Another Mosquito Virus Slips Across the Border

I may have been wrong. In an August 2005 column, I suggested that Rift Valley Fever virus might become the next immigrant virus to follow in the footsteps of West Nile virus and settle in the U.S. Instead, that dubious honor may go to another once obscure African virus: Chikungunya. (If the name seems hard to pronounce be thankful I’m not writing about one of its cousins, O’nyong’nyong.) The virus was discovered in Tanzania in 1953. It never got much attention until last winter when it popped up on the daily ProMED* report of disease outbreaks around the world. ProMED recorded a number of surprising outbreaks on Reunion Island, Mauritius, Comoros, and several other beautiful little islands in the India Ocean. French-owned Reunion, Mauritius and Comoros attracts large numbers of French tourists during the winter and some of them brought the virus back to France. That was an interesting example of how jet-age travel can move viruses quickly around the globe. Still, I wasn’t paying much attention until the disease spread north, across the Indian Ocean, to start a larger outbreak in India. By mid-October, Indian health officials were reporting 1.25 million suspected cases of Chikungunya in eight states, and New Delhi. (That makes downtown New Delhi a triple mosquito threat to travelers because of malaria, dengue, and now Chikungunya.) Last month, two Colorado residents came home from Asia, and East Africa. Both developed Chikungunya, which must have initially puzzled most of the local doctors. The two travelers join a short list of at least twelve other Americans who have come home with the infection, including one Maryland resident who visited Reunion Island. These accidental importations of Chikungunya are worrisome for three reasons.

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First, the virus is transmitted by a mosquito called Aedes aegypti, which also is found in the U.S. A second type of mosquito—known as the Asian tiger mosquito—also may transmit the virus. The Asian tiger mosquito was accidentally imported into the U.S. many years ago in a shipment of old tires. So two competent mosquito species in the U.S. theoretically could start and sustain domestic infections. Charles Calisher, an internationally known virologist based in Colorado, recently told Newhouse News Service that if the virus got into the southern states, “then it could spread all over the U.S.” Second, Chikungunya infections may be getting worse. For a long time, the infection was described as being a self-limiting, febrile illness characterized by joint pain or arthritis, a rash, nausea and vomiting. Some cases produced fatigue lasting several weeks or prolonged joint pain. Inapparent or subclinical infections were common and subsequent immunity was thought to be long lasting. Chikungunya was not thought to be fatal. Until now. During the 2005-2006 outbreaks on Reunion Island there were 255,000 reported cases of Chikungunya. Health authorities began receiving death certificates listing Chikungunya as the cause of death. Curious, French epidemiologists looked at “crude death rates” during the outbreak period and compared the figures with “expected death rates” for the earlier 2002-2004 period. The difference was 226-260 extra deaths that probably could be attributed to the virus. Most of the excess deaths were in people aged 75 and older. Third, there are no specific treatments for this virus. Rest, fluids, and non-aspirin painkillers are the recommended treatments. Mosquitoes also should be kept away from patients because they can acquire the virus from patient blood and pass it to other people.

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There is also no vaccine, but that’s not for lack of research. In 1962, a strain called Chik 15561 was identified in Thailand and subsequently used to manufacture an experimental vaccine. Vaccine trials were carried out by the U.S. Army, but funding shortages apparently kept the vaccine from ever reaching licensure and commercial use. Will Chikungunya establish itself in the U.S.? It’s certainly possible. Quoting Dr. Calisher again: “We’ve been lucky so far. There really haven’t been many serious infectious epidemics in the United States. But as far as Chik is concerned, I think it’s a crapshoot.”

*”The popular ProMED-mail e-list [www.promedmail.org] offers a daily update on all the known diseases outbreaks flaring up around the world, which surely makes it the most terrifying news source known to man.” Steven Johnson, author of “The Ghost Map.”

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