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Don’t Worry about Ebola, Worry About Chikungunya

Saturday, August 2, 2014 // Uncategorized

There is a lot in the news about the outbreak of Ebola in West Africa and concern that treating infected healthcare workers in the US might cause it to spread here.  That’s not going to happen, but there is another African virus that has spread to the Caribbean and has now been reported being transmitted in Florida.  This is Chikungunya.  It’s like a replay of West Nile Virus, though this infection tends to be less severe.  It can become widespread since it can be spread by mosquitoes which are present in the U.S.

Chikungunya Spreads Through the Caribbean Stephen G. Baum, MD reviewing Fischer M and Staples JE. MMWR Morb Mortal Wkly Rep 2014 Jun 6. Stephen G. Baum, MD Local transmission of chikungunya virus has now been identified in 17 countries or territories in the Caribbean and South America. Stephen G. Baum, MDChikungunya virus — an alphavirus — and the illness it causes have long been recognized in countries in Africa, Asia, Europe, and the Indian and Pacific oceans. Before December 2013, when locally spread infection was reported from Saint Martin, cases in the Western Hemisphere all involved travelers returning from endemic regions. Since that time, local transmission is known to have occurred in 17 countries or territories in the Caribbean and South America. As of May 30, 2014, 103,018 suspected and 4406 laboratory-confirmed cases have been reported from that area — more than 95% of them in the Dominican Republic, Martinique, Guadeloupe, Haiti, and Saint Martin.Infection is spread mainly by Aedes aegypti and Aedes albopictus mosquitoes, both of which transmit dengue virus as well. These vectors are prevalent in the Caribbean but also exist in the continental U.S. (NEJM JW Infect Dis Apr 10 2014). Humans are the primary amplifying host. Most infected individuals develop symptomatic disease typified by acute onset of fever and symmetrical polyarthralgia; joint pain may be debilitating and long-lasting. There is neither a vaccine nor a specific therapy. – See more at: http://www.jwatch.org/na34937/2014/06/11/chikungunya-spreads-through-caribbean#sthash.pw1VhwYr.dpuf

2 in Florida Said to Catch Fever Found in Tropics

By JULY 17, 2014 New York Times

Doctors have been warning that Chikungunya fever, a tropical disease that causes severe joint pain, would soon reach the continental United States. Now it has done so, federal and state officials said Thursday.

The first domestically acquired cases were found in two Florida residents, one from the Miami area and one from Palm Beach, according to the state’s Health Department. Neither had traveled to countries where the mosquito-borne disease is endemic. One case has been confirmed by the Centers for Disease Control and Prevention; the second has not.

While seldom fatal, the Chikungunya virus (pronounced CHIK-en-goon-ya) causes high fever and sometimes a rash in addition to joint pain. Its name, from the Makonde language of East Africa, refers to people walking “bent up” with pain. In about 20 percent of patients, the pain can last a year or more.

The disease has been widespread in the tropics for centuries, but until 50 years ago it was confused with dengue fever, which kills far more people.

Dengue has been transmitted inside Texas along the Mexican border a few times since 1980. In 2009, it temporarily established itself in Key West, Fla., setting off a large mosquito-control effort.

Last year, Chikungunya cases were found for the first time on a Caribbean island, St. Martin. The virus quickly established itself in Puerto Rico. Until Thursday, all the 232 cases detected in the continental United States were in people who had returned from endemic areas.

On Wednesday, two researchers at the National Institutes of Health published an article titled “Chikungunya at the Door — Déjà Vu All Over Again?” in The New England Journal of Medicine predicting that local transmission was imminent. The first case was confirmed by the C.D.C. about 24 hours later.

Dr. Anthony S. Fauci, one of the authors, called it an “amazing coincidence.”

 

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