Bill & Melinda Gates Foundation

To avoid chikungunya infection, listen to Lindsay Lohan!

January 15, 2016

Chikungunya (chihk-uhn-GUHN-yuh) is not from chickens, even though the first 2 syllables of the name sounds like the word chicken. It is a mosquito-borne disease caused by an alphavirus from the Togaviridae family. The Chikungunya virus (CHIKV) is transmitted by the Aedes mosquitoes.

The usual clinical signs of chikungunya are non-specific flu-like symptoms, a distinctive rash and severe joint pain. The disease shares some clinical signs with dengue and can be misdiagnosed in areas where dengue is endemic. There is no vaccine nor a specific antiviral treatment for CHIKV. Patients diagnosed with chikungunya may be treated with corticosteroids or physiotherapy for joint pain and may take nonsteroidal anti-inflammatory drugs for pain and fever. Most of those infected with chikungunya do not die, but it causes extreme joint pain which can persist for months. Chikungunya means “to walk bent over” in in some east African languages; a reference to the stooped posture of many sufferers.

CHIKV was initially seen in the early 1950’s at the boundary of Tanzania and Mozambique. For the past 5 decades, CHIKV was limited to sub-Saharan Africa in addition to Southeast Asia. The situation worsened when CHIKV re-emerged in Kenya in 2004 and reached several other countries in and around the Indian Ocean. The epidemic swiftly reached regions like India and Southeast Asia and the transmission of CHIKV was reported for the first time in Europe (Italy) in 2007. The Chikungunya virus has spread like wildfire through the Caribbean and Central America. Since the 1st cases were reported in St. Maartin in December 2013, more than a million have caught the mosquito-borne disease. A 2015 study published in Neurology found that chikungunya caused central nervous system disease in many patients during an outbreak in Reunion Island. A review of CHIKV outbreaks in the 15-year period from 2000 to 2015 showed that periodic outbreaks have occurred not only in Asia and Africa, but in Europe and the Americas. It is evident that CHIKV is not restricted to a single region, but has become a global public health challenge.

Medical professionals must learn to recognize such cases among travelers returning from areas endemic for CHIKV fever with non-specific symptoms such as fever, arthralgia and skin eruptions. In endemic areas for mosquito-borne diseases, clinicians must be educated about the recognition, diagnosis and timely reporting of chikungunya virus disease cases.

There are several vaccine candidates in preclinical and clinical development. One particular vaccine that was based on a weakened measles virus looked promising in a phase 1 trial, with most recipients developing neutralizing antibodies. Nevertheless, we don’t expect to have a vaccine ready any time soon. Hollywood star and darling of the tabloids, Lindsay Lohan, made headlines after becoming infected with the virus during a trip to French Polynesia. Lindsay gave advice to millions of her social media followers: “use bug spray, please.” And rightly so, pending the development of a CHIKV vaccine, the only effective means of prevention is to protect individuals against mosquito bites.


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