CARMEL, California — Chikungunya is a disease that is almost unheard of in the United States. But in recent months, the virus that is endemic in other parts of the world has put itself on the American medical map.
Chikungunya (pronounced: chik-un-gun-ya) is transmitted through a mosquito vector. Fortunately, it is rarely fatal and cannot transfer from person to person directly, but it does lead to fever, rash and horrible joint pain. This pain usually lasts for five to 12 days and is so excruciating the patient has trouble grasping objects or standing. In extreme cases, joint discomfort can last for months, even years. The only remedy is painkillers for the aching joints and fluids for dehydration.
The disease most commonly affects adults and those with preexisting medical complications. However, because there is no vaccine, the entire population of an affected area is at risk. Once the disease strikes a community, it is unlikely to return for some time since it hits everyone at once and leaves all survivors immune, possibly for life.
Similar to diseases like dengue and malaria, chikungunya is spread through contact with infected mosquitos. It has two main carriers, the Aedes aegypti and Aedes albopictus, both of which live in the Caribbean. Aedes albopictus is also found in the eastern continental U.S. While Aedes aegypti is not common, it can live in the southern borders of the U.S. The presence of either mosquito puts the population at risk for the spread of the disease.
Although chikungunya was not an issue in the Western Hemisphere until recently, it is endemic in parts of Asia and Africa. It was first discovered in Tanzania in 1950; from there it has spread to much of West and Central Africa, as well as many Asian islands. At this point, an estimated 35-50 percent of people in West Africa have the antibodies for the disease.
Now chikungunya is making its grand entrance in the western world, most significantly in the Caribbean. According to the Pan American Health Organization, there have been 250,000 suspected and confirmed cases in the Caribbean region since the outbreak began around December of 2013. So far, 21 patients across the islands have died.
The disease was first located in the Caribbean in October 2013 on the French island of St. Martin. It is suspected that this patient contracted the disease while traveling and brought it to the region. Since then, the disease has spread. The Dominican Republic has been most heavily affected, with 135,000 suspected cases. A further 40,000 cases were found in Guadaloupe and another 39,000 more in Haiti, with the rest in the surrounding islands also affected at high levels.
Chikungunya is now becoming a United States health concern as well. In the past few months, 112 travelers have brought the disease to 27 states , according to the CDC. So far, it has not infected others in the U.S. beyond these cases because the virus is not in the local continental mosquito population yet, but it is likely to spread. Aedes albopictus is found in the eastern U.S. as far north as Connecticut and New York, but scientists are comfortable saying that the disease is not likely to spread in huge numbers, even in these areas.
The disease is also infecting other regions whose travelers have visited affected areas. Travelers from the French Antilles account for 70 percent of France’s current cases. Likewise, Paraguay reported its first case on July 1, but this strain originated from the Dominican Republic. El Salvador has more of a concern, with 1,300 suspected cases.
Chikungunya in the Caribbean could be disastrous for a few reasons. First, it is likely that the epidemic is much bigger than recorded because many people do not go to health clinics and the diagnosis is difficult. The disease also looks similar to influenza and dengue fever, both of which occur in the region as well. Second, the two types of transmitting mosquitos both live in the Caribbean, meaning that the disease could become endemic and challenging to eradicate, much like dengue.
Most importantly, however, is the severe joint pain associated with chikungunya which keeps patients from working. Infected patients cannot earn money or provide food for themselves or their families while ill. As it spreads across the region, it keeps its victims in precarious, even impoverished situations.
In the United States, chikungunya is less likely to have such a dramatic affect. Mosquito-borne disease is less common in the states, mostly due to better sanitation and water storage than in parts of the world that are most affected. Mark Heise of University of North Carolina at Chapel Hill says, “It’s something we should be concerned about, but I don’t think people need to panic about it either.”
So far, travelers to the Caribbean, Asia and Africa are being warned about mosquitos and informed on ways to avoid infection, but measures to keep the disease from entering the U.S. have not become extreme as of yet.
Overall, chikungunya’s spread to a new territory will likely wreak havoc in its new stomping ground for some time until communities are almost all immune. Hopefully, the disease will fail to get a strong foothold in this half of the world and will not become endemic.
In order to ensure that this does not happen, it is important that the Caribbean, South America and continental U.S. implement measures which get rid of all standing water, restructure sanitation and water storage systems and minimize exposure.
– Caitlin Thompson