The Chikungunya Pandemic

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With all the news focusing on the Ebola epidemic in West Africa, we forget that there is a pandemic running rampant on this side of the Atlantic right now. The Chikungunya virus has traveled from Africa and has ravaged the Caribbean and Latin America. In this hemisphere, the number of cases has reached 729,000 in 34 countries or territories as of mid-September 2014. Compare this to 6,000 cases of Ebola in the same time frame.

Chikungunya (an African term meaning “that which bends up”) is a viral illness that is not fatal, but causes excruciating pain in joints as well as a high fever. The pain is reminiscent of severe arthritis and can last for weeks, months, or even years. Unlike some other viruses like Enterovirus D68, which can be without symptoms in many cases, the majority of those infected will suffer the effects of the illness.

Other symptoms, besides joint pain and fever, include:

• Headache
• Nausea and vomiting
• Red eyes
• Sensitivity to light
• Leg swelling
We don’t yet know what causes some of the above symptoms.

The virus isn’t brand new; it was first originally identified in 1952, but is thought, in hindsight, to have caused outbreaks since the 18th century. Epidemics of Chikungunya have been reported in the regions of the Indian Ocean, Africa, Asia, and some Pacific Islands.

Chikungunya is an example of a mosquito-borne disease, with the common Aedes Aegyptus species and the more aggressive Asian Tiger Mosquito proven as vectors (agents than transmit the virus to humans). Monkeys and apes were original reservoirs of the virus, but it is thought to have traveled to this hemisphere through rats and other rodents. Since it is new to the area, few are immune; this has caused the number of cases to skyrocket.

There is no known cure or treatment other than pain relief and fever control through medications like Acetaminophen (Tylenol). The disease is prevented by good mosquito control. Areas where air-conditioning is widely available seem to be less affected.

Diseases like Chikungunya, while not fatal, can cause economic damage in the form of lost work days; 13% of businesses in the Dominican Republic have reported absenteeism due to the illness. The strain on medical facilities is also significant, with many hospitalizations in the acute phase.

CDC recommendations include caution for those who travel to the Caribbean or Latin America, especially:

• Arthritis sufferers
• Those with chronic illnesses such as diabetes or heart disease
• The elderly
• Pregnant women; Chikungunya may possibly be passed to the fetus
• Aid workers, missionaries, and other long-term travelers
• People whose travel involves large amounts of time outdoors

With the large amount of Americans traveling on vacations to the Caribbean and Latin America, we can expect more issues with the Chikungunya virus in the near future.

Joe Alton, M.D.

Joe Alton, M.D., aka Dr. Bones

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