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AbledAlert Post Banner shows a photo of a white striped Asian Tiger Mosquito biting human skin set against a red transparent layer covering a map of the Caribbean region. The text over this background reads: Chikungunya, Special Ongoing Coverage. The Post headline reads AbledAlert: Outbreak: 'Contorted With Pain' Virus Spreads From Caribbean To U.S. And Abroad.

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 has now reached epidemic proportions in many parts of the world and has been identified in 75 countries throughout Africa, Asia, Europe and has been spreading quickly from the Caribbean though the Americas.

See our extended coverage for more details. Daily news reports are tallying cases showing up in Florida, Mississippi, and Long Island, New York. Puerto Rico has recently declared a CHIKUNGUNYA epidemic. 

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.

At least 74 countries plus the United States are reporting local transmission of Chikungunya. That means mosquitoes have spread the infection locally, in addition to ‘imported cases’ that are brought back by returning travelers or tourists who’ve visited infected regions.

Because of the differentiation in cases, it’s difficult to get an accurate total number of cases until the World Health Organization (WHO) releases more current data than its last report in March, 2014.

The start of this most recent outbreak of Chikungunya has been traced back to the French part of St. Martin in October, 2013. It may be conceivable that worldwide cases may soon be approaching 443,000.

Awaiting correlated data.

24% increase in the Americas

The Pan American Health Organization (PAHO) reports, as of July 18th, that Chikungunya cases in the Americas increased over the last week by 24%, to 442,310, with the Dominican Republic accounting for most of the new infections, followed by Guadaloupe, Haiti, and Martinique each contributing thousands of new cases to the total. This epidemic began on St. Martin last December.

The total reported by PAHO includes 436,586 suspected and 5,724 confirmed cases, versus 350,580 suspected and 5,037 confirmed cases (a total of 355,617) a week earlier. These figures include data from the U.S., but we’ve detailed more recent data from the Centers for Disease Control in the United States tab section.

Four deaths on Guadeloupe, and one other on Martinique raised the death toll to 26.

The Dominican Republic’s case total climbed by 58,538 to reach 251,951, a 30% increase from the previous week.

The island of Guadeloupe reported 11,000 new cases, upping its total to 63,000, for the second-biggest jump last week, according to PAHO figures. Haiti, the Dominican Republic’s neighbor, logged 10,592 new cases, pushing its total to 62,422.

In Puerto Rico, where a Chikungunya epidemic was declared last week, the case total reached 685 (502 suspected and 182 confirmed), an increase of 277. Puerto Rico’s health department is paying for laboratory tests that determine whether someone has the chikungunya virus amid an epidemic in the U.S. territory.


The announcement comes amid concerns that cases are being under reported because insurance does not cover the $250 test.


Elsewhere in the Americas, Martinique reported 5,390 new cases raising its cumulative total to 48,940.

PAHO has added three nations to its list of those reporting imported cases but no locally acquired ones: Bolivia (3), Trinidad and Tobago (3), and Jamaica (1).

The report also shows that Venezuela has reported its first (2) locally acquired Chikungunya cases. The country also has had 43 imported cases, which is up from 28 listed a week ago.

Awaiting correlated data.

Several EU/EEA countries have reported imported cases of Chikungunya infection in patients with travel history to the affected areas: Greece, Italy, the Netherlands, Spain (11) and Switzerland (15). A consolidated and updated total for the EU has been difficult to come by.

Between 1±11 July, France has detected 148 imported cases of Chikungunya using enhanced surveillance for Dengue and Chikungunya. 

It is expected that the number of cases will continue rising as more European travelers return home from summer vacation is affected areas.

As of July 22,2014, The United States has 537 cases of imported and locally acquired Chikungunya

The Centers for Disease Control (CDC) say a total of 497 Chikungunya cases have been reported to ArboNET from U.S. states and territories (Table). 197 locally-transmitted cases have been reported from Florida, Puerto Rico, and the US Virgin Islands. All other cases occurred in travelers returning from affected areas in the Caribbean and South America (295), the Pacific Islands (4), or Asia (1).

The total U.S. figure rises to 537 when you factor in reports from state and local public health reporting agencies. The CDC figures also don’t include the following updates on imported cases of Chikungunya being reported from Alabama (5), California (1), Indiana (4), Massachusetts (2), North Carolina (1), South Carolina (3), Texas (3), U.S. Virgin Islands (3).

With the recent outbreaks in the Caribbean and the Pacific, the number of Chikungunya cases among travelers visiting or returning to the United States from affected areas will likely increase. These imported cases could result in additional local spread of the virus in the continental United States.

The following map from the CDC shows the geographic distribution of Chikungunya cases throughout the United States, followed by a table with state-by-state numbers reported by ArboNET as of July 22. Keep in mind that it’s thought the total numbers are likely under-reported:

Centers for Disease Control map shows the distribution of Chikungunya cases throughout the United States, including separate maps for Alaska, Hawaii, Puerto Rico and the U.S. Virgin Islands. The next table will detail the number of U.S. cases.



Table from the U.S. Centers for Disease Control shows the number of Chikungunya cases reported to ArboNET as of July 22nd. With the exception of Puerto Rico, all of these are imported or travel-related cases where the person was bitten by an infected mosquito outside the United States and brought the infection back to the U.S. Arizona reports 1 case, Arkansas 3, California 11, Connecticut 11, Florida 77, Georgia 6, 1 each in Hawaii, Idaho and Illinois, 3 in Indiana, 2 in Kansas, 7 in Kentucky, 3 in Louisiana, 1 in Maine, 7 in Maryland, 2 in Massachusetts, 7 in Michigan, 8 in Minnesota, 5 in Mississippi, 4 in Nebraska, 1 in Nevada, 2 in New Hampshire, 12 in New Jersey, 30 in New York State, 9 in North Carolina, 8 in Ohio, 6 in Oklahoma, 1 in Oregon, 7 in Pennsylvania, 16 travel cases in Puerto Rico and 193 locally transmitted cases there, 11 travel related cases in Rhode Island, 18 in Tennessee, 4 in Texas, 2 in the U.S. Virgin Islands as well as 2 local cases there, 9 in Virginia, 1 in West Virginia and 2 in Wisconsin. The CDC also notes that Chikungunya is not a nationally notifiable disease.

Awaiting correlated data.

Tracking The Global Spread Of Chikungunya map shows global alerts for Chikungunya over the past month

Global map from shows clusters of 5 different colored dots ranging from yellow to purple representing infections of Chikungunya. The large dots represent countries while the smaller dots represent local infections. Yellow dots represent low numbers of infection while purple dots represent high infections. The greatest clusters are seen in the Caribbean, the south eastern and south central parts of the United States, the northern half of South America, western Europe, Southern India, the Philippines and Japan. They represent the number of alerts received over the past month.
AbledAlert Chikungunya world wide statistics board shows worldwide cases of infection approaching 443 thousand from reports in 75 countries. Because of the difficulty in centralized reporting from health agencies, we are awaiting correlated data from Africa, Asia, the Middle East and Europe. Cases in Europe are said to be approaching 180. In the Americas, including the United States, there are approximately 442 thousand 310 imported and local cases, of which 573 are being reported from the United States, with scattered additions coming from more and more individual states. Check back often as we gather more updates.

The Human Faces Of Chikungunya

A photo series from the Pan American Health Organization puts a human face on the spread of Chikungunya in the Dominican Republic, which has the highest number of cases in the world 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 has been a 30% increase in the confirmed number of Chikangunya cases (58,538) in the week preceding July 18th, 2014, the Ministry of Health has 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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