Chikungunya Disease

Chikungunya disease is an acute febrile illness accompanied by arthralgia and rash. Other symptoms may include headache, muscle pain, or joint swelling. After an acute phase of febrile illness, some (40 to 80% of patients) can develop a chronic polyarthritis that may persist for months or years and can be severe and disabling. The arthralgia is typically symmetrical and has a preference for distal joints. Death is extremely rare.

Chikungunya disease is suspected in patients with sudden onset of fever and arthralgias who live in or have traveled to endemic areas.

Chikungunya virus RNA can be detected using RT-PCR, with testing recommended within the first 8 days of infection (1). Serologic testing for virus-specific IgM can be done for patients presenting more than 7 days following onset of symptoms, although antibodies may cross-react with other alphaviruses and with flaviviruses (eg, dengue virus), leading to a false-positive result.

Dengue and Zika viruses are transmitted by the same mosquitoes causing infections with clinical features similar to chikungunya disease and thus should be considered in the diagnostic evaluation (2, 3). It is important to exclude dengue virus infection, because proper clinical management of dengue can improve outcome.

• Supportive care

Treatment of chikungunya disease is symptomatic and may include rest, fluids, and use of analgesics and antipyretics. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to help with acute fever and pain. However, acetaminophen is the preferred first-line treatment for fever and joint pain in dengue-endemic areas, to reduce the risk of hemorrhage until dengue can be excluded.Treatment of chikungunya disease is symptomatic and may include rest, fluids, and use of analgesics and antipyretics. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to help with acute fever and pain. However, acetaminophen is the preferred first-line treatment for fever and joint pain in dengue-endemic areas, to reduce the risk of hemorrhage until dengue can be excluded.

Prevention of chikungunya disease involves avoiding mosquito bites and vaccination (1). One chikungunya vaccine is a live attenuated virus single dose vaccine. It can be used in people age 18 years or older who are at increased risk of exposure to chikungunya virus due to travel abroad or laboratory work in the United States. It should not be given to immunocompromised people. In the United States, the live attenuated vaccine should not be used among people ≥ 60 years until reports of cardiac and neurologic adverse events undergo further investigation.). One chikungunya vaccine is a live attenuated virus single dose vaccine. It can be used in people age 18 years or older who are at increased risk of exposure to chikungunya virus due to travel abroad or laboratory work in the United States. It should not be given to immunocompromised people. In the United States, the live attenuated vaccine should not be used among people ≥ 60 years until reports of cardiac and neurologic adverse events undergo further investigation.

A second vaccine, using a molecule that is virus-like particle but not itself a virus, has also been developed and can be used in people age 12 years and older who are at increased risk of exposure, such as travelers to endemic areas and laboratory personnel at risk.