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Chikungunya: Making its way from the Caribbean to the United States and Canada

 

To the majority of North Americans, Chikungunya is a foreign concept – the word itself seems to speak of an untold terror.

 

Even though there has been a lack of proper news media coverage, it is important to be aware of Chikungunya, especially during this time of year when a trip to the Caribbean seems like the ideal thing to do. In Canada alone, there have already been 320 confirmed travel-related Chikungunya cases.

Chikungunya is a mosquito-borne virus that results in high fever and severe joint pain and is currently making its way around the Caribbean, up to Florida and Canada.

First described during an outbreak in Tanzania in 1952, the disease is named Chikungunya (pronounced “chik-en-gun-ye”) for a reason. The word finds its origin from the Kimakonde language of Mozambique and Tanzania and it means “those which bend up”, referring to the distorted posture of people affected with severe joint pain and arthritic-like symptoms associated with the disease.

The virus is transmitted to humans from female mosquitoes of the species A. albopictus and A. aegypti. After transmission, the disease takes about 2 to 12 days to incubate. Between 72 to 97 percent of those infected will develop symptoms. These include an abrupt onset of fever that typically lasts from a few up to ten days, with body temperatures rising above 39°C and reaching 41°C. This fever is commonly accompanied by severely strong joint pain or stiffness. This infamous affliction of the disease can last weeks to months and sometimes even years, leaving people debilitated and often unable to work. Other symptoms that can result from Chikungunya include rash, muscle pain, inflammation of the eyes, headache, fatigue, nausea and vomiting.

 

Prevalence and location

Chikungunya has had its outbreaks in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. But only a year ago, the disease reached the Western Hemisphere for the first time, starting with an outbreak on the Caribbean island of St. Martin. After it was first spotted on St. Martin, it quickly made its way across the other Caribbean islands. At the end of 2014, a year after the start of the outbreak, among 800,000 people had contracted Chikungunya in the Caribbean and surrounding nations. St. Martin, an island of just 33,000 people, alone had 4,240 suspected cases this year. It’s currently making its way to the United States, not only from travellers coming from the Caribbean, but also from recent mainland infections in Florida. This means that the mosquitoes in Florida are transmitting the virus and the people infected have “locally acquired” the virus. Finally, the media has drawn the public’s attention to Chikungunya.

Chikungunya has even reached Canada; by the end of 2014 there were 320 confirmed cases and 159 probable cases of this disease, related to Canadians travelling back home after a vacation in the Caribbean. The majority of cases were found in Ontario (165) and Quebec (114). The Public Health Agency of Canada states that this is the largest annual number of Chikungunya cases ever reported in Canada. Although a local transmission of Chikungunya in Canada seems unlikely, due to the fact that the mosquito season is short-lived, it is still possible that a traveller comes back infected during this season, when it could spread among Canadians.

 

Chikungunya vs. Dengue

Dengue, an infectious disease very similar to Chikungunya, has been one of the most prevalent epidemics in the Caribbean for years. These two infectious diseases are very similar in that they are both mosquito-borne diseases, transmitted by the same mosquito (the Aedes aegypti), and they have some symptoms in common, like fever and joint pains. Aside from the similarities, there are some main differences between the two diseases: dengue is associated with high bleeding risk, and pain behind the eyes, while this is not evident in patients with Chikungunya. Both dengue and Chikungunya display joint pain, although the joint pain and inflammation associated with Chikungunya are more intense and pronounced and can last longer. Dengue also has a shorter incubation period, usually ranging from 3 to 4 days, whereas Chikungunya will take around one week before signs become obvious.

Although the severe joint pain associated with Chikungunya can last much longer than the joint pain acquired with Dengue, Dengue is overall a more dangerous disease. It has a fatality rate of 1-5%, while death due to Chikungunya is very rare. A severe case of dengue, also known as Dengue Haemorrhagic Fever, is a potentially deadly complication and can have mortality rates as high as 20%. With the proper medical care, this can be decreased to 1%. Severe dengue is a leading cause of hospitalization and death among children in some Asian and Latin American countries.

The interesting observation to make here is that although Dengue is far more lethal than Chikungunya and has been around in the Caribbean for years, it has never affected the tourism flow to the islands, unlike what has happened this past year due to Chikungunya.

 

Media Coverage and its effects on tourism

Media outlets in Europe portraying a false image of Chikungunya as a deadly virus have had a negative impact on the tourism flow to the islands in the Caribbean. A Dutch newspaper’s headline included the words “Killer Mosquito”, along with several TV news channels, which shocked many Dutch travellers and resulted in dozens of Dutch tourists cancelling their trips to the Caribbean. Other European tourists that frequent the Caribbean have also been held back and cancelled their flights as a result of sudden and alarming media reports warning them about a dangerous virus sweeping the Caribbean.

According to experts, there is no reason to panic. It is especially important that the international media are well informed about the virus and its effects.Instead of the media focusing on reaching the headlines by scaring tourists off, they should attempt to describe the disease for what it really is and focus on more proactive efforts to combat Chikungunya.

 

Lack of funding for research

Although there is a possibility of discovering an adequate vaccine for Chikungunya, a lack of funding from pharmaceutical companies in the United States is holding this back. This seems to be the cause of a lack of proper media and public attention on this new disease, comparable to the lack of interest when Ebola had not yet reached the States, and was not yet on the front pages.

It is unfortunate, since Chikungunya, just like Ebola, is a disease that has been carefully watched and studied for years and for which scientists might have potential treatments. All the same, there is not enough incentive and funding for further research. A lack of interest in Chikungunya may also stem from the fact that it has a low fatality rate. Chikungunya might rarely lead to death, but it is still a real public health issue. The economic impact from disability that results from the disease is high. The severe joint pain caused by it can last from several months to years, leaving people debilitated and sometimes even unable to walk. Many people will thus be unable to work, as they spend their days in and out of bed.

 

Regrettably, developing countries, like those in the Caribbean and in Africa, have the highest prevalence of infectious diseases, and at the same time have inadequate health care systems for the prevention and cure of these diseases. The fate of the infected people in these countries often depends on whether this disease affects First World countries, like the United States or Europe. It isn’t until the disease reaches these countries and the interest rises, that the media will finally bring it to the attention of the public. This sudden increase in attention will finally bring forth with it the incentive for scientists, pharmaceutical companies and healthcare systems to work towards a cure.

Only after an affordable cure has been found, do the developing countries have a chance to recover from this disease.

Ultimately, it is essential that there be an increase in the media coverage on Chikungunya in the correct way, with accurate information being communicated to the public. Not only will this push for the possible discovery of an adequate treatment, it will also help in eliminating the virus faster by focusing on the measurements for prevention.

Addressing the risks of Chikungunya is crucial for the prevention of a further spread of the disease to the United States, Canada and other nearby countries, as well as for the treatment and elimination in the countries where Chikungunya is already prevalent. If just an increase in adequate media coverage on Chikungunya can help prevent this from happening, much like what was done with Ebola, there is no doubt of how important it is for journalists and media outlets to focus on this improvement.

 

Prevention

Since there are no specific treatments or vaccines available yet, the only prevention for someone living in or travelling to a Chikungunya-affected area is to guard against mosquitoes. Seems simple enough, right? So for those thinking of escaping the cold winter to visit a beautiful Caribbean island, go for it!

Don’t be held back by a disease that you can easily prevent by taking the right precautions:

  • Wear long sleeves/minimize skin exposure to the mosquitoes.
  • Wear repellent with a high percentage of the active ingredient DEET.
  • Avoid products that combine sunscreen with repellent.
  • Be especially mindful in the morning, these mosquitoes are mostly daytime biters

For people with arthritis, the elderly, and women who are late in their pregnancies it is recommended to discuss their travel plans with a doctor, since they can be at higher risk for more serious symptoms of Chikungunya.

But for anyone else who is planning a trip to the Caribbean though, by all means go and enjoy yourself. It’s all just about taking the right measures to avoid being bitten.

 

 

Fiorella Wever is a third year student studying Life Sciences at the University of Toronto.

 

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