Chikungunya disease – an emerging threat from the West Indies

Perhaps if you want to avoid attention, name a disease in such a fashion as to be unpronounceable.  The illness comes from a Makonbe word meaning “that which bends up” in reference to the impact the disease has on joints.   The illness has been widely found in Africa and Southeast Asia, has only recently been reported from the West Indies islands of the Caribbean since Dec 2013.   IN a short space of time, some 500 cases have been reported

The typical illness begins 3-4 days after a bite from an Aedes aegypti or A. albopictus infected mosquito.  Notable in presentation for fever, its hallmark is arthritis/arthralgia that can be debilitating in the short term and can result in rheumatologic symptoms for months to years – hence the unwieldy name.  While debilitating, mortality is uncommon and supposedly limited to older persons, currently with only one recorded death in the West Indies outbreak. Albeit that most work is done in developing countries where immunologically compromised persons may not be identified as a risk population.

The most notable issue with this outbreak is the geographic jump to the Americas, and the potential for yet another introduction of an organism previously not known to be endemic.  Comparative examples include Lyme disease and West Nile Virus Fever, where introductions into relatively naïve populations are associated with manifestations not noted in the countries from which they arose.  

In this respect, watching the dispersion of this virus through the Americas should be of public health interest.   Expansion in just a couple of months has been notable, and cases of exportation among travelers have been documented.  As the virus crosses into more populous tourist areas, further exportation may be expected.  

PAHO is maintain good information, and an excellent  information sheet for health care workers,  as well as regular updates on disease spread.  The geographic distribution as of mid-February is posted below.   The question, when will we see the first cases crossing into US or Canada among tourists?