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Traveler Summary

Key Points

  • Chikungunya is a viral infection acquired through the bite of day-biting mosquitoes, primarily in tropical Africa, Asia, Central and South America, and the Caribbean.
  • Risk is high for travelers going to affected countries, especially in urban areas with poor sanitation and mosquito breeding sites near human habitation.
  • Symptom onset is sudden, primarily with fever and severe joint pain; headache, muscle aches, weakness, and rash may occur.
  • Consequences of infection include chronic, recurrent joint pain in 20% of people; rarely, inflammation of the brain, heart, or liver occurs.
  • Prevention includes wearing long sleeves and long pants, as well as observing personal protective measures against mosquito bites.
  • No vaccine or preventive drugs are currently available.

Introduction

Chikungunya is a viral infection transmitted by the bite of day-biting mosquitoes in tropical countries, resulting primarily in sudden fever and severe joint pain. Chikungunya is sometimes confused with dengue or Zika, which also causes fever, rash, and muscle and joint pain.

Risk Areas

Chikungunya is historically common in tropical Africa, the Indian Ocean area, Asia, Central and South America, and the Caribbean. A widespread epidemic in the Caribbean Islands and contiguous Central and South America (between 2013 and 2016) resulted in over 2 million cases from more than 40 countries and territories, including hundreds of cases imported into North America and Europe.

Transmission

Chikungunya virus is predominantly transmitted through the bite of day-biting mosquitoes (Aedes aegypti and Aedes albopictus). Aedes mosquitoes usually bite during the day, with 2 peaks of biting activity: the first 2 to 3 hours after dawn and the mid-to-late afternoon hours. However, when indoors or during overcast days, the mosquitoes bite all day.

Risk Factors

Chikungunya is relatively common in travelers going to endemic areas, especially for those residing in urban areas where sanitation is poor, where Aedes mosquito breeding sites (such as discarded tires, flowerpots, and blocked rain gutters) are numerous, or in unscreened buildings.

Symptoms

Symptoms commonly develop about 3 to 7 days (range: 1-12 days) following an infective bite and include sudden onset of fever and severe joint pain. The fever may decline for 1 to 2 days then reoccur. Peripheral joints (hands, wrists, ankles, knees, spine, shoulders, feet, and elbows) are most affected with pain. Other symptoms include headache, muscle aches, weakness, chills, and gastrointestinal symptoms. Approximately half of infected persons develop a rash on the trunk and limbs. Most people recover from the acute illness within 7 to 10 days, but symptoms may persist for weeks to months.

Consequences of Infection

After a year, more than 20% of patients still suffer recurrent joint pain. Serious illness rarely occurs, but complications can include inflammation of the brain, heart, or liver; kidney damage; and bleeding. The death rate is low for most individuals, but is increased in persons older than 65 years or with underlying disease.

Need for Medical Assistance

Travelers do not usually require medical assistance because most chikungunya infections resolve spontaneously over a few days; serious complications are very rare. Taking paracetamol (acetaminophen) may help relieve symptoms. Because febrile illness in the tropics can be due to other serious diseases such as malaria, dengue, or Zika virus infection, travelers with persistent fever should see a health care professional when possible.

Prevention Strategies

Nonvaccine

Wear long sleeves and long pants and observe daytime personal protective measures against mosquito bites. See Insect Precautions. Additionally, containers with stagnant water can serve as mosquito breeding sites and should be removed from the proximity of human habitation whenever possible.