From Cayman Islands Public Health Department

Chikungunya Update in Cayman Islands as of 22 September 2014

The total number of confirmed cases of chikungunya has reached seven as at 22 September 2014.

• Since the last update on 15 September 2014, 10 new cases were placed under investigation during the week of 16- 22 September 2014. The blood samples were sent for testing at Caribbean Public Health Agency (CARPHA) in Trinidad on 22 September 2014.
• Of the five samples sent last week, four results were received from the Caribbean Public Health Agency CARPHA. Three tested negative, and one positive. The results of a fifth case remain pending.
• The patient who tested positive (16- 22 September) is a resident of George Town, with a travel history to Jamaica. The onset of symptoms took place on 13 September. Therefore the patient is no longer considered infectious as it has been more than a week. The chikungunya virus is transmitted by mosquitoes biting infected persons during the first week of illness.
• Total number of cases investigated for chikungunya since 25 June 2014 is 46
• The total results received thus far are 35. Seven have come back positive, 26 negative and two inconclusive. Results of 10 blood samples sent on 22 September are awaited and one from the period 9 – 15 September.
• Of the seven confirmed cases, six have reported a travel history to countries having an outbreak, (two to Dominican Republic, two to Guyana, two to Jamaica). One had no travel history, an indication that the infection was acquired locally.

“As the onset of symptoms of the locally acquired case was on 11 July we feel that we have been able to contain the outbreak through an integrated approach, that includes the Public Health Department, Mosquito Research and Control Unit, and the community efforts,” said Medical Officer of Health, Dr. Kiran Kumar.

Urging the public to take protective measures against mosquito bites during travel abroad but also within the Cayman Islands, he added: “We cannot afford to become complacent. We will continue to have imported cases as we are in the midst of the regional outbreak.”

Distribution of all confirmed cases: George Town- three; Cayman Brac – two; West Bay one and Savannah (Bodden Town) – one.

As at 15 September, 10,972 confirmed/probable cases of chikungunya have been reported from 20 CARPHA Member States and 11 other Caribbean countries/territories. Total suspected cases are 690,309.

Further information can be obtained through www.hsa.ky. Regional updates can be accessed by visiting the CARPHA website on http://carpha.org/What-We-Do/Public-Health-Activities/Chikungunya. In addition United States updates are available from the Centers for Disease Control and Prevention on http://www.cdc.gov/chikungunya/geo/united-states.html

IMAGE: www.news.com.au

Related story:

Chikungunya virus: Caribbean and the Americas – update 9

From NaTHNac

This updates the Clinical Update of 24 July 2014.

The outbreak of chikungunya virus (CHIKV) in the Caribbean region, first reported by the World Health Organization (WHO) in December 2013, continues. The most recent country to report autochthonous (locally acquired) transmission is Colombia; the first ever cases in the country were reported from Bolivar State on 10 September 2014 [1].

Since the initial report, autochthonous (locally acquired) transmission of CHIKV has been reported from several countries and territories in the Caribbean, as well as from mainland North, South and Central America [2].

As of 12 September 2014, 706,093 suspected cases and 113 deaths have been reported in the region [2].

As of 12 September 2014, the countries and territories in the Caribbean and the Americas with confirmed autochthonous transmission are: [2]

Central, North and South America

Colombia, Costa Rica, El Salvador, French Guiana, Guyana, Panama, Suriname, United States (US), Venezuela

Caribbean Islands

Aruba, Anguilla, Antigua and Barbuda, Bahamas, Barbados, British Virgin Islands, Cayman Islands, Curacao, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Puerto Rico, Saint-Barthélemy, Saint Kitts and Nevis, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Maarten, Trinidad & Tobago, Turks and Caicos, US Virgin Islands

The two main vectors of CHIKV, Aedes aegypti and Aedes albopictus mosquitoes, are distributed throughout the Caribbean and the Americas, so the region is highly susceptible to the introduction and spread of the virus [3]. Autochthonous transmission from an imported viraemic chikungunya case during the summer season in the EU is possible, as the competent vector (Aedes albopictus) is present and the environmental requirements are met during the summer and early autumn in Europe [4].

Further information on confirmed and suspected CHIKV outbreaks can be accessed via the NaTHNaC Outbreak Surveillance Database.

In symptomatic illness, there is the sudden onset of fever, headache, myalgia and arthralgia. After two to three days, a generalised maculo-papular rash can develop. Most cases recover in three to five days. However, up to 10% of cases experience arthritis, chronic joint pain and fatigue.

Complications of CHIKV infection can include hepatitis, myocarditis, neurological and ocular disorders. Treatment is supportive [5].

Advice for travellers

There is no vaccine or chemoprophylaxis to prevent CHIKV. Travellers to affected areas can reduce their risk of infection by practising insect bite avoidance measures. Aedes mosquitoes are most active during daylight hours. Particular vigilance with bite avoidance should be taken around dawn and dusk.

Advice for health professionals

CHIKV does not occur in the UK, but a number of cases are reported each year in travellers returning from endemic areas [6]. The majority of UK cases are associated with travel to South and South East Asia. However in 2014, as of 16 September 2014, 37 cases of CHIKV have been reported in UK travellers returning from the Caribbean, most from the Dominican Republic or Antigua and Barbuda (provisional data) [7].

Health professionals should be aware of the possibility of CHIKV in febrile travellers who have recently visited affected areas. If a case is suspected, appropriate samples should be sent for testing (including a full travel and clinical history with relevant dates) to the Public Health England, Rare and Imported Pathogens Laboratory.

The Imported Fever Service: Public Health England is available to local infectious disease physicians or microbiologists should specialist advice be needed on 0844 7788990.

References

1. Ministerio de Salud y Protección Social. Boletín de Prensa No 250 de 2014; 10.09.2014. Confirmados primeros cuatro casos de chikunguña en Bolívar [In Spanish]. [Accessed 17 September 2014]. Available at: http://www.minsalud.gov.co/Paginas/Confirmados-primeros-cuatro-casos-chikungu%C3%B1a-en-Bolivar.aspx
2. Pan American Health Organization (PAHO)/World Health Organization. Cases of chikungunya fever in the Americas, by country or territory 2013-2014. Epidemiological Week 37 (updated 12 September, 2014). [Accessed 17 September 2014]. Available at: http://www.paho.org/hq/index.php?option=com_topics&view=

article&id=343&Itemid=40931

3. Vega-Rua A, Zouache K, Girod R et al. High vector competence of Aedes aegypti and Aedes albopictus from ten American countries as a crucial factor of the spread of Chikungunya. Journal of Virology. 2014 Jun; 88(11): 6294-306.
4. European Centre for Disease Prevention and Control. Rapid Risk assessment. Chikungunya outbreak in Caribbean region. 25 June 2014. [Accessed 17 September 2014]. Available at: http://ecdc.europa.eu/en/publications/Publications/chikungunya-caribbean-june-2014-risk-assessment.pdf
5. World Health Organization, Chikungunya fact sheet. March 2014. [Accessed 17 September 2014]. Available at: http://www.who.int/mediacentre/factsheets/fs327/en/
6. Public Health England. Chikungunya: epidemiology in England, Wales and Northern Ireland 10 July 2014. [Accessed 17 September 2014]. Available at: https://www.gov.uk/government/statistics/chikungunya-epidemiology-in-england-wales-and-northern-ireland
7. Public Health England Travel and Migrant Health Section and Rare and Imported Pathogens Laboratory. 17 September 2014 personal communication.

Links

ECDC: Chikungunya outbreak in Caribbean region

Caribbean Public Health Agency: Chikungunya

NaTHNaC: Insect bite avoidance

NaTHNaC: Country Information Pages

NaTHNaC: Outbreak Surveillance Database

PAHO: Chikungunya

Public Health England: Chikungunya

For more on this story go to: http://nathnac.org/pro/clinical_updates/chikv_caribb_170914.htm

IMAGE: ensegundos.net