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.