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Chikungunya investigated in Tennessee
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The Tennessee Department of Health said it is investigating possible cases of chikungunya virus infection in the state after several travelers returned from the Caribbean and now have symptoms of the disease, according to a press release.
“This is often a terribly painful and uncomfortable illness, with no vaccine to prevent it and no specific treatment for those infected,” John Dreyzehner, MD, MPH, commissioner of the Tennessee Department of Health, said in the release. “Recovery can be prolonged, so prevention is the only good option. Outbreaks have occurred in Africa, Asia, Europe and the Indian and Pacific Ocean areas, and late last year the virus was found to have spread to the Caribbean. It is, unfortunately, probably just a matter of time before we have confirmed cases here.”
According to the CDC, there have been more than 100,000 suspected cases of chikungunya in the Caribbean and Americas since the disease was first detected on the French side of the island of Saint Martin in December. As of June 6, 4,406 cases have been confirmed by the Pan American Health Organization. Local transmission has been detected in 17 countries and territories in the Western Hemisphere.
Although the suspected Tennessee cases are believed to be imported, a primary vector of the disease — Aedes albopictus mosquitoes — are found in abundance in the state, increasing the risk for transmission.
“It is imperative individuals experiencing symptoms of chikungunya virus minimize their exposure to mosquitos to reduce risk of local transmission,” said Abelardo Moncayo, PhD, director of the Tennessee Department of Health’s vector-borne diseases program. “A mosquito can pick up the virus from an infected human and infect others.”
Symptoms include fever, joint and muscle pain, rash, and joint swelling.
The Tennessee Department of Health is urging health care providers to contact their local or regional health departments with suspected cases and coordinate with state health officials to determine whether the infection was imported or indigenous.
It also is advising travelers and residents to increase prevention efforts, which include:
- Awareness that Aedes mosquitos feed during the day, as well as at dusk and dawn;
- Use of insect repellents;
- Wear permethrin-treated clothing to repel mosquitos;
- Refrain from using any perfumes, colognes or scented deodorants that may attract mosquitos;
- Wear loose-fitting, long-sleeved shirts and long pants, and for improved effectiveness, tuck pants into socks and shirts into pants to keep out insects;
- Remove any standing water around the house that can serve as a breeding ground for vectors;
- Keep wading pools empty when not in use and replace bird baths on a weekly basis; and
- Keep windows and doors closed or covered with screens.
Perspective
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Donald Kaye, MD
Clinicians in the US have been seeing occasional imported cases of chikungunya virus infection for years, mainly from Asian and African countries. The recent large outbreak in the Caribbean has resulted in an increase in imported cases and we can expect much more.
For example, as of May 29, the Florida department of health had reported 10 imported chikungunya cases in 2014. All individuals had a travel history to a chikungunya-endemic country or area in the Caribbean experiencing an outbreak in the 2 weeks prior to onset (Dominica, Dominican Republic, Haiti and Martinique).
We can expect autochthonous cases in the US in the future as we have the vector Aedes mosquitos here.
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