Chikungunya Fever and International Travel

[Sally Furniss]

Posted on behalf of Florida1 in tropical storm Fay


Outbreak Notice
Chikungunya Fever and International Travel
This information is current as of today, August 21, 2008 at 20:09

Updated: August 21, 2008

Information

Chikungunya fever is a virus that is spread to people through the bite of infected mosquitoes. Symptoms can include sudden fever, chills, headache, nausea, vomiting, joint pain with or without swelling, lower back pain, and a rash. Chikungunya mainly occurs in the continents of Africa and Asia (see the Chikungunya Distribution and Global Map webpage) but illness has also been reported in Europe. Countries that have experienced recent outbreaks of chikungunya fever include India, Indonesia, Malaysia, Singapore, and Sri Lanka.
In August 2008, health authorities in Italy and Singapore reported cases of chikungunya fever.

• On August 7, 2008, Italian health authorities reported a case of imported chikungunya fever in a traveler who had recently returned from Sri Lanka.
• As of August 19, 2008, Singapore’s Ministry of Health had reported 33 cases of chikungunya fever from Kranji Way and 4 cases of chikungunya fever from Pasir Panjang Wholesale Centre (PPWC). Kranji way is a northern district of Singapore and a popular recreation area and Pasire Panjang Wholesale Centre is located in a southwestern district of the country.

CDC cautions persons traveling overseas to areas where chikungunya has been reported to protect themselves from insect bites.
Advice for Travelers

No medications or vaccines are available to prevent a person from getting sick with chikungunya fever. If you are traveling to a place where there is a risk for chikungunya, you can take the following steps to help avoid being bitten by mosquitoes carrying the virus.

• Use insect repellent on exposed skin when outdoors, especially during the day.
  • Adults should use an insect repellent that contains 30% to 50% DEET (N,N-diethyl-m-toluamide). Repellents that contain less than 30% DEET give protection for a shorter amount of time and need to be applied more often during the day.
  • Insect repellents that contain up to 15% picaridin are available in the United States and require frequent reapplication. Repellents with higher concentrations of picaridin may be available in some regions outside the United States.
  • For more information about using repellents on infants and children, see the “Insect and Other Arthropod Protection” in Traveling Safely with Infants and Children and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.
• Wear long-sleeved shirts and long pants when outdoors.
  • You can also spray your clothes with a repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: don't use permethrin on skin.)
• Where possible, stay in hotels or resorts that have window screens, are air conditioned, or have bed nets.

If you get sick with a fever, go to the doctor right away. Though there is no specific treatment for the disease, doctors can help treat symptoms.
For more travel health information, see the destinations section and search for the country you are planning to visit.
More Information

The incubation period for chikungunya (time from infection to illness) can be 2-12 days, but is usually 3-7 days. Chikungunya fever typically lasts a few days to a couple of weeks, but some patients feel fatigue lasting several weeks. Some patients have reported incapacitating joint pain, or arthritis which may last for weeks or months. The symptoms are very similar to those of dengue fever, but, unlike dengue, patients do not usually experience hemorrhage (bleeding) or go into shock. People with chikungunya fever generally get better on their own and rarely die from the disease.
There is no specific drug treatment for chikungunya fever, and medical care is usually focused on treating the symptoms of the disease. Bed rest, fluids, and mild pain medications such as ibuprofen, naproxen, or acetaminophen (paracetamol) may relieve symptoms of fever and aching, provided that there are no medical reasons not to use these medications. Because aspirin can increase the risk of bleeding and possibly increase the risk for Reye syndrome, it should be avoided during the illness. Few people are sick enough to need to stay in the hospital. All people who become sick with chikungunya fever should be protected against additional mosquito bites to reduce the risk of further transmission of the virus.

http://wwwn.cdc.gov/travel/contentChikungunyaFever.aspx

[KBD]

Re: Chikungunya Fever and International Travel

http://www.bloomberg.com/apps/news?pid=20601124&sid=a9Geegg8o7Do&refer=science

Singapore's Virus Scourge Exposes Vulnerability to Asian Bugs

By Jason Gale

Aug. 29 (Bloomberg) -- Singapore reported more than 100 new cases of chikungunya fever this month, 10 times last year's total, as outbreaks elsewhere in Asia spread to the city-state through travelers and migrant workers.

The disease, which can trigger debilitating joint pain lasting months, probably caused sporadic infections at 18 separate sites this year, the Ministry of Health said in an Aug. 25 statement. The cases highlight the equatorial island's struggle to control virus-carrying mosquitoes and the threat of exotic diseases posed by international travel.

``In this day of rapid cross-border travel, Singapore, just like other countries, is at risk from the importation of viruses,'' said Ng Lee Ching, head of the nation's Environmental Health Institute. ``With the recent surge in importations, our risk of local transmission has increased significantly.''

Chikungunya is a reminder of globalization's role in the international spread of SARS, the deadly respiratory virus that probably infected more than 8,000 people worldwide in 2002 and 2003, including 238 in Singapore. The disease, first reported in southern China, cost Asian businesses an estimated $60 billion.

Until this year, Singapore found cases of chikungunya only in travelers who had caught the bug overseas. Since January, 70 ``imported'' and 80 locally acquired infections have been officially reported, almost two-thirds of which were in non- Singaporeans, according to ministry data.

Chikungunya, which means to become contorted in the Makonde language of southeastern Tanzania, was first recorded in Africa in 1953, and has infected people in 35 countries. There's no vaccine or specific treatment for the fever, rash and joint- swelling, which are usually nonfatal.

Ng says genetic analysis shows the viruses in Singapore are similar to strains from India, Sri Lanka and Malaysia.

A Passage From India

Fifteen Indian states and territories had a total of 1.39 million confirmed or suspected chikungunya cases in 2006, according to health authorities in New Delhi. Kerala and Karnataka have had cases as recently as this month.

Malaysia, linked to Singapore by a causeway, has had more than 1,500 infections since late July, according to the country's health ministry. Of Singapore's imported cases, 56 patients had been in the adjacent Malaysian state of Johor Bahru before their illness, Health Minister Khaw Boon Wan told Parliament on Aug. 27.

An outbreak in Italy last year, the first in Europe, provided an example of how chikungunya can take hold when an infected person enters an area and is bitten by a mosquito capable of transmitting the virus, and the insect then feeds on the blood of people who aren't immune to the pathogen.

The World Health Organization says 2.5 billion people globally live in areas where epidemics of chikungunya, and the potentially lethal diseases dengue and yellow fever, can occur.

Tiger Mosquito

A chikungunya epidemic hasn't erupted in Singapore, even though most of its 4.6 million inhabitants are susceptible to it.

That may be because one of the main transmitters of the disease here -- the Asian tiger mosquito, or Aedes albopictus -- is less inclined to hover inside homes, and also feeds on other mammals that don't catch the virus, said Duane Gubler, director of the emerging infectious diseases program at the Duke-National University of Singapore Graduate Medical School.

``The fact that you have got such widespread transmission but it's still sporadic is a good indication that it's not going to blow up into a big epidemic,'' Gubler said in an interview.

Public Health Cost

Chikungunya's persistence in Singapore may reveal a hidden public-health cost of lower-paid, unskilled laborers -- many of whom come from Malaysia and Indonesia, where the disease is endemic -- to work in the city's booming construction and shipping industries.

Singapore had about 757,000 unskilled and semiskilled foreign workers as of Dec. 31, according to the Ministry of Manpower. Laborers working in construction or manufacturing were paid a median gross monthly wage of S$800 ($564) last year, according to ministry data.

Many laborers are put up in ``unhygienic, very cramped'' dormitories by their employers at a monthly cost of S$150-S$200 per bed, said Jolovan Wham, executive director of the Humanitarian Organization for Migration Economics, a charity that supports foreign workers.

By comparison, the average daily room rate at a Singapore hotel was S$238 in July.

``You can imagine what kinds of conditions they would be living in if it's going to be so cheap,'' Wham said. ``Many companies are willing to cut corners.''

More Beds

Land for 11 dormitory sites was released during the past 18 months to provide about 65,000 more ``housing spaces,'' Acting Minister for Manpower Gan Kim Yong said this month. Efforts to improve housing must be supported by dormitory operators and employers by ``maintaining and enhancing standards of current housing facilities,'' Gan said.

At a three-story, corrugated-iron dormitory in northwestern Singapore, laundry, buckets and cooking paraphernalia clutter 54 bunk-bed-lined rooms, each ventilated by a single window lacking insect screens.

``Anytime you're importing a large number of laborers from a highly endemic area, and these laborers are housed in a communal area that is unscreened, you're at a high risk of creating a focal outbreak that can spread,'' said Scott A. Ritchie, a medical entomologist with the Tropical Public Health Unit Network in Cairns, Australia.

The National Environment Agency says foreign workers are an important target for its education and outreach programs. In response to the chikungunya cases, the agency produced more pamphlets in English, Mandarin, Malay and Tamil detailing ways foreign workers can protect themselves and prevent mosquito breeding, and is preparing versions in Bengali, Burmese, Tagalog and Thai. It also holds mandatory safety courses and seminars.

To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net.