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.

Chikungunya-virus

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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  • http://musephotos.wordpress.com/ GarySFBCN

    I am a mosquito magnet. And I sometimes have reactions to mosquito and spider bites. For example, if I am bitten on the face, sometimes my face will swell up to the point that it impairs my vision.

    Several years ago I noticed that when I ate any food with curry, I got fewer bites. I also read a lot about vitamin B-1 repelling mosquitoes, although I see that tests of this seem to indicate that it doesn’t work.

    So when I planned on a hike in the Everglades, for two days before, I took vitamin B-1, ate meals with curry, and, on the day of the hike, I slathered myself with DEET. On the day of the hike, I only got a few bites. My two friends with me, were bitten hundreds of times.

  • http://heimaey.us/ heimaey

    Do we really need mosquitoes? Can’t we just get rid of them all?

  • Elijah Shalis

    It will be all under water soon enough

  • docsterx

    I just posted this below, but, in light of the Florida case, and in case there CHIKV is already becoming a problem, it might be worth posting it as a separate post:

    You can’t see it on the map posted above, but there have been lots of
    cases in Haiti and the Dominican Republic. Insecticides containing DEET
    are more effective against mosquitoes than other types of inscticides
    (Read the label and instructions carefully.)
    From other research,
    mosquitoes pick victims based preferentially on how they smell to the
    mosquito. Investigators found that, in people whom mosquitoes like to
    bite, the foot sweat was the most attractive odor to the mosquito. They
    recommend washing your feet every time before going outside and that
    you wear flipflops of clogs that have just been rinsed or washed, as
    well. In the research, those who did this, even among the people that
    the mosquitoes preferred to bite, had a significantly lower number of
    bites.

  • docsterx

    You can’t see it on the map posted above, but there have been lots of cases in Haiti and the Dominican Republic. Insecticides containing DEET are more effective against mosquitoes than other types of inscticides (Read the label and instructions carefully.)
    From other research, mosquitoes pick victims based preferentially on how they smell to the mosquito. Investigators found that, in people whom mosquitoes like to bite, the foot sweat was the most attractive odor to the mosquito. They recommend washing your feet every time before going outside and that you wear flipflops of clogs that have just been rinsed or washed, as well. In the research, those who did this, even among the people that the mosquitoes preferred to bite, had a significantly lower number of bites.

  • Indigo

    Funny (not funny ha-ha but funny odd) that you bring that up this morning because it’s here! A case was reported just yesterday in Orange County, Florida. That’s Central Florida aka Metro-Orlando:
    http://www.wesh.com/health/chikungunya-fever-case-reported-in-orange-county/26402022#!WX3EI
    Keep the Deet handy and dress sensibly. Although the majority of Euro-Americanos in Florida wear shorts, t-shirts and flip-flops much of the time, you don’t see people used to the sub-tropical life exposing much skin. Light weigh clothing, keeping the arms covered and a hat to protect from the sun’s ultra-violet. We have good mosquito control here in Orange County, the patient with CHIKV probably contracted it in Haiti, a neighboring Caribbean country.

  • whipmeco

    We are going down to the Dominican Republic at the end of this month. For reasons passing understanding my in-laws who live there don’t have screens on their windows. I am not going to the DR to spend it indoors, however we will be taking extra precautions when we are there. I am sure that we will all get the virus at some point and will have to deal with it. Sadly, my Dominican Wife does not seem to think that this is a concern.

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