INFECTIOUS DISEASES - Blackherbals.com

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Chik Virus Has NowSpread To the USFrom The CDCSeptember 29, 2006Chikungunya Fever Diagnosed Among InternationalTravelers -- United States, 2005 --2006Chikungunya virus (CHIKV) is an alphavirusindigenous to tropical Africa and Asia, where it istransmitted to humans by the bite of infectedmosquitoes, usually of the genus Aedes (1).Chikungunya (CHIK) fever, the disease caused byCHIKV, was first recognized in epidemic form inEast Africa during 1952-1953. The word"chikungunya" is thought to derive from descriptionin local dialect of the contorted posture of patientsafflicted with the severe joint pain associated withthis disease. Because CHIK fever epidemics aresustained by human-mosquito-humantransmission, the epidemic cycle is similar to those ofdengue and urban yellow fever. Large outbreaks ofCHIK fever have been reported recently on severalislands in the Indian Ocean and in India (refs. 2-6). In2006, CHIK fever cases also have been reported intravelers returning from known outbreak areas toEurope, Canada, the Caribbean (Martinique), andSouth America (French Guyana) (2,3,5-7). During2005-2006, 12 cases of CHIK fever were diagnosedserologically and virologically at CDC in travelerswho arrived in the United States from areas known tobe epidemic or endemic for CHIK fever. This reportdescribes 4 of these cases and provides guidance tohealth-care providers.Clinicians should be alert for additional cases amongtravelers, and public health officials should be alert toevidence of local transmission of chikungunya virus(CHIKV), introduced through infection of localmosquitoes by a person with viremia.Case Reports ------ Minnesota. On 12 May 2005, anadult male resident of Minnesota returned from a 3-month trip to Somalia and Kenya. He had onset ofillness hours after arrival in the United States,including fever, headache, malaise, and joint painmainly in a shoulder and a kneeLouisiana. On 15 Jan 2006, an adult female residentof India had onset of an illness characterized byfever, joint pain (in the knees, wrists, hands, andfeet), and muscle pain (in the thighs and neck). InMarch 2006, she traveled to Louisiana, where she soughtmedical attention for persistent joint pain. At CDC, testsof a single serum sample collected on 30 Mar [2006] (74days after illness onset) were positive for IgM andneutralizing antibodies to CHIKV. The patient wassubsequently lost to follow-up.Maryland. An adult female resident of Maryland visitedthe island of Reunion in the Indian Ocean from October2005 through mid-March 2006. On 18 Feb 2006, duringan ongoing CHIK fever outbreak on the island, she hadonset of fever, joint pain (in the hands and feet), and rash.A local physician clinically diagnosed CHIK fever, butno laboratory tests were conducted. After returning to theUnited States, the patient sought medical attention forpersistent joint pain. At CDC, tests of a single serumsample collected on 22 Mar [2006](32 days after illnessonset) were equivocal for IgM and positive forneutralizing antibody to CHIKV, consistent with a recentCHIKV infection in which IgM antibody was waning. At5 months after onset, the patient had persistent joint pain(in the hands and feet).Colorado. An adult male resident of Colorado visitedZimbabwe during 17 Apr -- 29 May 2006. On 29 Apr[2006], he had onset of illness with fever, chills, jointpain (in the wrists and ankles), and neck stiffness; a rashappeared a few days later. All symptoms resolved within2 weeks, except for joint pain, which persisted forapproximately 1 month. At CDC, tests of a single serumsample collected on 12 Jun [2006] (44 days after illnessonset) were positive for IgM and neutralizing antibody toCHIKV.MMWR Editorial Note:Most CHIKV infections are symptomatic (8). In clinicalinfections, the incubation period typically is 2-4 days.Illness is characterized by sudden onset of fever,headache, malaise, arthralgias or arthritis, myalgias, andlow back pain. Skin rash occurs in approximately half ofcases (9). Joint symptoms can be severe and involvesmall and large joints. Although CHIK fever typicallylasts 3-7 days and full recovery is the usual outcome,certain patients experience persistent joint symptoms forweeks or months and occasionally years after illnessonset (1).Serious complications (e.g., neuroinvasive disease) arerare, and fatal cases have not been documentedconclusively. Transplacental CHIKV transmission andsevere congenital CHIKV disease have been described(10). CHIKV infection is believed to confer life-longimmunity (1).Because no specific drug therapy is available, treatmentContinued on page 25-24- Traditional African Clinic December 2006
Continued from page 24 – Chik Virusof CHIK fever is supportive. No licensed CHIKVvaccine exists. Therefore, prevention recommendationsfor travelers to tropical Asia and Africa shouldemphasize mosquito repellent and avoidancemeasures. Additional information is available athttp://www.cdc.gov/ncidod/dvbid/chikungunya/chickvfact.htmDuring May 2004-May 2006, approximately 300 000suspected CHIK fever cases were reported on islandsin the Indian Ocean, including approximately 264000 suspected cases on Reunion, a French overseasdepartment (2,3). Other affected areas includedMombasa, Kenya, and the islands of Comoros, Lamu,Madagascar, Mauritius, Mayotte, and the Seychelles.In addition, since early 2006, an estimated 180,000suspected CHIK fever cases have occurred in theIndian states of Andhra Pradesh, Karnataka, andMaharashtra (4). In recent years, extensive CHIKVactivity also has been documented in Southeast Asia(9). In 2006, as of 11 May, approximately 340imported CHIK fever cases were reported in Europe,mainly in France, reflecting the high frequency oftravel between Europe and islands in the IndianOcean (2). To date, no known local mosquito-borneCHIKV transmission has occurred in Europe or othernon-indigenous areas._Aedes aegypti_ is the primary CHIKV vector inAsia, but _Ae. albopictus_ (the Asian tiger mosquito)likely was the primary vector in Reunion (2,3). InAsia, CHIKV epidemics involve a human-mosquitocycle with humans serving as the sole vertebrateamplifying hosts (1). In Africa, sylvatic cyclesinvolving nonhuman primates and forest-dwellingAedes species (e.g., _Ae. furcifer_) also occur. MostCHIKV epidemics occur during the tropical rainyseason and abate during the dry season (1,9). HumanCHIKV infections include a transient, high-titeredviremia (typically detectable during the first 2 days ofillness, ranging up to 6 days after illness onset) that isadequate to infect feeding mosquitoes (1). _Ae.aegypti_ and _Ae. albopictus_ are abundantperidomestic species and aggressive daytime bloodfeedersin all tropical and most subtropical areas ofthe world, and _Ae. albopictus_ now lives in manytemperate areas of the eastern and westernhemispheres, including Europe and the United States.Therefore, some risk exists that CHIKV might beintroduced into previously nonendemic areas bytravelers with viremia, leading to local transmissionof the virus, especially in tropical or subtropical areasof the United States (e.g., the Gulf Coast and Hawaii)or its territories (e.g., Guam, Puerto Rico, and the U.S.Virgin Islands).Early recognition of local transmission followed byprompt, aggressive vector control and other public healthmeasures might prevent long-term establishment of thevirus in new areas. Of the 4 patients described in thisreport, 3 posed no substantial public health risk becausethey probably no longer had viremia upon arrival in theUnited States; although the 4th patient was likely viremicupon arrival in Minnesota in mid-May, transmission tocompetent local mosquito vectors in that climate wasunlikely.In early illness, the clinical features of CHIK fever can besimilar to those of dengue and malaria, especially inpatients without joint symptoms. In both dengue andCHIK fever, rash usually is generalized. During 1991-2004, 9 confirmed or probable cases of CHIK fever werediagnosed serologically at CDC among travelers to theUnited States (CDC, unpublished data, 2006). Additionalimported but unrecognized cases likely occurred.Clinicians should be aware of possible CHIKV infectionin travelers returning from CHIK-fever--endemic oroutbreak areas, particularly if an acute febrile illness witharthralgias or arthritis occurs. Suspected cases should bereported promptly to local and state public health officialsand to CDC. Mosquito exposure should be strictlyavoided (e.g., by staying within a screened environmentand using barrier clothing and repellents) during the firstweek of illness to prevent infection of local mosquitoes.In the United States, diagnostic tests for CHIKV infectionare not available commercially but are available at CDCby special arrangement through state health departments.Laboratory diagnosis depends on antibody-capture IgMELISA and plaque-reduction neutralization tests ofserum. Comparative serologic tests for closely relatedalphaviruses (e.g., o'nyong-nyong and Sindbis viruses)should be conducted as geographically appropriate, andtests for dengue usually are indicated. Virus isolationattempts and PCR assays are performed selectively.Serologic tests should be performed on both acute- andconvalescent-phase serum specimens collected at least 2weeks apart, but clinicians should not delay submissionof acute-phase samples pending collection ofconvalescent-phase samples. To arrange submission ofspecimens to CDC for diagnostic testing, cliniciansshould consult their state public health laboratory andCDC's Arboviral Diseases Branch (telephone, 970-221-6400). Specimen shipping and handling instructions areavailable athttp://www.cdc.gov/ncidod/dvbid/misc/specimensubmission.htmContinued on page 26-25- Traditional African Clinic December 2006
Page 1: African Traditional Herbal Research
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