For health professionals: Chikungunya
Get detailed information on chikungunya, its clinical assessment and treatment.
Reports of hospitalization for cardiac or neurologic events following vaccination with IXCHIQ in persons 65 years of age or older are being investigated in the United States by the Centers for Disease Control and Prevention. Health Canada is monitoring the safety of IXCHIQ and will take appropriate action if new safety information that may affect the benefit-risk profile of IXCHIQ is identified.
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.
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).
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
Treatment
There is no specific treatment 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.
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
The live-attenuated vaccine, IXCHIQ, is authorized for use in Canada for the prevention of disease caused by the chikungunya virus. Recommendations for this vaccine are being developed by the Committee to Advise on Tropical Medicine and Travel (CATMAT).
Factors that health care providers should discuss with their patients to support shared decision making about the IXCHIQ vaccine include:
- chikungunya activity levels at a location, such as an outbreak known to be occurring
- activities that the traveller will be engaged in at their destination
- patient-specific health risk factors that might increase the impact of chikungunya, such as medical history, older age and very young age
- traveller willingness to use measures to prevent mosquito bites
Health care providers should also discuss with their patients the benefits and risks of vaccination based on the individual's risk factors for receiving a vaccine, including underlying medical history and age.
Learn more:
Page details
- Date modified: