As thousands of holidaymakers pack their bags for a Christmas or New Year break in the Caribbean, the chikungunya virus that has spread like wildfire through the region and, to a lesser extent, other parts of the Americas, has become a source of concern for health professionals.
Are ill-informed travellers more focused on their choice of cocktail than taking adequate steps to protect themselves from chikungunya? How serious is the disease, how can you avoid it, and what symptoms should you look out for if you fall ill during or after a trip?
Open-air ‘bar’, Dominican Republic. Image by Ronald Saunders / CC BY-SA 2.0
What is chikungunya and should I be worried?
Chikungunya is a debilitating mosquito-borne virus transmitted primarily by the same types of mosquitoes that pass on dengue fever. It’s not usually life-threatening: in the past 11 months, out of more than 700,000 suspected cases across the Caribbean, just over 150 deaths have been recorded according to Dr Laith Yakob, an infectious disease specialist at London’s School of Hygiene & Tropical Medicine. However, chikungunya can leave patients in agony for days, weeks or sometimes months.
A vaccine or cure has yet to be found for the virus, though anti-viral drug trials have been running for years. Treatment focuses on relieving symptoms of the disease, hospitalisation is sometimes necessary and victims will most certainly be bedridden for a period of time (usually days, but in some cases weeks) due to debilitating aches and pains. The name ‘chikungunya’ derives from a word in the Kimakonde language of Tanzania – where the disease was first documented – meaning ‘to become contorted’, alluding to sufferers bent with joint pain. Historically, some patients have reported feeling lingering effects from the disease for months or even years in extreme cases.
Wear permethrin-treated walking gear if jungle-trekking is on your Caribbean itinerary. Image by Frans Lemmens / Getty
What are the symptoms of chikungunya and what should I do if I get them?
The sorts of aches and pains commonly associated with flu are telltale signs of chikungunya. Other symptoms include fever and rash. These symptoms are similar to those of dengue and in regions where dengue is present, this has sometimes led to misdiagnosis. Rare cases have documented eye, neurological and heart complications arising from the virus, as well as gastrointestinal complaints. “Normally [patients experience] fever – often with a headache – within three to five days post-bite. Followed by a rash and joint pain, normally in the hands and wrists,” says Dr Yakob, who advises travellers to seek medical attention if they get any of these symptoms.
Symptoms of chikungunya include joint pain and fever. Image by Pascal Deloche / Getty
Treatment is not difficult to administer, but only lab diagnosis can confirm infection. If you feel ill, start by drinking plenty of fluids and avoiding further exposure to mosquitoes. “Treatment usually involves paracetamol first (often even before a lab-confirmed diagnosis has been made), then non-steroidal anti-inflammatory drugs if paracetamol doesn’t work,” Dr Yakob explains. Symptoms clear up within three weeks of treatment for the majority of patients.
Where has the disease been found and should I avoid travelling there?
It’s more a question of where hasn’t it been found: since December last year, when local transmission of the disease was discovered on St Martin, chikungunya has cropped up in 26 Caribbean nations as well as parts of South and Central America. That means less than 15 percent of the Caribbean’s islands are unaffected (for now). The Dominican Republic is the worst affected nation, with almost 500,000 suspected cases and six confirmed deaths from the disease. In Central and South America, countries including El Salvador, Nicaragua, Costa Rica, Panama, Colombia, Venezuela and Brazil have all recorded cases of chikungunya.
Although new to the Americas, chikungunya is not a new disease; traditionally, the virus’s stronghold has been Africa, Asia and islands in the Indian Ocean and South Pacific, according to the US’s Centers for Disease Control & Prevention (CDC). The first case of chikungunya was recorded in Tanzania in 1952. Dr Yakob puts the recent outbreaks in the Caribbean down to the fact that the local population has never been exposed to the disease before, meaning they have little to no natural immunity.
Dominican Republic and Haiti: two of the Caribbean nations worst-hit by chikungunya. Image by Hans Laubel / Getty
The infection rates speak for themselves: it is strongly recommended that travellers take every effort to protect themselves against chikungunya (see below). That said, the recent outbreaks are by no means a reason to avoid travel to the Caribbean islands this winter unless you fall into a high-risk category. In a nutshell, that’s the elderly, the very young, pregnant women in their third trimester, those with underlying medical conditions (such as high blood pressure, diabetes or heart disease) and people who suffer from arthritis, according to the CDC. Long-term travellers are also more at risk. Dr Yakob says: “I would only seriously reconsider travelling to the Caribbean if you are 1) very elderly, as symptoms can be worse for the elderly, or 2) you are taking a very young infant because many of the repellents cannot be used on individuals under two months.” He advises parents check insect repellent manufacturers’ instructions for advice on using repellents on babies.
It is worth noting that the vast majority of cases involve island residents in the Caribbean, many of whom will spend less time in air-conditioned environments and are unlikely to wear insect repellent. So far there have been less than 40 cases of chikungunya diagnosed in travellers returning from islands including St Lucia, the Dominican Republic and Antigua and Barbuda, according to a report in specialist industry publication Travel Weekly.
What precautions can I take to protect against chikungunya?
The types of mosquitoes carrying chikungunya are indiscriminate day and night biters, meaning it’s important to cover up and apply strong insect repellent all day as well as in the evening. During the daytime, apply sunscreen first and spray insect repellent over the top. Permethrin-treated clothing and gear such as boots, socks, trousers and tops are also designed to help fend off biters and can be bought from outdoors stores before you travel.
In terms of accommodations, air-conditioned rooms or rooms with screened windows are preferable to shelters exposed to the outdoors; beds covered by mosquito nets would be the next best thing.
Avoid sleeping in open-sided bedrooms where mosquitoes can find an easy target. Image by Brigitte Merle / Getty
Is there any good news?
The vast majority of chikungunya sufferers recover well and feel no lasting effects. And you can only catch it once because patients develop immunity to the virus upon recovery.
What’s happening now?
With suspected cases already approaching 1 million spread across most Caribbean islands, travel restrictions won’t make the disease go away. Instead, the CDC and WHO are focusing on efforts to eradicate mosquito larvae breeding sites and spray insecticides in areas with dense mosquito populations.
Early detection and diagnosis of the disease will also be key to clamping down on the spread of chikungunya across the region – particularly as the Caribbean is flooded with tourists during the upcoming peak tourist season. If you suspect you may have contracted the disease while overseas, be sure to tell your doctor that you’ve travelled to an infected region when you go for a check-up.