For health professionals: Chikungunya
For the latest recommendations on the use of chikungunya vaccine in travellers: Committee to Advise on Tropical Medicine and Travel chikungunya statements
On this page
- What health professionals need to know about chikungunya
- Clinical manifestations
- Diagnosis
- Treatment
- Prevention
- Vaccine
- Related links
What health professionals need to know about Chikungunya
Infected mosquitoes spread the chikungunya virus through their bites. The main transmitters are the Aedes aegypti and Aedes albopictus species. The same 2 species of mosquitoes also transmit dengue. Circulation of both viruses in a geographic region is possible, as is co-infection.
Chikungunya occurs in parts of:
- Asia
- Africa
- Mexico
- the Caribbean
- South America
- Central America
- the Pacific Islands
- the Southeastern U.S.
Clinical manifestations
Chikungunya virus infection has an abrupt onset. It is characterized by fever and severe arthralgia, which is seen in approximately 70% of cases. The fever rises quickly, often reaching 39°C to 40°C, and is accompanied by intermittent shaking chills.
The arthralgias are polyarticular, migratory and predominantly affect the small joints of the:
- feet
- wrists
- hands
- ankles
Cutaneous manifestations are typical with many patients presenting a flush over the face and trunk. This is usually followed by a maculopapular rash, involving most commonly the trunk and limbs. The face, palms and soles can also show lesions.
Other symptoms of chikungunya infection may include:
- nausea
- myalgia
- vomiting
- headaches
- photophobia
- conjunctivitis
- nasal discharge
- retrobulbar pain
- lymphadenopathy
Haemorrhagic manifestations (petechiae, purpura, bleeding gums, nosebleeds, haematemesis and melena) have been documented, but only in Asia.
The average case fatality rate is 0.4% (2.8% in children and 1.6% in elderly people).
Diagnosis
Monitor for symptoms. Confirm the presence of chikungunya virus or virus-specific antibodies in blood samples by using any or all of the following:
- enzyme-linked immunosorbent assays (ELISA)
- reverse transcriptase polymerase chain reaction (RT-PCR)
- real-time RT-PCR
- indirect immunofluorescence
- viral culture
- neutralization assays
Monitor for symptoms. Confirm the presence of chikungunya virus or virus-specific antibodies in blood samples by using any or all of the following:
- enzyme-linked immunosorbent assays (ELISA)
- reverse transcriptase polymerase chain reaction (RT-PCR)
- real-time RT-PCR
- indirect immunofluorescence
- viral culture
- neutralization assays
Differential diagnosis
Chikungunya shares several clinical manifestations and geographic distributions with other vector-borne diseases, such as dengue, Zika, and Oropouche virus infections. Co-infections with these viruses are possible, and should be considered in the diagnostic evaluation.
Treatment
There is no specific antiviral treatment for chikungunya virus infection.
Treatment for acute disease is supportive, and may include rest, fluids, and pain and fever management. Non-steroidal anti-inflammatory drugs (NSAIDS) and acetylsalicylic acid should be avoided until a diagnosis of dengue has been ruled out, due to the increased risk of bleeding.
Movement and mild exercise tend to improve joint stiffness.
Under experimental conditions, in a concentration-dependent manner in vitro, the chikungunya virus yield has been known to be reduced by:
- interferon-α2b
- glycyrrhizin
- 6-azauridine
- ribavirin
Moreover, there is evidence of a synergistic efficacy between interferon-α and ribavirin against chikungunya virus in vitro.
Prevention
Prevention against chikungunya virus can be achieved using the following methods:
- personal protection
- mosquito control
- vaccination
Personal protection can be achieved by reducing exposure to mosquitoes (for example, by using mosquito repellants).
Learn more:
Vaccine
Canada has authorized the use of the live-attenuated vaccine, IXCHIQ, for the prevention of disease caused by the chikungunya virus.
Learn more: