Clinical Updates
12 June 2009
Chikungunya virus activity – Global update
Chikungunya virus (CHIKV) is endemic to large parts of Africa, the Middle East, India and South East Asia.
This update reports on current and recent CHIKV outbreaks; it is not a comprehensive listing of all outbreaks. Further information on confirmed and suspected outbreaks can be accessed via the NaTHNaC Outbreak Surveillance Database.
India
As of 30 April 2009, 2,717 suspected cases of CHIKV have been reported from seven states in India. The state of Karnataka reported 70% of the cases and Andhra Pradesh reported 20%. The remaining cases were reported from Goa, Kerala, Maharashtra, Tamil Nadu and West Bengal [1].
Indonesia
Unverified media sources have reported outbreaks of CHIKV in Indonesia in 2009. Infected areas include Central Java, East Java, Riau and South Sumatra. Details of these unverified outbreaks can be found on the NaTHNaC Outbreak Surveillance Database.
Madagascar
Since March 2009, confirmed cases of CHIKV have been reported in Toamasina, Madagascar. In May 2009, one case was reported in a French traveller who had recently returned from Madagascar [2].
Malaysia
Between 1 January and 30 May 2009, 2,504 cases were reported, with the most cases (684) in the state of Kedah, followed by Selangor (363), Kelantan (343) and Perak (308). Three cases have been reported in the state of Sabah, in Malaysian Borneo [3].
In February 2009, two cases in travellers to Malaysia were reported. One case was in a Malaysian national, living in Japan, who had travelled between 19 December and 3 January 2009 [4], and a second case in an expatriate US citizen living in Malaysia [5].
Singapore
As of 6 June 2009, 278 cases of CHIKV have been reported, of which 250 were locally transmitted. The majority of cases occurred in the first five weeks of 2009. Between 31 May and 6 June 2009, one imported and two local cases were reported [6].
Thailand
Between 1 January and 2 June 2009, 24,029 cases of CHIKV were reported. The province of Songkhla reported the most cases (8,727). In Phuket, there were 534 cases, of which 528 occurred in May 2009 [7]. In May 2009, a confirmed case was reported in a Belgian traveller who had been in Phuket from 2 to 13 April 2009 [8].
Advice for travellers
CHIKV is a mosquito transmitted viral infection endemic to large parts of Africa, the Middle East, India and South East Asia.
Initial symptoms include sudden onset of severe arthralgias and myalgias, accompanied by fever, headache and conjunctivitis. Joint involvement is usually symmetrical, affects the extremities and can result in swelling, pain, redness and limitation of movement.
A maculopapular rash involving primarily the trunk can occur concurrently with resolution of fever. Illness usually resolves over three to five days. Most patients recover fully over a period of a few weeks, although 5 to 10% of patients will experience persistent joint pain, stiffness and swelling.
There is no vaccine available to protect against CHIKV. Travellers to affected areas are advised to take insect bite precautions, particularly during daylight hours when Aedes mosquitoes are active.
Health professionals in the UK should consider the diagnosis of CHIKV infection in returned travellers with a compatible illness and travel history.
References
1. Government of India. National Vector Borne Disease Control Programme. Status report on dengue and chikungunya, 30 April 2009. [Accessed 11 June 2009]. Available at: http://nvbdcp.gov.in/Doc/dengue-chikun-report-30.04.09.pdf
2. ProMED-Mail. Chikungunya (21): Madagascar, Southeast Asia, 11 June 2009. [Accessed 12 April 2009]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193
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3. Director General of Health, Malaysia. Dengue and chikungunya in Malaysia for epidemiological week 21 (24 to 30 May 2009.). [Accessed 12 June 2009]. Available at: http://moh.gov.my/MohPortal/newsFull.jsp?action=load&id=432
4. ProMED-Mail. Chikungunya: Japan ex Malaysia, 4 February 2009. [Accessed 11 June 2009]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193
9::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_I
5. ProMED-Mail. Chikungunya: Malaysia, 5 February 2009. [Accessed 11 June 2009]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193
9::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_I
6. Ministry of Health, Singapore. Weekly Infectious Disease Bulletin. Epidemiological week 32, 31 May – 6 June 2009. [Accessed 11 June 2009]. Available at: http://www.moh.gov.sg/mohcorp/uploadedFiles/Statistics/Infecti
ous_Diseases_Bulletin/2009/2009_week_22.pdf
7. Ministry of Public Health, Thailand. Situation of chikungunya, 2 June 2009. [Accessed 11 June 2009]. Available at: http://203.157.15.4/wesr/file/y52/F52225.pdf
8. ProMED-Mail. Chikungunya (19): Belgium ex Thailand, India (Karnataka), 4 June 2009. [Accessed 11 June 2009]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193
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