Written by Roxanne Royce from Colorado Travel Health
www.coloradotravelhealth.com.
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Incidence
In 2009 there were many confirmed cases in South India, especially in the Krishnagiri District. Large amounts of stagnant water in this area has provided the mosquitoes with prime breeding grounds.
Infectious Agent
Chickungunya is a virus transmitted mainly by the Ae. Aegypti mosquito (less frequently by Ae. Albopictus). It is endemic throughout Africa and Asia where there have also been many epidemics. In 2004 it re-emerged resulting in millions of cases in countries in and around the Indian Ocean. Since the disease produces a high level of viremia and the Ae. aegypti and Ae. Abopictus mosquitoes circulate globally, the probability of it spreading into new areas also exists. Disease transmission is highest in areas of persistent epidemics. The tropical rainy season poses a higher risk for travelers to become infected. The responsible mosquitoes bite during the daytime.
Clinical Presentation
The incubation period ranges from 2-12 days but is typically 3-7 days. Symptom onset most often includes a sudden onset of high fever (usually greater than 102°F) and severe arthragias (joint pain). Fevers often persist for several days and up to a week. Joint pains typically occur in the hands and feet and can be excruciating. A rash is also common after the onset of fever and usually involves the trunk and extremities. Headache, fatigue, nausea, vomiting and myalgias (muscle pains) sometimes also emerge.
Serious complications of the disease are rare as are fatalities. (Those with underlying medical conditions and advanced age are at a greater risk).
Persistent fatigue for several weeks can follow an acute illness. Reports of debilitating joint pain lasting weeks or months has been documented. Some cases document prolonged joint stiffness and/or pain for more than a year after the initial exposure.
Diagnosis
A diagnosis based on clinical features; history of travel and possible exposure risks can then be confirmed by laboratory testing.
Treatment
As there is no antiviral treatment specific to chikungunya fever, supportive measures include rest, fluids, pain medicines, and antipyretics (fever reducing meds). In order to prevent further spread of the disease (during the first few days of illness), one should stay indoors and sleep under bed netting.
Preventive Measures for Travelers
Mosquito-bite prevention is the best way to avoid infection with Chikungunya Virus. 20-35% DEET or Picaradin can be applied to exposed skin. Permethrin can be applied to clothing. Long sleeved shirts, pants and socks are also protective. Air conditioned dwellings with window screens is also advised. And any possible breeding ground for the insect (flower pots, buckets, etc…) should be eliminated.
References
CDC. Chikungunya. [Cited 2010 April 30]. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/chikungunya.aspx
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