Mosquito-borne Illnesses in Travelers: A Review of Risk and Prevention

Edith Mirzaian, Pharm.D.; Melissa J. Durham, Pharm.D.; Karl Hess, Pharm.D.; Jeffery A. Goad, Pharm.D., M.P.H.

Disclosures

Pharmacotherapy. 2010;30(10):1031-1043. 

In This Article

Chikungunya Fever

Chikungunya fever is caused by a single-stranded RNA alphavirus (CHIKV) from the family Togaviridae. The vector and mode of transmission of chikungunya, as in dengue fever, is by a bite of an infected A. aegypti mosquito and less commonly by the A. albopictus.[27] The incubation period of chikungunya ranges from 2–12 days.[3] Many people infected with CHIKV will remain asymptomatic, and the disease is rarely fatal. The clinical presentation is very similar to that of dengue fever, the most common symptoms consisting of fever, arthralgia, backache, and headache. Other symptoms include rash, fatigue, nausea, vomiting, and myalgias. The joint symptoms of chikungunya are severe and often debilitating, lasting from weeks to up to a year, with the hands and feet most often affected, but the lower limbs and back can also be involved.[3] The name "chikungunya" translates to "that which bends up" in the Makonde dialect of Tanzania, describing the physical appearance of a patient with severe clinical features.[27]

Chikungunya is endemic to parts of Africa and Asia. Outbreaks occurred in these areas between 1960 and 1982.[28] Then in 2004, the disease reemerged in several countries including India, Indonesia, Maldives, Thailand, and various Indian Ocean islands including Comoros, Mauritius, Reunion, and Seychelles. More than 1.25 million cases of chikungunya fever have been reported in India, mainly in the Karnataka and Maharashtra provinces.[28,29] There is a significant risk of importation of CHIKV to nonendemic countries worldwide due to the high viremia of infected individuals and expansive distribution of both A. aegypti and A. albopictus.[28] Autochthonous transmission has also been documented in a limited area in Italy when an infected traveler transmitted the virus to local A. albopictus.[3] For travelers, risk is highest in endemic areas during the rainy season, when the density of the vector is highest.[3]

Currently, no specific treatment is available for chikungunya fever, although various antiviral agents are being investigated.[30] To limit further transmission of the virus, patients should be kept under mosquito netting while febrile. Treatment is mainly supportive and includes rest, fluids, and management of fever with acetaminophen. As in dengue fever, salicylates should be avoided in children because of the risk of Reye's syndrome, but NSAIDs may be used cautiously if acetaminophen is not sufficient since there is limited risk of hemorrhagic complications with chikungunya fever.[27] As with dengue fever, no vaccine exists for chikungunya fever; therefore, the best prevention is to avoid mosquito bites with proper insect precautions.[3]

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