Chikungunya

Mosquito-borne virus could become public health nuisance for Florida

 

A mosquito-borne virus rapidly spreading in the Caribbean may become a public health issue for Florida, experts warn.

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While chikungunya is rarely fatal some people can suffer chronic, arthritis-like symptoms for years.

After getting bitten by an infected mosquito, symptoms can last for two to three days. The virus remains in the human system for five to seven days, and mosquitoes biting an infected person during this period can also become infected, helping to spread the virus.

Among the symptoms that appear between four and seven days after someone has been bitten by an infected mosquito:

High fever (40°C/ 104°F)

Joint pain (lower back, ankle, knees, wrists or phalanges)

Joint swelling

Rash

Headache

Muscle pain

Nausea

Fatigue


jcharles@MiamiHerald.com

Emilio Jean-Paul could barely take it as he listened to his 3-year-old’s heart-wrenching cries in the middle of the night.

Papi, Papi, my feet hurt; my hands hurt,” little Emmanuel called out as his tiny body burned up with fever.

Jean-Paul, who lives in the southern Haiti town of Léogâne , was all too familiar with his son’s symptoms. They are the common signs of chikungunya (pronounced chik-en-gun-ye), the painful mosquito-borne virus infection that has been spreading rapidly across Haiti and the rest of the Caribbean since its arrival in the hemisphere in December.

“Chikungunya is everywhere and everyone in the country is crying ‘fever, fever’ ” said Jean-Paul, who works with soccer nonprofit GOALS Haiti, of which several employees and at least one recent visitor from the United States have been infected. “Almost everyone has it. This thing is serious all across Haiti.”

And it soon could become serious in Florida, according to health experts.

A viral disease spread by the same mosquitoes that carry dengue, chikungunya (CHIKV) rarely is fatal. But it has been linked to at least 14 deaths in the Caribbean, most likely individuals with prior health issues.

Since its first detection in the French island of Saint Martin, it has spread to about one new country a week, with the U.S. territory of Puerto Rico and English-speaking Guyana last week becoming the latest to confirm cases. Guyana is now the second country after French Guiana on mainland South America to confirm chikungunya.

In all, there have been 4,406 confirmed cases and 103,018 suspected cases in 17 countries including Puerto Rico. The Dominican Republic recently reported it has 38,639 suspected cases, said Dr. Pilar Ramon-Pardo, a clinical management specialist with the the Pan-American Health Organization.

Ramon-Pardo said imported cases also have been confirmed in Panama, while the Atlanta-based Centers for Disease Control and Prevention announced that Florida reported 10 cases through the CDC’s national arboviral surveillance system — coming from travelers returning from the Caribbean territories of Dominica, Dominican Republic, Haiti, Martinique, Saint Martin and Sint Maarten, and Indonesia in Southeast Asia.

So far, no case has been reported of people catching the disease in Florida.

“There’s a high likelihood, as we continue to monitor and investigate, that we will find some,” said Roger Nasci, a CDC expert on vector-borne diseases.

Nasci said international public-health authorities in the Western Hemisphere are not surprised by the outbreak because they have been keeping a careful eye on chikungunya for a decade.

However, concerns were heightened in 2004 and 2005 when it began to spread from its traditional African stronghold. It migrated from Kenya and Uganda to islands in the Indian Ocean and then India. The disease soon spread to other Asian countries.

It was an outbreak in northern Italy in 2007— it began with a traveler from India — that prompted authorities to view chikungunya as truly a global threat.

“That was the first outbreak in a northern, temperate climate,” Nasci said. “That was the shot over the bow, the warning that the disease could flourish outside tropical areas. The global public-health community began paying careful attention. … We knew this was eventually going to happen.”

In the wake of the Italian outbreak, PAHO, CDC and other agencies have been warning public health authorities in the Western Hemisphere to be on the lookout for chikungunya, instructing them on the disease’s origins and symptoms and its proper treatment.

In turn, Caribbean nations have increased spraying for mosquitoes and have urged people to remove standing water where the insects breed.

If there is a bright side to chikungunya fever, it is that people only seem to get it once.

In Haiti, physicians and others have questioned whether the disease triggers other illnesses.

“I’ve seen lots of weird manifestations of it in people who are already sick,” said Dr. Vincent DeGennaro Jr., the director of internal medicine at Project Medishare’s Bernard Mevs hospital in Port-au-Prince. “Not quite sure what to make of it.”

For instance, there is the patient with a leg infection that before chikungunya only required oral antibiotics but afterward had to be hospitalized and given Intravenous therapy. There also are those with unexplainable fevers that are neither chikungunya nor dengue.

Dr. Marc Fischer, a CDC epidemiologist, said chikungunya virus infections can cause rare, severe or atypical clinical ailments, such as cardiovascular, neurologic or renal disorders.

“These severe or atypical manifestations have been described in a small proportion of all cases, probably less than 1 percent, and are more likely to occur in the elderly or people with underlying medical conditions,” Fischer said. “Some of these atypical findings may be due to worsening of preexisting medical conditions, or coincidental and not causally related to the chikungunya virus infections.”

Medications that are used to manage the fever and joint pains also may cause side effects, and should only be used as prescribed or according to the label to reduce the risk of any complications, he said.

The disease is leaving a socio-economic impact as schools close temporarily because so many students and teachers call in sick; construction projects slow down because workers are a no-show, and hospitals report difficulty in delivering patient care because too many nurses are out sick or patients in need of urgent medical care reschedule procedures.

“Probably between 15 and 25 percent of my staff has had it,” said DeGennaro, who also is an epidemiologist but has had no experience with chikungunya before now. “It puts most people down for three days and then they come back to work, and then they are miserable for the next week while at work.”

On Saturday, the hospital, which specializes in trauma care, was forced to stop admitting new patients because too many staff members were out sick with chikungunya, DeGennaro said.

Unlike cholera, the water-borne disease that triggered pandemonium after it was introduced in Haiti in 2010, chikungunya has been received differently by Haitians who say “It’s not a question of if, but when you will get the fever.”

“I expect to get it at any point,” said DeGennaro, whose roommate has had it as well as three of the eight people in his office. “It’s unbelievable how it’s spreading. It’s being spread by mosquitoes but it’s spreading as if it were a cold. But it’s even worse than that. You can’t just wash your hands and avoid chikungunya.”

And as the busy summer travel and hurricane season begin, many fear infections may get much worse. Rainfall typically expands the breeding of mosquitoes and increases the population.

“The outbreak is going to accelerate once it starts to rain,” said Scott Weaver, a world expert on the virus and the director of the University of Texas Medical Branch’s (UTMB) Institute for Human Infections and Immunity.

Weaver recently spent four days in the Dominican Republic, which shares the island of Hispaniola with Haiti, to see how the virus was spreading and evaluate the mosquito population. He also wanted to see whether it was being spread by both species of mosquitoes — the Aedes aegypti and Aedes albopictus — that are present on the island as well as in the southern and eastern United States.

Weaver said he believes the culprit is the dreaded Aedes aegypti mosquito, which also transmits dengue and yellow fever, that is behind the spread.

During his visit, Weaver said he saw a number of patients who were diagnosed with the virus, but whom he believes did not have it. Dominican doctors, he said, are operating in the dark because of their inability to test for chikungunya locally. The same is true in neighboring Haiti where the CDC is helping the Haitian staff at the National Laboratory develop the ability to test locally, said Barbara Marston with the CDC’s Divison of Global Health Protection.

While the ability to confirm cases locally won’t necessarily help those who have the virus, it will help epidemiologists control the spread and survey the pattern of the disease, said Weaver, who is currently working on a vaccination that has still not yet undergone human trials.

It is also important for patients and physicians to distinguish between chikungunya and dengue because they require different treatments. For instance, while it is recommended that those with chikungunya fever take up to two 500mg of the over-the-counter painkiller paracetamol four times daily, aspirin, for instance, is not recommended for dengue sufferers because of bleeding complications.

Weaver said it’s very likely that the disease will soon reach the southern United States as dengue has.

“People flying in and out of places like the Dominican Republic and landing and getting bitten by mosquitoes will start the cycle off,” he said. “It’s a disease you don’t want to get. It is very painful, debilitating. The pain and swelling in joints can last for years. It’s a bad disease. It makes you very sick.”

Herald Staff Writer Glenn Garvin contributed to this report.

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