospedales said.
To date Chikungunya virus has been confirmed in Anguilla, Aruba, Virgin Islands, Dominica, Dominican Republic, French Guiana, Guadeloupe, Martinique, St Barthelemy, St Kitts and Nevis, St Lucia, St Vincent and the Grenadines, St Maarten (Dutch) and St Martin (French).
Chikungunya Virus Outbreak Likely in the U.S., Say Experts
Chikungunya (pronounced chik-en-gun-ye) is a viral disease transmitted to humans by the bites of infected Aedes aegypti and Aedes albopictus mosquitoes, which are found across the globe. First described during an outbreak in southern Tanzania in 1952, the virus then spread to Africa, Asia, and the Indian subcontinent.
Originally believed to be a “tropical” disease, experts were surprised when an outbreak occurred in northeastern Italy in 2007. Now it has spread farther—to 14 Caribbean island countries since it was first detected on the island of St. Martin in December 2013. On May 1, 2014, the Caribbean Public Health Authority declared it an epidemic, with 4,108 probable cases across the region.
The most common symptoms of chikungunya are acute, high fever and intense joint pain. The infected person may also experience headaches, muscle pain, swollen joints, and/or a rash.
According to the U.S. Centers for Disease Control and Prevention (CDC), chikungunya infection should be considered as a possibility in anyone who develops a high fever and joint pain, and who has traveled to the location of an active outbreak within the previous three to seven days.
A blood test is used to diagnose chikungunya and to differentiate it from dengue, a more serious viral infection, which is also transmitted by Aedes mosquitos. Outbreaks of dengue usually occur in tropical urban areas, according to the CDC. "People should prevent mosquito bites by using adequate clothing, applying repellent, and getting rid of potential mosquito breeding sites."
Even though chikungunya symptoms can be severe, the disease is rarely fatal, unlike dengue, which can be lethal if not treated in a timely manner. Most patients with chikungunya begin feeling better within a week; a few may experience joint pain for several months. Some cases result in persistent arthritis symptoms. People at risk for more severe cases of the disease include newborns, adults over the age of 65, and patients with underlying medical conditions.
There is no cure for chikungunya, and no vaccine to prevent it, so treatment is focused on relieving the symptoms. An infected person needs to rest, drink lots of fluids, and take medicines like ibuprofen, naproxen, or acetaminophen to relieve fever and pain until the symptoms fade.
Because the Caribbean islands are close to the U.S., there is some concern that chikungunya will spread to the U.S., perhaps via Florida.
The disease has been diagnosed in the U.S. before, but only in travelers returning from areas where there are outbreaks, according to the Center for Infectious Disease Research and Policy. So far, no U.S.-based infections have occurred. But Dr. Gio J. Baracco, an associate professor of clinical medicine at the University of Miami Miller School of Medicine, told Healthline that the mosquitoes spreading the virus are already in the southeastern part of the U.S. “This fact, and the large amount of travelers passing through South Florida en route to and from the Caribbean islands, makes it very likely that chikungunya will be introduced into the U.S.,” he said.
Another infectious disease expert, Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University, explained how this “spreading” might occur. “Patients can acquire the infection while in the Caribbean through mosquito bites, and be incubating the infection. They’re feeling well as they come to the U.S. and then when they get sick, the virus is circulating in their blood streams.”
Then, an Aedes mosquito could bite that person and become infected itself, said Schaffner. “The mosquito thus infected in the U.S. infects another U.S. person, and that person in turn infects further mosquitoes. That’s how the virus appeared for the first time in a temperate zone, in Italy in 2007."
The virus could be carried beyond Florida, Schaffner said, but he added, “It might be established more readily in Florida, partly due to the volume of travel.”
Dr. Aileen M. Marty, a professor of infectious diseases at the Herbert Wertheim College of Medicine in Miami, agreed. “It can spread to any part of the U.S. where the mosquitoes live and breed,” she said.
Learn More: The Big Dangers of Small Bug Bites »
Although an outbreak may occur at any time, Baracco said that summer is a vulnerable time. “The likelihood of an outbreak is related to the amount of vectors [infected mosquitoes] present. Aedes mosquitoes breed in stagnant water, and therefore are more common during the rainy season.”
The CDC's Dr. Erin Staples told Healthline that although it’s not possible to say at this point when local cases may occur here, it becomes more likely as more travelers return from areas where there are currently outbreaks, as mosquito populations grow, and as the weather gets warmer. How Can I Protect Myself from Chikungunya?
To avoid becoming infected, Baracco said, “People should prevent mosquito bites by using adequate clothing, applying repellent, and getting rid of potential mosquito breeding sites."
Business travelers and vacationers in the Caribbean should exercise extra caution, Schaffner added. “Cruise travelers and people who stay in the islands for a period of time will need much more awareness about the prevention of mosquito bites. Use repellant—especially if you go out in the evening or in the early morning, when most of these mosquitoes like to bite. Wear longer trousers and long sleeves.”
Schaffner also envisions a wider use of bed netting. “People like to go to the islands, open the windows, and let the Caribbean breezes come through—they’re not always in hermetically sealed, air conditioned rooms. If you do that now, you might have to sleep under a bed net.”
The CDC is taking several steps to educate travelers to the Caribbean about the risks of chikungunya and how to protect themselves. Staples explained, "We are continually updating our travel notice with the latest on the spread of the virus and recommendations to prevent infection. In addition, the CDC has been working with its partners at airports with flights to the Caribbean to educate outgoing travelers about how to stay safe from chikungunya while in the Caribbean, and returning travelers about what symptoms to watch for and when to seek care. We’re also working to post them at additional airports and to translate them into Spanish."