Letter to the Editor

Dear Sir:

A Caribbean subregional workshop introducing the new guidelines for preparedness and response for chikungunya virus was held in Kingston, Jamaica, at the Jamaica Pegasus Hotel from May 28-30, 2012. The big question is what happened after that? There is a lovely picture with smiling faces of the participants who are described as “experts and participants from 22 countries” who attended the workshop.

Why were we not prepared for this outbreak? The majority of us had never even heard of chikungunya prior to this terrible outbreak, which has cost the region millions of dollars in loss of productivity, time and resources and has brought a new level of possible avoidable suffering to millions of citizen across the region.

The workshop document is very focused and describes chikungunya fever (CHIK) as “an emerging, mosquito-borne disease caused by an alphavirus, chikungunya virus (CHIKV). The disease is transmitted predominantly by Aedes aegypti and Ae. Albopictus mosquitoes, the same species involved in the transmission of dengue.”

This document can be found online through the Pan-American Health Organisation.

It also stated that “Although indigenous transmission of CHIKV does not occur in the Americas now, the risk for its introduction into local vector mosquito populations is likely higher than had previously been thought, especially in tropical and subtropical areas where Ae. aegypti, one of the main vectors of CHIKV, has a broad distribution. There is an intense travel/cultural exchange between the Caribbean and chikungunya virus (CHIKV) endemic countries, such as India and other Asian countries. This fact put the Caribbean as one of the most vulnerable sub-regions in the Americas.

“Most of the countries and other territories in this sub- region of the Americas are relatively small islands, which makes disease containment a possibility. The effectiveness of these measures will depend on the early detection and diagnosis of indigenous CHIKV transmission. Aggressive vector control coupled with quarantine (i.e., travel restrictions) has the potential to limit the spread of CHIKV in the Region.”

There were participants from 22 countries, including clinicians, vector control teams and laboratory technicians and the objective of the meeting was to train public health staff from the Caribbean countries on the detection, diagnosis, clinical management, and prevention of chikungunya (CHIK) and dengue (DEN) virus infections.

An additional objective of the meeting was to raise the capacity of Caribbean countries’ health systems for the timely identification of CHIK outbreaks in the context of other epidemic prone diseases, such as dengue.

One of the outcomes of the meeting was the development of a draft preparedness, control, and response plan for CHIK outbreaks in the Caribbean sub-region with the following immediate actions to be taken, and I quote:

• PAHO will communicate with ministries of health to convey the importance of preparing for the introduction of CHIK.

• Participants of the training course will promote sensitization of senior health staff at the country level (minister, CMO, PS).

• Each country’s ministry of health will review existing plans and develop country- specific programs based on the framework developed at meeting.

• Each country’s ministry of health will evaluate the capacity of current dengue surveillance and response programs as a background for CHIKV introduction.

Why were we not informed so that we could have been braced for the impact?

Aine Brathwaite

St George’s

Grenada

END

IMAGES:

Front cover of workshop plan referred to in above letter

The ‘smiling faces’

To download the whole report referred to in the above go to: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=22287&Itemid=

Related story:

Mexico detects first case of mosquito-borne chikungunya virus

(Reuters) – Mexico has detected its first domestic case of the painful mosquito-borne viral disease chikungunya in the southwest of the country, the state government of Chiapas said on Saturday.

Chikungunya is spread by two mosquito species, and is typically not fatal. But it can cause debilitating symptoms including fever, headache and severe joint pain lasting months.

The government of Chiapas, which borders Guatemala, said an 8 year old girl became the first person to contract the disease in Mexico, and that she was treated in hospital in the town of Arriaga. The girl has since been released.

There is no commercial vaccine for the virus, which was detected for the first time in the Americas late last year.

Chikungunya has already appeared in much of the Caribbean, Central America and the United States. A handful of people have had the virus in Mexico, having contracted it abroad.

In September, El Salvador said it had detected nearly 30,000 cases of the virus. In the United States, locally transmitted infections – as opposed to infections in Americans traveling abroad – were reported for the first time this year.

Chikungunya, a virus more commonly found in Africa and Asia and transmitted by the aedes aegypti mosquito that causes dengue fever, was first detected in the eastern Caribbean at the start of 2014.

(Reporting by Veronica Gomez and Dave Graham, editing by Louise Heavens)

For more on this story go to: http://www.reuters.com/article/2014/11/15/us-mexico-chikungunya-idUSKCN0IZ0S420141115