22 Sep 2017
Chikungunya outbreak in Italy – Summer 2017Advice for travellers and health professionals
On 7 September 2017, Italian authorities reported three cases of chikungunya virus (CHIKV) infection in Anzio, a seaside town 60km from Rome. As of 21 September, 92 cases have been reported in three different locations: the municipality of Rome, the city of Anzio, and Latina (20km from Anzio) [1,2]. The Italian authorities are coordinating mosquito control measures in these areas.
The first outbreak of CHIKV in Europe was reported in 2007 in northern Italy where it was introduced by a traveller from India. A total of 205 cases with one death were recorded in the province of Ravenna in the summer of 2007. Southern France has since seen smaller outbreaks in 2010 (two cases) and 2014 (11 cases), including an outbreak in August 2017 in the Var Department (11 cases) . The outbreak in Italy is the latest and largest outbreak in Europe this summer.
CHIKV was first isolated in Tanzania in 1952  and is now widely distributed through tropical and subtropical countries [4, 5].
CHIKV is spread by day-biting Aedes species (Aedes aegypti and Aedes albopictus) mosquitoes. Aedes albopictus is distributed throughout southern Europe and neighbouring countries .
Infection with CHIKV may not result in symptoms; when symptoms do occur, there can be sudden onset of fever, headache, myalgia (muscle pain) and arthralgia (joint pain). After two to three days, a generalised rash can develop. Most cases recover in three to five days. However, up to 10% of cases experience arthritis, chronic joint pain and fatigue, which can persist for several months or years in some cases. Serious complications of CHIKV infection are rare, but can include myocarditis (inflammation of the heart muscle) and nervous system and eye disorders. Treatment is supportive .
Advice for travellers
There is no vaccine or drug currently available to prevent CHIKV infection. You should follow insect bite avoidance measures when travelling to outbreak affected areas. Aedes mosquitoes are most active during daylight hours. You are advised to be vigilant with insect bite avoidance, particularly around dawn and dusk when the mosquito that transmits CHIKV infection is more active.
You can check our Outbreak Surveillance section for further information on CHIKV outbreaks, including country specific CHIKV case reports.
Advice for health professionals
Health professionals should be aware of the possibility of CHIKV in febrile travellers who have recently visited affected areas, including the Mediterranean area where the vector for CHIKV is present. If a case is suspected, appropriate samples should be sent for testing (including a full travel and clinical history, with relevant dates) to: 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.
- ECDC (2017) Rapid Risk Assessment: Clusters of autochthonous chikungunya cases in Italy [Accessed 22 September 2017]
- Lazio Region (2017) Chikungunya [Accessed 22 September 2017]
- WHO (2017) Chikungunya Factsheet [Accessed 22 September 2017]
- Mayer et al. (2017) The emergence of arthropod-borne viral diseases: A global prospective on dengue, chikungunya and zika fevers. Acta Tropica 166, 155-163
- CDC (2016) Chikungunya geographic distribution [Accessed 22 September 2017]