rapa
01-26-2007, 02:43 PM
Chikungunya fever is a viral disease transmitted to humans by the bite of infected Aedes and Culex mosquitoes, including the daytime-biting Aedes aegypti and Ae. albopictus species. Symptoms can include sudden onset of fever, chills, headache, nausea, vomiting, joint pain with or without swelling, low back pain, and rash. The symptoms are very similar to those of dengue, but, unlike dengue, there is no hemorrhagic or shock syndrome form. This disease is almost always self-limited and rarely fatal.
Since April 2006, a chikungunya fever outbreak has been on-going in the following states in India: Andhra Pradesh, Andaman & Nicobar Islands, Tamil Nadu, Karnataka, Maharashtra, Gujarat, Madhya Pradesh, and Kerala. At this time, investigations are on-going for identification of chikungunya fever in other areas of India, as it is important to confirm the diagnosis of chikungunya fever and rule out other mosquito-borne diseases, such as dengue fever and malaria in India.
A chikungunya fever outbreak on the Indian Ocean islands of Mayotte , Mauritius, Réunion ( territory of France), and the Seychelles that began in March 2005 is waning. However, transmission can still occur, and travelers to all tropical and subtropical areas of the world are reminded to take precautions to avoid mosquito bites.
Prevention Measures
There are no preventive medications or FDA-approved vaccines for chikungunya fever, but travelers can take steps to reduce their risk of being bitten by infected mosquitoes.
Use insect repellent on exposed skin surfaces when outdoors, particularly during the day.
Repellents containing 30% to 50% DEET (N,N-diethyl-m-toluamide) are recommended. Lower concentrations of DEET offer shorter-term protection and require more frequent reapplication.
Repellents containing picaridin are available in the U.S. in formulations of up to 15% concentration, which require frequent reapplication. Repellents with higher concentrations of picaridin may be available in some regions outside the U.S. Wear long-sleeved shirts and long pants when outdoors.
Clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent for greater protection.
Where possible, stay in hotels or resorts that are well screened or air-conditioned and take measures to reduce the mosquito population.
Reduce Aedes breeding sites by emptying standing water that may have collected in containers (e.g., uncovered barrels, flower vases, or cisterns) and either overturning the vessels or covering the opening.
If illness develops, stay under a mosquito net or indoors to limit mosquito bites and to avoid further spread of infection. These preventive measures are the same steps that one would take to reduce the risk of other mosquito-transmitted infectious diseases, such as dengue, malaria, and yellow fever.
Treatment
No specific drug treatment against chikungunya fever is available; thus, treatment of chikungunya fever is supportive: bed rest, fluids, and mild pain medications such as ibuprofen, naproxen, acetaminophen, or paracetamol may relieve symptoms of fever and aching, provided that the person has no contraindications to these medications. Because aspirin can increase the risk of bleeding and possibly increase the risk for Reye's syndrome (http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm), it should be avoided during the acute stages of the illness. Few cases are severe enough to warrant hospitalization. All persons with chikungunya fever should be protected against additional mosquito bites to reduce the risk of further transmission of the virus.
For more information about chikungunya fever, see the Chikungunya Fever Fact Sheet (http://www.cdc.gov/ncidod/dvbid/Chikungunya/chickvfact.htm).
For more information on protection from mosquitoes, including repellents, see "Protection against Mosquitoes and Other Arthropods (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=recs&obj=bugs.htm)" in Health Information for International Travel.
Other Mosquito-related Diseases
This outbreak highlights the risk that travelers to tropical and subtropical areas of the world may encounter for contracting diseases transmitted through the bites of infected mosquitoes, such as dengue (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=dengue.htm), malaria (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=index.htm), Japanese encephalitis (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=jenceph.htm), yellow fever (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=yellowfever.htm), and others.
In addition to the mosquito bite prevention measures listed above, medications are available for prevention of malaria that can greatly reduce the risk of infection (http://www.cdc.gov/travel/malariadrugs.htm (http://www.cdc.gov/travel/malariadrugs.htm)). Vaccines are available to prevent yellow fever (http://www2.ncid.cdc.gov/travel/yellowfever/ (http://www2.ncid.cdc.gov/travel/yellowfever/)) and Japanese encephalitis.
Additional Information
Chikungunya Fever Diagnosed Among International Travelers — United States, 2005–2006 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5538a2.htm)
Chikungunya fever outbreaks in India: "Chikungunya in India" (WHO) (http://www.who.int/csr/don/2006_10_17/en/index.html) and "Chikungunya Fever, A Re-emerging Disease in Asia (http://www.searo.who.int/en/Section10/Section2246.htm)" (WHO South-East Asia Regional Office)
Chikungunya fever outbreaks on Indian Ocean Islands, "Chikungunya and Dengue in the South West Indian Ocean (http://www.who.int/csr/don/2006_03_17/en/index.html)" (WHO)
Diseases transmitted by bites from infected mosquitoes:
CDC - Division of Vector-Borne Infectious Diseases
· Dengue fever (http://www.cdc.gov/ncidod/dvbid/dengue/)
· Japanese encephalitis (http://www.cdc.gov/ncidod/dvbid/jencephalitis/)
· Yellow fever (http://www.cdc.gov/ncidod/dvbid/yellowfever/)
CDC - Malaria Branch
· Malaria (http://www.cdc.gov/malaria/)
Since April 2006, a chikungunya fever outbreak has been on-going in the following states in India: Andhra Pradesh, Andaman & Nicobar Islands, Tamil Nadu, Karnataka, Maharashtra, Gujarat, Madhya Pradesh, and Kerala. At this time, investigations are on-going for identification of chikungunya fever in other areas of India, as it is important to confirm the diagnosis of chikungunya fever and rule out other mosquito-borne diseases, such as dengue fever and malaria in India.
A chikungunya fever outbreak on the Indian Ocean islands of Mayotte , Mauritius, Réunion ( territory of France), and the Seychelles that began in March 2005 is waning. However, transmission can still occur, and travelers to all tropical and subtropical areas of the world are reminded to take precautions to avoid mosquito bites.
Prevention Measures
There are no preventive medications or FDA-approved vaccines for chikungunya fever, but travelers can take steps to reduce their risk of being bitten by infected mosquitoes.
Use insect repellent on exposed skin surfaces when outdoors, particularly during the day.
Repellents containing 30% to 50% DEET (N,N-diethyl-m-toluamide) are recommended. Lower concentrations of DEET offer shorter-term protection and require more frequent reapplication.
Repellents containing picaridin are available in the U.S. in formulations of up to 15% concentration, which require frequent reapplication. Repellents with higher concentrations of picaridin may be available in some regions outside the U.S. Wear long-sleeved shirts and long pants when outdoors.
Clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent for greater protection.
Where possible, stay in hotels or resorts that are well screened or air-conditioned and take measures to reduce the mosquito population.
Reduce Aedes breeding sites by emptying standing water that may have collected in containers (e.g., uncovered barrels, flower vases, or cisterns) and either overturning the vessels or covering the opening.
If illness develops, stay under a mosquito net or indoors to limit mosquito bites and to avoid further spread of infection. These preventive measures are the same steps that one would take to reduce the risk of other mosquito-transmitted infectious diseases, such as dengue, malaria, and yellow fever.
Treatment
No specific drug treatment against chikungunya fever is available; thus, treatment of chikungunya fever is supportive: bed rest, fluids, and mild pain medications such as ibuprofen, naproxen, acetaminophen, or paracetamol may relieve symptoms of fever and aching, provided that the person has no contraindications to these medications. Because aspirin can increase the risk of bleeding and possibly increase the risk for Reye's syndrome (http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm), it should be avoided during the acute stages of the illness. Few cases are severe enough to warrant hospitalization. All persons with chikungunya fever should be protected against additional mosquito bites to reduce the risk of further transmission of the virus.
For more information about chikungunya fever, see the Chikungunya Fever Fact Sheet (http://www.cdc.gov/ncidod/dvbid/Chikungunya/chickvfact.htm).
For more information on protection from mosquitoes, including repellents, see "Protection against Mosquitoes and Other Arthropods (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=recs&obj=bugs.htm)" in Health Information for International Travel.
Other Mosquito-related Diseases
This outbreak highlights the risk that travelers to tropical and subtropical areas of the world may encounter for contracting diseases transmitted through the bites of infected mosquitoes, such as dengue (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=dengue.htm), malaria (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=index.htm), Japanese encephalitis (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=jenceph.htm), yellow fever (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=yellowfever.htm), and others.
In addition to the mosquito bite prevention measures listed above, medications are available for prevention of malaria that can greatly reduce the risk of infection (http://www.cdc.gov/travel/malariadrugs.htm (http://www.cdc.gov/travel/malariadrugs.htm)). Vaccines are available to prevent yellow fever (http://www2.ncid.cdc.gov/travel/yellowfever/ (http://www2.ncid.cdc.gov/travel/yellowfever/)) and Japanese encephalitis.
Additional Information
Chikungunya Fever Diagnosed Among International Travelers — United States, 2005–2006 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5538a2.htm)
Chikungunya fever outbreaks in India: "Chikungunya in India" (WHO) (http://www.who.int/csr/don/2006_10_17/en/index.html) and "Chikungunya Fever, A Re-emerging Disease in Asia (http://www.searo.who.int/en/Section10/Section2246.htm)" (WHO South-East Asia Regional Office)
Chikungunya fever outbreaks on Indian Ocean Islands, "Chikungunya and Dengue in the South West Indian Ocean (http://www.who.int/csr/don/2006_03_17/en/index.html)" (WHO)
Diseases transmitted by bites from infected mosquitoes:
CDC - Division of Vector-Borne Infectious Diseases
· Dengue fever (http://www.cdc.gov/ncidod/dvbid/dengue/)
· Japanese encephalitis (http://www.cdc.gov/ncidod/dvbid/jencephalitis/)
· Yellow fever (http://www.cdc.gov/ncidod/dvbid/yellowfever/)
CDC - Malaria Branch
· Malaria (http://www.cdc.gov/malaria/)