The Chikungunya virus is moving into our neighborhood

Yet another scary virus in the news, this time it’s the Chikungunya (CHIKV) virus.

CHIKV is a virus that is fairly common in Africa, and has been reported in several other areas like Asia, the Pacific Rim and parts of Europe. CHIKV is only rarely fatal. But it’s symptoms can be debilitating.

It often starts with a fever and then joint pains begin. Patients who have experienced the disease describe the pains as if “my bones were being crushed” or “all of my joints were on fire.” One patient said, “It didn’t kill me but I almost wish it had, it was so painful.” The joints in the hands and feet are most commonly affected, but other joints can be involved. Some patients will also develop a rash, muscle aches, headache, fatigue and other symptoms.

The disease is spread by mosquito bites. A mosquito bites someone infected with CHIKV, and the virus enters the mosquito. The next time the mosquito feeds, some of the virus gets regurgitated into the blood of the victim and then CHIKV develops in him. Not all people bitten will develop clinical disease. Most will and begin getting symptoms in about a week after the bite.

There is no vaccine or specific treatment. Rest, fluids, medications to relieve fever and pain are given. The pain is so severe in some patients that they require narcotics to control it. For most patients, the disease is self-limited and symptoms disappear within a week or two. But for some unfortunates, the symptoms can last longer, sometimes over two months.

Since 2006, there have beenonly a few cases of Chikungunya (<65/year) seen in the US. Similarly there were sporadic cases seen in travelers returning to the Caribbean and South America. All cases were seen in returning travelers. But that changed recently, and drastically.


From the CDC.

Since December 2013 there have been over 100,000 cases in the Caribbean. A few cases have been seen in localized areas of South America (e.g., Guyana.) Obviously these cases are not all seen in people just returning from overseas travel. That means that the virus is spreading locally in these regions. There have also been about 30 cases of CHIKV seen in the US recently. These were all thought to have occurred in travelers. But that information may be incomplete because the CDC and local public health departments do not require that cases of Chikungunya be reported to them.

Recently, the first documented case of CHIKV was found in Puerto Rico that had occurred there. This patient had no history of recent travel. That means that CHIKV is now present in the Americas (Puerto Rico, the Caribbean and parts of South America) and circulating there.

With the Caribbean being a popular vacation spot, it’s probably just a matter of time before the virus becomes more common in the US and may evan be able to establish itself in the local mosquito populations here.

The Centers for Disease Control recommends that people take standard precautions against mosquito bites: stay indoors when possible, wear long sleeved clothes, use insect repellant, make sure that window screens are in good repair, drain standing water, etc.

If you do develop fever and severe joint pain be sure to see your doctor especially if you’re aware of a recent mosquito bite or if you’ve returned from an area where Chikungunya virus is present.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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