For health professionals: Chikungunya

Get detailed information on chikungunya, its clinical assessment and treatment.

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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.

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 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).


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


There is no specific treatment or vaccine for chikungunya virus infection in humans. Patients are treated for their symptoms.

Treatments available are for symptoms only. They include antipyretic and anti-inflammatory drugs, such as diclofenac.

Avoid the use of steroids. Also avoid acetylsalicylic acid until a diagnosis of dengue can be ruled out to reduce the risk of hemorrhage.

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.

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