The Chikungunya Virus

The chikungunya virus has come to the Caribbean and US.

What is the Chikungunya Virus?

The chikungunya virus, a vector-borne illness, is transmitted via mosquitoes. Joint pain and fever are common symptoms of the virus. Rash, joint swelling, headache, and muscle pain are also possible signs of infection. Historically, the chikungunya virus was found in “Africa, Asia, Europe, and the Indian and Pacific Oceans”; however it had spread to the Caribbean as of 2013. There is no vaccine or medication to treat the chikungunya virus.¹ The CDC noted that some people may be in a high-risk group, such as those who are over the age of 65, women late in pregnancy, long-term travelers, those with arthritis, and people with serious medical conditions (e.g., heart disease, diabetes, high blood pressure).²

Treatment and Prevention

Travelers to regions where chikungunya is prevalent need to prevent getting bitten by mosquitoes. The best ways to do that is to stay indoors, preferably in air conditioned places or rooms with screens, and by wearing pants, long sleeves, hats and insect repellant.³ The insect repellants should include active ingredients such as DEET, Picaridin, IR3535, or Oil of Lemon eucalyptus (OLE). Insect repellant should be applied after sunscreen. Some travelers may wish to use “permethrin-treated clothing and gear”. If a patient feels ill, it is important to mention to healthcare workers if they have traveled, and they should also try to avoid getting bitten by mosquitoes while they are sick, in order to prevent more transmission. They should also rest and drink fluids.⁴ Other treatment options to alleviate symptoms include using anti-pyretics and optimal analgesics. In some locations it is important for people to sleep under mosquito netting and to use insecticides. The World Health Organization (WHO) is working on managing outbreaks, including training for vector control.⁵ As of May 2014, chikungunya had entered Florida, spreading to other southern states over the summer.⁶

Disease Course

The incubation of the chikungunya virus is “one to twelve days, typically two to three”. After the fever, patients may experience “joint pain, intense headache, (and) insomnia”. For some, the joint pain can last “as long as two years”, although it is important to note that recovery “varies by age”. It can take a couple of weeks for younger patients to recover, but months for the middle-aged and elderly. During recent epidemics, chikungunya has caused some longer term issues, such as musculoskeletal pain, arthralgia, joint and muscle pains, and even long-term arthritis. Those most at risk of the prolonged problems are people who are older or who have “prior rheumatological disease”.⁷