Reappearance of Chikungunya, Formerly Called Dengue, in the Americas

Scott B. Halstead


Emerging Infectious Diseases. 2015;21(4):557-561. 

In This Article

Discovery of Chikungunya Pandemics

When Dr. Christie left Africa in 1876 to assume a post as a lecturer on public health at Anderson's College, Glasgow, he discovered reports in the medical literature of 3 pandemics of kidinga pepo. The epidemic of 1870–1880 had begun in Zanzibar and then spread to India and Southeast Asia. That epidemic had been preceded by one in 1823–1828 that originated in Africa and then spread to India, Southeast Asia, and the Americas, and that epidemic had been preceded by an even earlier one in 1779–1785 that was reported in Egypt, Africa, Arabia, India, and Southeast Asia.[5] Of interest to contemporary observers, in 1872, an epidemic of kidinga pepo affected most inhabitants of low-lying areas of Réunion Island, the site where the chikungunya pandemic of 2005–2006 was first recognized.[11] Dr. Christie suspected that the illness in all 3 pandemics was kidinga pepo because he had personally observed the 1870 epidemic spread from Zanzibar to the entire Indian subcontinent and progress on to Southeast Asia. Then, from a published report, he learned of an epidemic of kidinga pepo in Cairo in 1779. This report was followed by others that reported outbreaks in Arabia, India, and Southeast Asia. This epidemic reached Indonesia in 1779, where another astute physician, David Bylon, municipal surgeon for the city of Batavia (now Jakarta, Indonesia), acquired the disease. Dr. Bylon described the epidemic in a classic account, which has been widely cited as the initial clinical description of dengue fever:

"It was last May 25, in the afternoon at 5:00 when I noted while talking with two good friends of mine, a growing pain in my right hand, and the joints of the lower arm, which step by step proceeded upward to the shoulder and then continued onto all my limbs; so much so that at 9:00 that same evening I was already in my bed with a high fever.… It has now been three weeks since I… was stricken by the illness, and because of that had to stay home for 5 days; but even until today I have continuously pain and stiffness in the joints of both feet, with swelling of both ankles; so much so, that when I get up in the morning, or have sat up for a while and start to move again, I cannot do so very well and going up and down stairs is very painful." (, [12] as translated by K. DeHeer)

Carey, who rediscovered Christie's work, noted that chikungunya pandemics originating in eastern Africa had crossed the Indian Ocean at roughly 40- to 50-year intervals: the 1770s, 1824, 1871, 1902, 1923, and 1963–1964.[1] To those cycles we now can add 2005–2014. The last 2 trans–Indian Ocean pandemics occurred in the modern virologic era and have been documented by the isolation of virus. In 1963–1964, a chikungunya epidemic swept down the eastern coast of India from Calcutta to Sri Lanka.[13–15] It was this epidemic that resulted in the recognition of the pronounced clinical differences between syndromes caused by dengue viruses and chikungunya virus. During the 1964 epidemic in Vellore, in southern India, most of the 275 patients with virologically or serologically confirmed chikungunya were adults.[16] The patients had "sudden onset… of fever, headache and severe pains in the joints, these last being the dominant complaint. The pains mainly affected the small joints of the hands, wrist and feet, but frequently occurred in the knees as well".[16] After 1964, chikungunya virus gradually disappeared from India, with the last isolates recorded in 1972.[17,18] During 2005–2006, a chikungunya epidemic that originated in eastern Africa was observed on Réunion Island and then in Mauritius, Madagascar, Mayotte, and Seychelles;[19] the epidemic soon spread to India and Southeast Asia.[20,21] The Réunion Island outbreak was noteworthy because Ae. albopictus mosquitoes were efficient vectors that were aided by a genetic mutation in the virus.[22] This virus was subsequently introduced into Europe by tourists returning from visits to Réunion Island or India, resulting in modest outbreaks of autochthonous Ae. albopictus mosquitoborne chikungunya in southeastern France and northeastern Italy.[23–24]