Chikungunya: Now in the Caribbean

Map needs to be updated to now include
the Caribbean (cdc.gov)

It's official: Chikungunya has now been reported in the Caribbean. According to the World Health Organization (WHO) there have been 2 confirmed, 4 probable and 20 suspected cases of the mosquito-borne viral illness in Saint Martin (as of 12/10/13).

Chikungunya is a viral illness carried by mosquitoes that was first isolated in Tanzania in the 1950s. The name derives from the Kimakonde language and means "to become contorted." Profound joint pain leads to a 'stooped over' appearance, thus the name.

Symptoms of acute infection are nonspecific and are similar to dengue, with fever, headache, nausea, muscle and joint pains and fatigue. Peculiar to this virus, some people can have longstanding joint pain that can last for months, even years. There is no vaccine to prevent this illness and no treatment (other than supportive care).

Chikungunya is endemic in Southeast Asia and Africa. In recent years the disease "emerged" in these areas; in 2005 there were outbreaks on islands in the Indian Ocean with subsequent spread across India; a related outbreak occurred in Italy in 2007, as well.

The WHO report is significant in that this is the first time we have seen sustained transmission of this disease in the Caribbean. It's not surprising that we are seeing this (see here for a blog post I wrote about the potential for the disease to emerge in the US) as one of the primary mosquito vectors (Aedes aegypti) is the same for dengue and Chikungunya, and Aedes aegypti mosquitoes and dengue are already widespread in the Caribbean and Latin America. Disturbingly, Chikungunya is also transmissible by Aedes albopictus ("Asian Tiger") mosquitoes; this species has a wider geographic range than Aedes aegypti and can thrive as far north as Chicago.

Unfortunately the Chikungunya outbreak in Saint Martin likely heralds future sustained transmission throughout the region. Although rarely deadly, the disease can be associated with significant morbidity (long-term joint pain and fatigue). Aggressive surveillance and mosquito control efforts are needed.

Click here for the WHO report.

Drs. Lee, Collins and Bucheit Honored for Their Work with the Stewardship Interest Group of Virginia

The blogger with Drs. Lee, Collins and Bucheit in April 2013

Congratulations to Drs. Kim Lee, Rebeccah Collins and John Bucheit who were honored with the Clinical Pharmacy Practice Achievement Award at the Virginia Society of Health-System Pharmacists' Fall meeting for their work in creating the Stewardship Interest Group of Virginia (SIGoVA). SIGoVA is an interest group for people involved in Antimicrobial Stewardship in (and around) Virginia, and is a forum for people to come together to share ideas and best practices in stewardship.

To find out more about SIGoVA please visit the SIGoVA website or email stewardship@vshp.org.

Congrats again to Drs. Lee, Collins and Bucheit!

World AIDS Day: Many Gains, Much to Do

Today is World AIDS Day; this is the 25th anniversary of the event. In the past quarter century there have been incredible gains in both HIV prevention and treatment, turning the disease into one that was nearly universally fatal to what is for many a chronic illness with a near-normal life expectancy. On the patient level the gains that have been made are due to antiretroviral drugs ("ART"); access to these life-saving drugs is still a major issue in much of the world, however.

In 2012 there were 2 million new HIV infections and 1.6 million HIV/AIDS related deaths. There are an estimated 35 million people living with HIV globally, with approximately 75% of all new infections occurring in sub-Saharan Africa.

I volunteered providing medical care in a small village in rural Kenya back in 2001. I remember having a conversation with a local health worker about HIV in this particular community and was amazed when she told me the HIV prevalence was over 40%. At the time the people living in the area had essentially no access to life-saving ART and many of the patients I saw had findings consistent with advanced HIV/AIDS and more likely than not are now dead. HIV/AIDS absolutely has devastated many communities in sub-Saharan Africa.

cdc.gov

The picture is not entirely grim, however. The President's Emergency Plan for AIDS Relief (PEPFAR) has led to millions of people in Africa receiving ART, and it is estimated that one million new infections in children have been prevented over the past decade. Many people who once had little to no hope of obtaining ART (such as those living in the community I described above) can now do so.

In the United States it is estimated that 1.1 million people are living with HIV, with 1 in 5 people

cdc.gov

unaware they have the infection. There are an estimated 50,000 new infections per year. There are racial disparities in HIV infection risk that are believed to be due, at least in part, to differences in access to care, poverty and discrimination. Although the incidence of new infections is going down in some subgroups (such as black women), it is increasing in others (such as men who have sex with men).

Much more needs to be done to prevent new infections, identify new infections early and to get patients with HIV into care. Health disparities need to be addressed both in the U.S. and globally. New therapies need to be developed (including a preventive vaccine).

See here for some terrific resources on HIV/AIDS, including more about World AIDS Day.