Clusters of autochthonous chikungunya cases in Europe – Travel advice – September 2017
According to World Health Organization (WHO) and European Center for Disease Control (ECDC) there is an ongoing outbreak of chikungunya virus (CHIKV) in Europe. As of 14 September, two clusters of autochthonous transmission of chikungunya virus have been reported in the cities of Anzio and Rome, in the Lazio region of Italy, where Aedes albopictus mosquitoes are established. These two areas are located 60 km apart. This is the second outbreak as a result of introduction of chikungunya virus local transmission in Italy; the first outbreak was in the Emilia-Romagna region in 2007.
Autochthonous transmission of chikungunya virus was also detected in France in 2010, 2014 and 2017. As of 13 September 2017, seven confirmed cases and two probable cases of CHIKV have been reported in Le Cannet-les-Maures, Var department, France. Chikungunya has been identified in more than 60 countries in Asia, Africa, Europe and the Americas. The disease mostly occurs in Africa, Asia and the Indian subcontinent. However a major outbreak in 2015 affected several countries of the region of the Americas.
Chikungunya virus (the name “chikungunya” derives from a word in the Kimakonde language, which means “to become contorted”, describing the stooped appearance of patients with joint pain) is transmitted from human to human by an infected female mosquito bite (mainly Aedes aegypti and Aedes albopictus).
The onset of illness after the bite of an infected mosquito occurs usually between 4 and 8 days but it may range from 2 to 12 days. Chikungunya is characterized by a fever of sudden onset often accompanied by joint pain. Other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash. The joint pain is often very severe and may last for a few days or may be prolonged to weeks. Therefore, the virus can cause acute, sub-acute or chronic disease. There is usually a full recovery; however, in some cases joint pain may persist for many months, or even years. Rare complications include eye, neurological and heart complications, as well as gastrointestinal complaints. Serious complications are rare but they may occur in older people.
Treatment is symptomatic, including anti-pyretics, analgesics and fluids. There is no commercial chikungunya vaccine.
Advice for travelers
Basic precautions for mosquito bite prevention should be taken by travelers to areas where chikungunya cases have been reported.
- Wearing long sleeves and pants which minimize skin exposure to the day-biting vectors.
- Using repellents which can be applied to exposed skin or to clothing in strict accordance with product label instructions.
- Using mosquito coils or other insecticide vaporizers in order to reduce indoor biting.
- Sleeping under a mosquito bed net and using air conditioning or window screens to prevent mosquito bites.
After the trip
Travelers returning from areas where chikungunya transmission occurs should be advised:
- To monitor their health for two weeks after return.
- Τo seek medical attention if they develop symptoms consistent with chikungunya virus disease in the first two weeks after return.
- To take mosquito bite protective measures for the first 14 days if they are suspected or confirmed to have chikungunya virus infection.