Clinical Updates
21 July 2006
Chikungunya virus - Update
La Réunion and other islands in the Indian Ocean
An outbreak of chikungunya virus (CHIKV) has been occurring on the island of Reunion since March 2005. Since the beginning of the outbreak 4,044 cases of CHIKV have been reported through sentinel surveillance and just over 266,000 people are estimated to have been infected [1].
The outbreak has been subsiding since the peak in February; only 2 cases were reported by the sentinel network of physicians during the week of 26 June to 2 July 2006, compared to more than 700 cases reported the week of 30 January to 5 February 2006 at the peak of the outbreak [1].
Since the beginning of January 2006 CHIKV infections were also reported on the islands of Madagascar, Maurice, Mayotte and the Seychelles [2]. All of these outbreaks are now in decline, having peaked during February and March 2006. In Mayotte, 7,090 suspected cases have been reported during 2006 and there were 30 suspected cases reported in the week between 26 June and 2 July 2006. Although this represents an overall decline in numbers, there was an increase in the number of cases reported in two districts, Sada and Chiconi [2].
India
Since December 2005 there have been reports of CHIKV infections in India and on 17 March 2006 the World Health Organisation confirmed cases of CHIKV infection in the states of Andhra Pradesh and Maharashtra [3]. Since then there have been numerous media reports of CHIKV outbreaks in Andhra Pradesh [4], Karnataka [5], Madhya Pradesh [6], Maharashtra [7] and Tamil Nadu [8] with cases also reported in Gujarat [9], Orissa [3] and Pondicherry [10]. Although official numbers are not known, unconfirmed reports have suggested that in Andhra Pradesh 60,000 cases have occurred since the outbreak began in December 2005 [11]. According to local media, as of 26 June 2006, over 286,000 cases have been reported in Karnataka [5] and as of 7 June 2006, a further 186,000 cases have been reported in Maharashtra [11]. The outbreak in Maharashtra is thought to be in decline with around 300 cases reported per day compared to 2000 per day in March and April [7]. The Health Ministers of Karnataka, Andhra Pradesh, Tamil Nadu and Maharashtra are due to meet in Bangalore next month to discuss CHIKV control strategies [12].
Advice for travellers
Information about CHIKV infection can be found in the NaTHNaC clinical update of 7 February 2006 [13]. 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 the vector mosquitoes are active.
References
1. Institute de Veille Sanitaire, Chikungunya à la Réunion, Point epidemiologique hebdomadaire pour le semain 27, 13 July 2006. Accessed 20 July 2006, available at:
http://www.invs.sante.fr/presse/2006/le_point_sur/chikungunya_
reunion_130706/chikungunya_reunion_s27.pdf
2. Institute de Veille Sanitaire, Epidemie de Chikungunya à la Réunion / Océan Indien, Point de situation au 13 Juillet 2006, 13 July 2006. Accessed 20 July 2006, available at:
http://www.invs.sante.fr/display/?doc=presse/2006/le_point_sur/
3. World Health Organization, Chikungunya and dengue in the south west Indian Ocean, 17 March 2006. Accessed 20 July 2006, available on line at:
http://www.who.int/csr/don/2006_03_17/en/index.html
4. ProMED-mail, Chikungunya - Indian ocean update (16) - Islands, India, [2] India (Andhra Pradesh), 15 April 2006. Accessed 20 July 2006, available on line at: http://www.promedmail.org/pls/promed/f?p=2400:1001:1566721
9909218073733::NO::F2400_P1001_BACK_PAGE,F2400_P100
5. ProMED-mail, Chikungunya - India (03), [5] Karnataka State, 11 July 2006. Accessed 20 July 2006, available on line at:
http://www.promedmail.org/pls/promed/f?p=2400:1001:1698829
9058080095968::NO::F2400_P1001_BACK_PAGE,F2400_P100
6. ProMED-mail, Chikungunya - India (03), [1] Madhya Pradesh State, 11 July 2006. Accessed 20 July 2006, available on line at:
http://www.promedmail.org/pls/promed/f?p=2400:1001:1698829
9058080095968::NO::F2400_P1001_BACK_PAGE,F2400_P100
7. ProMED-mail, Chikungunya - India (03), [4] Maharashtra State, 11 July 2006. Accessed 20 July 2006, available on line at:
http://www.promedmail.org/pls/promed/f?p=2400:1001:1698829
9058080095968::NO::F2400_P1001_BACK_PAGE,F2400_P100
8. ProMED-mail, Chikungunya - India (02), [1] Tamil Nadu State, 5 July 2006. Accessed 20 July 2006, available on line at:
http://www.promedmail.org/pls/promed/f?p=2400:1001:4372176
528729024184::NO::F2400_P1001_BACK_PAGE,F2400_P1001
9. ProMED-mail, Chikungunya - India (03), [6] Gujarat State, 11 July 2006. Accessed 20 July 2006, available on line at:
http://www.promedmail.org/pls/promed/f?p=2400:1001:1698829
9058080095968::NO::F2400_P1001_BACK_PAGE,F2400_P100
10. ProMED-mail, Chikungunya - Indian Ocean update (26): India, [1] Pondicherry State, 17 June 2006. Accessed 20 July 2006, available on line at:
http://www.promedmail.org/pls/promed/f?p=2400:1001:1698829
9058080095968::NO::F2400_P1001_BACK_PAGE,F2400_P100
11. The Hindu, Chikungunya cases down: central team, 27 June 2006. Accessed 20 July 2006, available on line at:
http://www.hinduonnet.com/thehindu/thscrip/print.pl?file=200606
2710650400.htm&date=2006/06/27/&prd=th&
12. The Hindu, Chikungunya: Health Ministers to meet, 19 July 2006. Accessed 20 July 2006, available on line at:
http://www.hindu.com/2006/07/19/stories/2006071911230100.h
13. NaTHNaC. Chikungunya virus - Réunion, Mauritius and Seychelles. 7 February 2006. Accessed 20 July 2006, available at: http://www.NaTHNaC.org/pro/clinical_updates/chik_070206.htm
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