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CHIKUNGUNYA (Hear it pronounced here) is an RNA viral disease that was first discovered after an outbreak in 1952 in Africa in the southern part of what is now Tanzania. The researchers who described it three years later loosely translated the word as “that which bends up”, referring to the positions sufferers contort themselves into while trying to alleviate the pain. It has also been called the “contorted with pain” virus.

CHIKUNGUNYA is an arthropod-borne  Alphavirus spread to humans by infected Aedes mosquitoes, especially the white-striped Asian Tiger Mosquito. The virus is not spread from person to person, but what may be facilitating how quickly it has spread throughout the Americas, and particularly, the Caribbean, is that a mosquito can bite an infected person and pass it along when it bites another person.

CHIKUNGUNYA is often misdiagnosed as Dengue Fever because it shares some clinical signs and is also spread by the same species of mosquito. After a person is bitten by an infected mosquito, initial symptoms usually appear between four and eight days but can range from two to 12 days. They include an abrupt onset of fever frequently accompanied by joint pain which can often become debilitating, hence the ‘contorted with pain’ meaning of its name.

Other signs include headache, muscle pain, nausea, fatigue and a characteristic rash. Most people who are infected recover in a few days to a few weeks. However, the joint pain can persist in some people for several months to several years, with complications sometimes contributing to cause of death in elderly persons.

There is no cure for CHIKUNGUNYA. Several vaccines are in the works, but it may be a few years before they are approved  for use. Available treatments usually focus on relieving the painful symptoms of the disease. If infected : Get plenty of rest. Drink fluids to prevent dehydration. Take medicines, such as ibuprofen, naproxen, acetaminophen, or paracetamol, to relieve fever and pain.

The best way to try and protect against further spread of CHIKUNGUNYA is to reduce the number of mosquito breeding sites in affected communities by cleaning up standing water areas or containers and/or using insecticides to kill the flying mosquitoes and their larvae.

Because the Asian Tiger mosquito flies during daylight hours when people are most active, it’s important to wear clothing that minimizes skin exposure – shirts with long sleeves and long pants. Use insect repellant on skin and clothing – it should contain DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester) or icaridin (1-piperidinecarboxylic acid, 2-(2-hydroxyethyl)-1-methylpropylester).

Most insect repellents can be used on children. However, never apply repellent to children younger than 2 months old (according to the American Academy of Pediatrics). Apply sparingly around ears, never on eyes or mouth. (Sources: WHO | CDC | PAHO). Ensure windows have screens and use mosquito coils or insecticide vaporizers for indoor protection

CHIKUNGUNYA reached epidemic proportions during the last major outbreak of 2014-2015 in many parts of the world and was identified in over 75 countries throughout Africa, Asia, Europe and spread quickly at the time from the Caribbean though the Americas.

2019 “hotspots” have been identified in Brazil and Congo, with increased infections being reported in Myanmar, Thailand and other areas in south-east Asia. Scroll further down the page for updated iinformation.

People traveling to identified risk areas need to take the same preventative precautions outlined in our How To Protect Against It section.

Photo from the Pan American Health Organization shows patients with suspected Chikungunya infection at a clinic in the Dominican Republic earlier this year. A woman in a wheelchair holds her face in her hands; a young man in the front row of white plastic chairs leans his head against his fist, while an older man in the middle of the third row leans back and holds the palm of his right hand to his forehead in obvious discomfort; a woman in the front row covers herself in a sweater and in later photos is seen collapsing in pain into a wheelchair.

Tracking The Global Spread Of Chikungunya

The disease mostly occurs in Africa, Asia and the Indian subcontinent. However a major outbreak in 2015 affected several countries of the Region of the Americas.

In June, 2019, the European Centre for Disease Prevention and Control (ecdc) reported over 54,125 suspected cases of chikungunya as documented on the global map in the tabbed section below. This total doesn’t include smaller numbers of cases reported from various countries. 

That number is in sharp contrast to the major outbreak in 2014-2015 when worldwide cases surpassed 443,000.

2019 GLOBAL OVERVIEW OF CHIKUNGUNYA CASES

The following map from ecdc shows the current chikungunya “hotspots” to be Brazil and Congo. In some countries, it’s difficult to get accurate numbers, and differentiation between local transmissions and those imported by travelers who’ve visited infected regions.

 

Global map shows major chikungunya outbreaks in Brazil and Congo. More geographic statistics are outlined by region in the adjacent tabs.

Africa 

Republic of the Congo: The outbreak in the Republic of the Congo is ongoing. As of 19 May 2019, the country has reported 9 015 cases, which represents an increase of 3 000 cases since the previous CDTR update. The most affected departments are: Kouilou, Bouenza, Pointe-Noire, Plateaux, Pool, Niari, Lékoumou and Brazzaville. 

Democratic Republic of the Congo: According to WHO, since the beginning of the outbreak and as of 17 April 2019, 823 cases, including 254 confirmed, have been reported. No deaths related to this outbreak have been reported. This represents an increase of 493 cases since the previous CDTR update. Most of the cases were reported in Kinshasa and Kongo Central Provinces bordering the Republic of the Congo.

Americas and the Caribbean 

Brazil: In 2019, Brazil has reported 38 000 confirmed cases, including 15 confirmed deaths, as of 8 June 2019. This represents a twofold increase compared with the 19 000 confirmed cases reported for the same period in 2018. Rio de Janeiro, Pará and Minas Gerais are the regions with the highest incidence in 2019.

Colombia: In 2019, Colombia has reported 308 cases as of 15 June 2019, 20 of which are laboratory-confirmed. This follows the same trend as in 2018 when 394 cases were reported for the same period.

El Salvador: El Salvador has reported 204 suspected cases as of 15 June 2019, compared with 127 cases for the same period in 2018.

Honduras: According to media sources quoting health authorities, 47 cases have been reported in Honduras in 2019 as of 8 April 2019.

Nicaragua: In 2019, Nicaragua has reported 74 suspected cases as of 15 June 2019, compared with 148 suspected cases, including 22 confirmed cases during same period in 2018.

Paraguay: In 2019, Paraguay reports less cases than in 2018. As of 1 June 2019, the country has reported 40 probable cases, compared with 945 probable cases and 56 confirmed cases during the same period last year.

Peru: In 2019, Peru has reported 127 cases in 30 districts across the country as of 8 June 2019, compared with 259 cases for the same period in 2018. The cases are mostly affecting Piura, San Martin and Tumbes.

 

Asia 

India: In 2019 and according to media sources citing health authorities, 250 cases have been reported in the State of Tamil Nadu up to April 2019. 

Indonesia: According to media sources quoting health authorities, 17 cases have been reported in Depok, West Java in April 2019. 

The Maldives: Health Protection Agency has reported a noticeable rise in chikungunya cases in the past months. As of 18 June 2019, there has been 1 226 cases, mostly affected the atolls of Thaa, Gaaf Alif and Kaafu. The last previous chikungunya outbreak in the Maldives was recorded in 2006

Thailand: In 2019, Thailand has reported 3 994 cases with no deaths associated in 27 provinces as of 22 June 2019. The most affected provinces are located in the southern part of the country. This represents an increase of 600 cases since the previous CDTR update. Last year, during the same period, there were only 34 cases recorded.

Australia and the Pacific 

No outbreaks have been reported since the previous update

AUGUST: 2019 Provisional data for the United States

Chikungunya virus disease became a nationally notifiable condition in 2015. Cases are reported to the U.S. Centers for Disease Control (CDC) by state and local health departments using standard case definitions.

As of August 1, a total of 40 chikungunya virus disease cases with illness onset in 2019 have been reported to ArboNET from 17 U.S. states (See Map and Data below). All reported cases occurred in travelers returning from affected areas. No locally-transmitted cases have been reported from U.S. states.

A total of two chikungunya virus disease cases with illness onset in 2019 have been reported to ArboNET from U.S. territories. To date, two locally- acquired cases have been reported from Puerto Rico.

Map of the 17 states in the U.S. that are reporting cases of Chikungunya virus infection. The text list follows this illustration.

2019 UPDATES

 

AUGUST: SOUTHEAST ASIA TRAVEL ADVISORIES

Taiwan’s Centers for Disease Control (CDC) has issued a level one travel health notice (exercise normal precautions) for chikungunya fever and a level two notice (exercise increased caution) for Zika for people travelling to Myanmar. The travel one advisory for chikungunya infection warns against all non-essential travel to Myanmar, the Maldives, Thailand and India, which are source countries  of infection for travelers who have brought  the virus  into Taiwan since July.

According to Taiwan CDC Deputy Director-General Chuang Jen-hsiang, 25 chikungunya fever cases have been confirmed this year, 12 of which were from Myanmar. Taiwan also reported its first indigenous case of chikungunya in July.

 

JUNE: SINGAPORE | THAILAND

Thirteen students and a teacher from the School of the Arts in Singapore contracted chikungunya fever while on a community service learning trip in Thailand in June. The following video report is from CNA Mediacorp which is funded in whole or in part by the Singaporean government:

APRIL: OVER 4,000 CASES OF CHIKUNGUNYA REPORTED IN CONGO

According to the World Health Organization, from 1 January to 14 April 2019, a total of 6,149 suspected cases of chikungunya have been reported in Congo with approximately 54% of reported cases being female. However, the scale of this outbreak has likely been underestimated given the limited detection capacity of the surveillance system in the country.

In the Video Reports section below, you can watch a report from Africa News on the situation in Congo.

The Human Faces Of Chikungunya

A photo series from the Pan American Health Organization put a human face on the spread of Chikungunya during the 2014-2015 outbreak in the Dominican Republic, which had the highest number of cases in the world at that time at 251,951.

Photographer Luz Sosa (PAHO/WHO) captured the experiences of patients at hospitals and clinics in Santo Domingo that show the discomfort and chronic pain felt by those in the acute and chronic phases of Chikungunya, including the characteristic rash that accompanies the onset of symptoms as seen on the legs of the infant below.

Photo from the Pan American Health Organization shows a young boy wrapped in a white towel leaning against his mother as they si in the waiting area of a hospital in Santo Domingo in the Dominican Republic. This series of photos bny Luz Sosa shows the physical pain many patients feel after the onset of symptoms of Chikangunya.
Photo from the Pan American Health Organization shows a closeup of an infant's legs as it lies on a hospital bed in Santo Domingo in the Dominican Republic. The legs are covered from the knees down by the characteristic rash that requently accompanies the onset of Chikangunya symptoms. This series of photos bny Luz Sosa shows the physical pain many patients feel after the onset of symptoms of Chikangunya.
Photo from the Pan American Health Organization shows a woman wincing in pain as she is helped into an examining room at a hospital in Santo Domingo in the Dominican Republic. This series of photos bny Luz Sosa shows the physical pain many patients feel after the onset of symptoms of Chikangunya, and why it's name means 'contorted with pain'.

The Need For Education and Prevention

Because there is currently no cure for Chikungunya, the best ways to try and contain the spread of the virus is by educating people about preventative measures they can take to try to minimize exposure to the mosquitoes that carry it.

In the Dominican Republic, where there was a 30% increase in the confirmed number of Chikangunya cases (58,538) in the week preceding July 18th, 2014, the Ministry of Health staged a ‘National Day Against Chikungunya’ to educate citizens in Santo Domingo and other communities about cleaning up areas of standing water that serve as mosquito breeding sites, as well as providing netting for sleeping children and the elderly – the two highest risk groups for serious complications from Chikungunya.

Photographer Luz Sosa (PAHO/WHO) went along with these officials to capture images of the effort.

Photo from the Pan American Health Organization series by Luz Sosa shows laundry hanging in a yard in the Dominican Republic with a barrel nearby used to catch rainwater for washing. However these rain barrels become breeding grounds for infectious mosquitoes that can carry Dengue Fever as well as Chikungunya.
Photo by Luz Sosa shows a closeup of the standing water inside a rain barrel used to collect water for washing clothing in the Dominican Republic.
Photo by Luz Sosa shows a baby sleeping on a bed protected by a hanging tent of mosquito netting in the Dominican Republic.
Photo by Luz Sosa shows a white pickup truck of the Ministry of Health with a banner 'skin' attached that depicts photos as well as an image of a mosquito with a red circle with a titled bar, meaning 'no' and other preventative information as part of a 'National Day Against Chikungunya' in the Dominican Republic.
Photo by Luz Sosa shows a young woman filling out a form on the roof of the pickup truck pictured in the previous photo as part of a 'National Day Against Chikungunya' in the Dominican Republic. More people are seen in the background at the event.
Photo by Luz Sosa shows a teenage girl sitting and resting her right arm on the open door window of the white pickup truck of the Ministry of Health with a banner 'skin' attached that depicts photos of mosquitoes along with illustrations about prevention measures as part of a 'National Day Against Chikungunya' in the Dominican Republic.
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