19 Nov 2015

Chikungunya virus: Caribbean and the Americas

Ongoing surveillance and updated case report numbers for Chikungunya virus in Caribbean and the Americas Chikungunya virus: Caribbean and the Americas

Since the introduction of Chikungunya virus (CHIKV) to the Americas in 2013, more than 1.6 million suspected and/or confirmed cases have been reported in the region [1].

Between 1 January and 13 November 2015, a total of 594,678 suspected and/or confirmed cases of CHIKV infection, including 76 deaths, have been reported in the Caribbean and the Americas. The majority of suspected cases during 2015 have been reported from Colombia (391,149 with 71 deaths). Large numbers of suspected cases have also been reported from Honduras (71,835), Nicaragua (52,942), El Salvador (39,704), Ecuador (29,242), Venezuela (14,973), Brazil (12,898) and Mexico (9,622) [2].

Because of different surveillance and reporting systems, up to date reports may not be available from some parts of the region.

View map of countries/territories in the Americas region with reported autochtonous (locally acquired) transmission during 2015 [3].

The two main vectors of CHIKV, Aedes aegypti and Aedes albopictus mosquitoes, are distributed throughout the Caribbean and the Americas, so the region is highly susceptible to the introduction and spread of the virus [4].

Autochthonous transmission from an imported viraemic chikungunya case, during the summer season in the EU is also possible; the competent vector (Aedes albopictus) is present and the environmental requirements are met during the summer and early autumn in Europe [5].

In symptomatic illness, there is the sudden onset of fever, headache, myalgia and arthralgia. After two to three days, a generalised maculo-papular rash can develop. Most cases recover in three to five days. However, up to 10% of cases experience arthritis, chronic joint pain and fatigue.

Complications of CHIKV infection can include hepatitis, myocarditis, neurological and ocular disorders. Treatment is supportive [6].

Advice for travellers

Aedes mosquitoes bite in the day, particularly around dawn and dusk. High mosquito numbers following the rainy season increases the risk of disease transmission. You should take insect bite avoidance measures to reduce the risk of infection with CHIKV and other mosquito borne diseases. There is currently no vaccine or chemoprophylaxis available to prevent CHIKV.

Please check the Outbreak Surveillance section for further information on confirmed and suspected CHIKV outbreaks, including country specific CHIKV case reports.

Advice for health professionals

CHIKV does not occur in the UK, but a number of cases are reported each year in travellers who have returned from endemic areas.

In 2014, the majority of cases (88%) diagnosed in returned travellers from England, Wales and Northern Ireland (EWNI) were acquired on trips to the Caribbean and South America, and only one case was associated with travel to the Pacific region (Tonga) [7]. This is in contrast to previous years, where the majority of EWNI cases were associated with travel to South and South East Asia.

Health professionals should be aware of the possibility of CHIKV in febrile travellers who have recently visited affected areas. If a case is suspected, appropriate samples should be sent for testing (including a full travel and clinical history, with relevant dates) to the Public Health England, Rare and Imported Pathogens Laboratory.

The Imported Fever Service, Public Health England is also available to local infectious disease physicians or microbiologists, if specialist advice is needed on: 0844 778 8990.

Resources

 

  1. Pan American Health Organization (PAHO/World Health Organization). 54th Directing Council 67th Session of the Regional Committee of WHO for the Americas. Report on Chikungunya virus transmission and its impact in the region of the Americas. 10 August 2015 [Accessed 19 November 2015].
  2. Pan American Health Organization (PAHO)/World Health Organization). Chikungunya: PAHO/WHO Data, Maps and Statistics. Number of reported cases of Chikungunya Fever in the Americas – EW 45 (November 13, 2015). [Accessed 19 November 2015]
  3. Countries or territories with reported autochthonous transmission during 2015.
  4. Vega-Rua A, Zouache K, Girod R et al. High vector competence of Aedes aegypti and Aedes albopictus from ten American countries as a crucial factor of the spread of Chikungunya. Journal of Virology. 2014 Jun; 88(11): 6294-306.
  5. European Centre for Disease Prevention and Control. Rapid Risk assessment. Chikungunya outbreak in Caribbean region. 25 June 2014. [Accessed 19 November 2015]
  6. World Health Organization, Chikungunya fact sheet. February 2015. [Accessed 19 November 2015]
  7. Public Health England. Chikungunya in England, Wales and Northern Ireland: 2014. 15 March 2015. [Accessed 19 November 2015]

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