It’s best to start learning how to pronounce the word “Chikungunya” (chik-en-gūn-ya): this crippling virus that is spread by mosquitoes has already reached the Caribbean and could soon be making landfall to a city near you.
The Chikungunya virus has no known treatment and can cause a very severe disease in people, with fevers, headaches, and painfully debilitating joint pain that can last for months to years.1 The word “chikungunya” is African (Makonde) in origin and translates to “that which bends up.” People infected with this virus are literally bent up from the extreme joint pain they experience. The virus is spread from person to person through the Aedes species mosquito.
Just a few months ago, in early December of 2013, the virus was found to be circulating in the Caribbean. This was the first evidence that this virus made the massive jump to the Western Hemisphere. By the end of March 2014, more than 17,000 suspected and confirmed cases were reported among several island countries throughout the Caribbean and most recently in South America.4 It has island-hopped from one country to the next, and now 17 countries are reporting local transmission,5 with cases exploding to more than 135,000 suspected or confirmed cases, including 14 deaths.6 Several imported cases have been reported in different states, but no sustained transmission in the mosquito populations as of yet. It is just a matter of time before it becomes established in the United States.
This week I gave a presentation to first year medical students and asked them if they had ever heard of Chikungunya. Only a couple of hands went up. The rest shook their heads. This is exactly our concern. Are we ready for a virus that the vast majority of America has never heard of and which has no known treatment yet? Will our medical community be educated and equipped to identify and diagnose cases? Is our already exhausted public health system ready to take on the burden of a new disease spread by mosquitoes? Will we need to start screening the blood supply? What will be the economic impact?
Considering the number of travelers coming from the Caribbean by plane and by sea as well as the vast mosquito populations that are more than capable of transmitting Chikungunya, we have high concerns that the disease could take hold and begin its spread here in the United States, particularly in Texas, Louisiana, Florida, and New York. At the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital, we are laying the groundwork to educate both the public and physicians about this potentially serious disease and create a surveillance network among affiliated hospitals in Texas in collaboration with the Centers for Disease Control and Prevention to try and prevent infected people from reaching the U.S.
As the weather begins to finally warm up this year and the mosquitoes come out in swarms, we need to keep this disease in the forefront of our minds and have heightened awareness of its potential emergence. Quick and early detection of cases will be critical for an adequate public health response to prevent further spread. We need to be proactive in our approach to this new disease threat, and think not “if” it will hit but “when.”
Charrel RN, de Lanballerie X, Raoult D. Chikungunya outbreaks—The globalization of vectorborne diseases. N Eng J Med 2007; 356:769-771.
Powes AM, Logue CH. Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus. J Gen Virol 2007;88:2363-2377.
Rezza G, Nicoletti L, Angelini R, Romi R, Finarelli AC, Panning M, et al. Infection with chikungunya virus in Italy: an outbreak in a temperate region. Lancet 2007;370:1840-1846.
W Van Bortel, F Dorleans, J Rosine, A Blateau, D Rousset, S Matheus, et al. Chikungunya outbreak in the Caribbean region, December 2013 to March 2014, and the significance for Europe. Eurosurveillance 2014;19:pii=20759.
CDC Website, accessed June 9, 2014: http://wwwnc.cdc.gov/travel/notices/watch/chikungunya-saint-martin
PAHO Website, Accessed June 9, 2014: http://www.paho.org/hq/index.php?option=com_content&view=article&id=9053&Itemid=39843