Chikungunya Fever - Information for travellers 

Several outbreaks of Chikungunya fever on islands in the Indian Ocean have been reported since March 2005. As of 12 March 2006, 3237 cases have officially been notified via the physician sentinel network from the island of La Réunion. Other cases have been reported from Seychelles, Mauritius and Mayotte. An outbreak of chikungunya virus infection has also been reported in Andhra Pradesh and Marahashtra states in India, where there also appears to be co-circulation of dengue virus, which is transmitted by the same mosquito vectors.

Imported cases

Imported cases have been reported in European countries, mainly France, following return of travellers from these countries. Other countries reporting imported cases include Germany, Switzerland, Italy, Norway and the UK.

Chikungunya fever is caused by an RNA arbovirus which is heat-sensitive. All physicians should consider it in their differential diagnosis when they are taking care of travellers returning from the Indian Ocean and Indian sub-continent.

Mode of Transmission

It is transmitted from human to human by Aedes mosquitoes (aedes aegypti, albopictus, polynesiensis). Transmission among monkeys is via Aedes furcifer and africanus. (These vectors are not present in the Maltese islands – but human cases can be imported).

Signs and Symptoms

Main Clinical Symptoms

• Fever

• Arthralgia

• Myalgia

• Headache

Other symptoms

• Haemorrhagic symptoms: nose and gum bleed (leukopenia)

Complications

• Meningo-encephalitis

• Cardiovascular decompensation

• Respiratory failure

Epidemiology

It is endemic in parts of Africa (including Transvaal, Uganda, Congo, Nigeria, Ghana, Zimbabwe, Senegal, Burkina Faso, the Central African Republic, Cameroon, Guinea-Bissau), southeast Asia (including Philippines, Malaysia, Cambodia) and the Indian-sub-continent (including Pakistan and southern India).

Prevention

1. All medical staff should make sure that he/she applies universal precautions when handling blood samples as patients present with a high viraemia.
2. Advise should be given to travellers (especially pregnant women, immuno-suppressed and people suffering from a severe chronic illness) visiting the above mentioned countries to:

a)      use anti-mosquito devices (insecticide-treated bed nets, coils, smudge pots, spray, repellents) and wearing long sleeve – long leg clothes, especially during the hours of highest mosquito activity (morning and late afternoon). Mosquito repellents based on 30% DEET concentration is recommended.

b)     Before using repellents, pregnant women and children under the age of 12 years should consult a physician or pharmacist

c)      For newborn children under three months repellents are not recommended: instead, insecticide-treated bed nets should be used.

    3.     There are currently no restrictions on travel             to islands in the Indian Ocean.

For further information please refer to the following website:

a) The European Centre for Disease Prevention and Control:  

http://www.ecdc.eu.int/

b) Eurosurveillance weekly release:

http://www.eurosurveillance.org/ew/2006/060202.asp: Chikungunya outbreak in Réunion, a French ‘overseas département’

http://www.eurosurveillance.org/ew/2006/060126.asp: E-alert 27 January: Chikungunya outbreak in Réunion, a French ‘overseas département’