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Germany: Chikungunya
http://www.promedmail.org/pls/promed..._ID:1000,32230
CHIKUNGUNYA - INDIAN OCEAN UPDATE (05): SPREAD TO EUROPE
************************************************** ******
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Germany
[2] Switzerland
[3] France, Switzerland, Germany
[1] Germany
Date: 24 Feb 2006***
***[ProMED deeply regrets the delay in posting the following 1st-hand report.
We just don't understand how it went missing. Thanks to Charlie Calisher for
finding it. - Mod.JW]
From: Dr. Martin Pfeffer <Martin1Pfeffer@Bundeswehr.org>
As the current chikungunya epidemic on the islands east of Africa is
accelerating, imported cases are to be expected in European countries, where
these islands are a popular destination for vacation.
We have identified 4 imported cases to Germany which have been confirmed in
the laboratory either by detection of chikungunya virus-specific IgM
antibodies, real-time RT-PCR and/or virus isolation from serum. Here we report
the details of one patient as an illustration of a typical case.
A 62-year-old tourist fell sick 3 days prior to her return to Germany after a
3-week vacation on Mauritius. Symptoms included a sudden onset of fever,
chills, severe headache and extremely painful joints on her hands, ankles and
toes. Self-medication included a total of 8 g paracetamol and 700 mg
diclofenac within the first 72 hours after onset. The first day back in
Germany, she was admitted to the Department of Infectious Diseases and
Tropical Medicine at the University in Munich. She was found to have a
temperature of 38.7 deg C [102 deg F], conjunctivitis and severe arthralgia of
the joints of hands, ankles and toes. Chikungunya fever was suspected based on
travel history and the severe arthralgia. This was confirmed the same day by
real-time RT-PCR (1). Tests for malaria, leptospiroses and typhus/paratyphus
were negative. The patient had leucopenia (3.200/microl), slight
thrombocytopenia (141/microl), high CRP and elevated liver enzymes
(transaminases), possibly a response to the level of painkillers taken. The
fever was not evident on day 5 after onset of the disease but returned on day
7 with a rash on the torso and the legs. Edema was also a significant feature
observed on both legs. The rash, fever and edema disappeared 2 days later, but
the arthralgia persists.
(1) Pastorino B, Bessaud M, Grandadam M, Murri S, Tolou HJ, Peyrefitte CN.
2005. Development of a TaqMan RT-PCR assay without RNA extraction step for the
detection and purification of African chikungunya viruses. J. Virol. Methods
124, 65-71.
--
Dr. Martin Pfeffer
Bundeswehr Institute of Microbiology
Neuherbergstr. 11
D-80937 Munich
<Martin1Pfeffer@Bundeswehr.org>
Prof. Dr. Thomas Loescher
Dept. of Infectious Diseases and Tropical Medicine
Leopoldstr. 5
D-80537 Munich
Dr. Petra Emmerich
Bernhard-Nocht-Institute for Tropical Medicine
Bernhard-Nocht-Str. 74
D-20359 Hamburg
Germany
*****
[2] Switzerland
Date: Wed, 1 Mar 2006 23:32:58 -0500 (EST)
From: Thomas Roesel <roesel@lycos.com>
Source: tsr.ch - Info, 1 Mar 2006 [trans. by Thomas Roesel; edited]
<http://www.tsr.ch/tsr/index.html?siteSect=200001&sid=6515041>
Chikungunya virus is devastating Reunion island, an overseas department of
France where it has infected nearly one out of 5 people. In the French-
speaking part of Switzerland, a dozen cases have been recorded, all tourists
who have returned from trips abroad having contracted the illness while in a
country at risk. Even though the virus can be lethal in some rare cases, there
is no need to panic: the risk of contracting the illness in Switzerland is
almost zero [owing to lack of competent vector].
Dr. Louis Loutan, the chief of travel medicine at the University Hospital of
Geneva, states that there have been some cases of chikungunya, and they have
survived. With stories about avian flu stories, there has been much confusion.
There are many people calling the hospital asking questions on this topic.
First, it is necessary to know that the chikungunya virus is not contracted
through just any mosquito bite, but a bite from the _Aedes albopictus_
mosquito.
"The small urban mosquito with striped legs is not very common in Switzerland.
Some specimens have been reported in Tessin (southern Italian-speaking part of
Switzerland) and in the Mediterranean area, " according to Dr. Loutan, "But in
the wintertime, there are no mosquitoes." Therefore, it is unlikely that this
is the start of an epidemic.
--
Thomas Roesel
<roesel@lycos.com>
******
[3] France (Marseilles), Switzerland (Geneva) and Germany (Munich)
Date: Wed, 1 Mar 2006 21:25:48 -0500 (EST)
From: David O. Freedman <dfreedman@geomed.dom.uab.edu>
Source: GeoSentinel 1 Mar 2006 [edited]
<http://www.istm.org/geosentinel/main.html>
<geosentinel@istm.org>
GeoSentinel, the global surveillance program of the International Society of
Travel Medicine, has been informed by 3 sites of cases of imported Chikungunya
virus infection in 3 European countries.
>From the Marseilles, France GeoSentinel Site (Dr. Philippe Parola, Hopital
Nord):
We had 2 cases [in 2005] that have just been confirmed retrospectively by
serology. Our colleagues from the military hospital in Marseilles got 13
imported cases from Comoros in 2005. We have again started to receive cases in
our unit that have been confirmed by serology and PCR from Reunion island and
Comoros.
>From the Geneva GeoSentinel Site:
Over the last month, we had 3 cases of Chikungunya returning from La Reunion
(one serologically confirmed, and 2 suspected). All had fever and symmetrical
arthralgia, mainly wrists, ankles, and joints with previous trauma. 2 had a
rash and adenopathies. Fever lasted for less than a week, but arthralgia
lasted for 3 to 4 weeks in 2 cases.
>From the Munich site (Frank von Sonnenburg, University of Munich):
Female patient, 62, in Mauritius for 2 weeks, returned on 14 Feb 2006, 3 days
before departure: acute high fever, shivers, conjunctivitis, joint pain
(knuckle and ankle), moderate leukopenia, moderate transaminase elevation.
Fever disappeared after 12 days, through joint pain (small joints) persists.
Hamburg has 3 more cases diagnosed with RT-PCR (hearsay).
Clinicians in all countries with travelers returning from the affected islands
should consider a diagnosis of Chikungunya in febrile rash illnesses when
there is accompanying joint pain especially in the smaller joints. The
syndrome may be easy to confuse with dengue, which is not widely prevalent in
these islands.
--
David O. Freedman, MD
University of Alabama at Birmingham
<dfreedman@geomed.dom.uab.edu>
--
ProMED-mail
<promed@promedmail.org>
[The main vector of chikungunya is _Aedes aegypti_, which does not occur in
the above 3 countries. _Aedes albopictus_ is a suspected vector in some
situations (see Archives 20060102.0007 & 20060302.0664).
In France there were until recently about 55 mosquito species, 18 of which
were _Aedes_ species, and there are about 46 species in Germany including 19
_Aedes_ species, and probably 29 species in Switzerland including 11 _Aedes_
species, none of which is a known vector anywhere of chikungunya. However,
the southeast Asian mosquito _Ae. albopictus_ was discovered in France in the
Orne and Vienne departments in October 1999 (Schaffner, F. et al. ( 2001)
European Mosquito Bulletin, 9: 1-3). Therefore some might argue that there
could be a risk of transmission in France, but personally I think this is
slight. However, it would be informative to have the thoughts of French
medical entomologists on the possible transmission of chikungunya virus in
France. Mod. MS]
[see also:
Chikungunya - Indian Ocean update (03): spread to France 20060225.0619
Chikungunya - Indian Ocean update (02): Reunion 20060224.0609
Chikungunya - India (AP): susp. 20060220.0551
Chikungunya virus vaccine 20060219.0544
Chikungunya - Indian Ocean update 20060218.0525
Chikungunya - Mauritius and Reunion Island (10): Mauritius 20060216.0509
Chikungunya - Mauritius and Reunion Island (09): Reunion 20060214.0491
Chikungunya - Mauritius and Reunion Island (08): Reunion 20060205.0378
Chikungunya - Mauritius and Reunion Island (07): Reunion 20060204.0358
Chikungunya - Madagascar: susp., RFI 20060202.0340
Chikungunya - Mauritius and Reunion Island (06): Reunion 20060203.0343
Chikungunya - Mauritius and Reunion Island (05): Reunion 20060131.0306
Chikungunya - Mauritius and Reunion Island (04): Reunion 20060127.0254
Chikungunya - Mauritius and Reunion Island (03): Reunion 20060124.0230
Chikungunya - Mauritius and Reunion Island (02): Reunion 20060121.0202
Chikungunya - Mauritius and Reunion Island: Reunion 20060102.0007
2005
----
Chikungunya - Mauritius and Reunion Island (04): Reunion 20051231.3716
Chikungunya - Mayotte, Reunion, Comoros 20050913.2707
Chikungunya - Indonesia (Tangerang) 20050717.2059
Chikungunya - Mauritius and Reunion Island (03) 20050624.1770
Deaths at sea - France (Reunion Island): RFI 20050622.1759
Chikungunya - Mauritius and Reunion Island (2) 20050520.1384
Chikungunya - Mauritius and Reunion Island 20050519.1372
Chikungunya - Indonesia (West Lombok) 20050422.1121
Chikungunya - Comoros (Ngazidja) 20050405.0986]
...................ry/pg/ms/jw
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************************************************** **********
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************** **********
Please support ProMED-mail by donating to the 2005 Internet-
a-thon at <http://www.isid.org/netathon2005.shtml>
************************************************** **********
Visit ProMED-mail's web site at <http://www.promedmail.org>.
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(NOT to an individual moderator). If you do not give your
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etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
################################################## ##########
################################################## ##########
CHIKUNGUNYA - INDIAN OCEAN UPDATE (05): SPREAD TO EUROPE
************************************************** ******
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Germany
[2] Switzerland
[3] France, Switzerland, Germany
[1] Germany
Date: 24 Feb 2006***
***[ProMED deeply regrets the delay in posting the following 1st-hand report.
We just don't understand how it went missing. Thanks to Charlie Calisher for
finding it. - Mod.JW]
From: Dr. Martin Pfeffer <Martin1Pfeffer@Bundeswehr.org>
As the current chikungunya epidemic on the islands east of Africa is
accelerating, imported cases are to be expected in European countries, where
these islands are a popular destination for vacation.
We have identified 4 imported cases to Germany which have been confirmed in
the laboratory either by detection of chikungunya virus-specific IgM
antibodies, real-time RT-PCR and/or virus isolation from serum. Here we report
the details of one patient as an illustration of a typical case.
A 62-year-old tourist fell sick 3 days prior to her return to Germany after a
3-week vacation on Mauritius. Symptoms included a sudden onset of fever,
chills, severe headache and extremely painful joints on her hands, ankles and
toes. Self-medication included a total of 8 g paracetamol and 700 mg
diclofenac within the first 72 hours after onset. The first day back in
Germany, she was admitted to the Department of Infectious Diseases and
Tropical Medicine at the University in Munich. She was found to have a
temperature of 38.7 deg C [102 deg F], conjunctivitis and severe arthralgia of
the joints of hands, ankles and toes. Chikungunya fever was suspected based on
travel history and the severe arthralgia. This was confirmed the same day by
real-time RT-PCR (1). Tests for malaria, leptospiroses and typhus/paratyphus
were negative. The patient had leucopenia (3.200/microl), slight
thrombocytopenia (141/microl), high CRP and elevated liver enzymes
(transaminases), possibly a response to the level of painkillers taken. The
fever was not evident on day 5 after onset of the disease but returned on day
7 with a rash on the torso and the legs. Edema was also a significant feature
observed on both legs. The rash, fever and edema disappeared 2 days later, but
the arthralgia persists.
(1) Pastorino B, Bessaud M, Grandadam M, Murri S, Tolou HJ, Peyrefitte CN.
2005. Development of a TaqMan RT-PCR assay without RNA extraction step for the
detection and purification of African chikungunya viruses. J. Virol. Methods
124, 65-71.
--
Dr. Martin Pfeffer
Bundeswehr Institute of Microbiology
Neuherbergstr. 11
D-80937 Munich
<Martin1Pfeffer@Bundeswehr.org>
Prof. Dr. Thomas Loescher
Dept. of Infectious Diseases and Tropical Medicine
Leopoldstr. 5
D-80537 Munich
Dr. Petra Emmerich
Bernhard-Nocht-Institute for Tropical Medicine
Bernhard-Nocht-Str. 74
D-20359 Hamburg
Germany
*****
[2] Switzerland
Date: Wed, 1 Mar 2006 23:32:58 -0500 (EST)
From: Thomas Roesel <roesel@lycos.com>
Source: tsr.ch - Info, 1 Mar 2006 [trans. by Thomas Roesel; edited]
<http://www.tsr.ch/tsr/index.html?siteSect=200001&sid=6515041>
Chikungunya virus is devastating Reunion island, an overseas department of
France where it has infected nearly one out of 5 people. In the French-
speaking part of Switzerland, a dozen cases have been recorded, all tourists
who have returned from trips abroad having contracted the illness while in a
country at risk. Even though the virus can be lethal in some rare cases, there
is no need to panic: the risk of contracting the illness in Switzerland is
almost zero [owing to lack of competent vector].
Dr. Louis Loutan, the chief of travel medicine at the University Hospital of
Geneva, states that there have been some cases of chikungunya, and they have
survived. With stories about avian flu stories, there has been much confusion.
There are many people calling the hospital asking questions on this topic.
First, it is necessary to know that the chikungunya virus is not contracted
through just any mosquito bite, but a bite from the _Aedes albopictus_
mosquito.
"The small urban mosquito with striped legs is not very common in Switzerland.
Some specimens have been reported in Tessin (southern Italian-speaking part of
Switzerland) and in the Mediterranean area, " according to Dr. Loutan, "But in
the wintertime, there are no mosquitoes." Therefore, it is unlikely that this
is the start of an epidemic.
--
Thomas Roesel
<roesel@lycos.com>
******
[3] France (Marseilles), Switzerland (Geneva) and Germany (Munich)
Date: Wed, 1 Mar 2006 21:25:48 -0500 (EST)
From: David O. Freedman <dfreedman@geomed.dom.uab.edu>
Source: GeoSentinel 1 Mar 2006 [edited]
<http://www.istm.org/geosentinel/main.html>
<geosentinel@istm.org>
GeoSentinel, the global surveillance program of the International Society of
Travel Medicine, has been informed by 3 sites of cases of imported Chikungunya
virus infection in 3 European countries.
>From the Marseilles, France GeoSentinel Site (Dr. Philippe Parola, Hopital
Nord):
We had 2 cases [in 2005] that have just been confirmed retrospectively by
serology. Our colleagues from the military hospital in Marseilles got 13
imported cases from Comoros in 2005. We have again started to receive cases in
our unit that have been confirmed by serology and PCR from Reunion island and
Comoros.
>From the Geneva GeoSentinel Site:
Over the last month, we had 3 cases of Chikungunya returning from La Reunion
(one serologically confirmed, and 2 suspected). All had fever and symmetrical
arthralgia, mainly wrists, ankles, and joints with previous trauma. 2 had a
rash and adenopathies. Fever lasted for less than a week, but arthralgia
lasted for 3 to 4 weeks in 2 cases.
>From the Munich site (Frank von Sonnenburg, University of Munich):
Female patient, 62, in Mauritius for 2 weeks, returned on 14 Feb 2006, 3 days
before departure: acute high fever, shivers, conjunctivitis, joint pain
(knuckle and ankle), moderate leukopenia, moderate transaminase elevation.
Fever disappeared after 12 days, through joint pain (small joints) persists.
Hamburg has 3 more cases diagnosed with RT-PCR (hearsay).
Clinicians in all countries with travelers returning from the affected islands
should consider a diagnosis of Chikungunya in febrile rash illnesses when
there is accompanying joint pain especially in the smaller joints. The
syndrome may be easy to confuse with dengue, which is not widely prevalent in
these islands.
--
David O. Freedman, MD
University of Alabama at Birmingham
<dfreedman@geomed.dom.uab.edu>
--
ProMED-mail
<promed@promedmail.org>
[The main vector of chikungunya is _Aedes aegypti_, which does not occur in
the above 3 countries. _Aedes albopictus_ is a suspected vector in some
situations (see Archives 20060102.0007 & 20060302.0664).
In France there were until recently about 55 mosquito species, 18 of which
were _Aedes_ species, and there are about 46 species in Germany including 19
_Aedes_ species, and probably 29 species in Switzerland including 11 _Aedes_
species, none of which is a known vector anywhere of chikungunya. However,
the southeast Asian mosquito _Ae. albopictus_ was discovered in France in the
Orne and Vienne departments in October 1999 (Schaffner, F. et al. ( 2001)
European Mosquito Bulletin, 9: 1-3). Therefore some might argue that there
could be a risk of transmission in France, but personally I think this is
slight. However, it would be informative to have the thoughts of French
medical entomologists on the possible transmission of chikungunya virus in
France. Mod. MS]
[see also:
Chikungunya - Indian Ocean update (03): spread to France 20060225.0619
Chikungunya - Indian Ocean update (02): Reunion 20060224.0609
Chikungunya - India (AP): susp. 20060220.0551
Chikungunya virus vaccine 20060219.0544
Chikungunya - Indian Ocean update 20060218.0525
Chikungunya - Mauritius and Reunion Island (10): Mauritius 20060216.0509
Chikungunya - Mauritius and Reunion Island (09): Reunion 20060214.0491
Chikungunya - Mauritius and Reunion Island (08): Reunion 20060205.0378
Chikungunya - Mauritius and Reunion Island (07): Reunion 20060204.0358
Chikungunya - Madagascar: susp., RFI 20060202.0340
Chikungunya - Mauritius and Reunion Island (06): Reunion 20060203.0343
Chikungunya - Mauritius and Reunion Island (05): Reunion 20060131.0306
Chikungunya - Mauritius and Reunion Island (04): Reunion 20060127.0254
Chikungunya - Mauritius and Reunion Island (03): Reunion 20060124.0230
Chikungunya - Mauritius and Reunion Island (02): Reunion 20060121.0202
Chikungunya - Mauritius and Reunion Island: Reunion 20060102.0007
2005
----
Chikungunya - Mauritius and Reunion Island (04): Reunion 20051231.3716
Chikungunya - Mayotte, Reunion, Comoros 20050913.2707
Chikungunya - Indonesia (Tangerang) 20050717.2059
Chikungunya - Mauritius and Reunion Island (03) 20050624.1770
Deaths at sea - France (Reunion Island): RFI 20050622.1759
Chikungunya - Mauritius and Reunion Island (2) 20050520.1384
Chikungunya - Mauritius and Reunion Island 20050519.1372
Chikungunya - Indonesia (West Lombok) 20050422.1121
Chikungunya - Comoros (Ngazidja) 20050405.0986]
...................ry/pg/ms/jw
*################################################# #########*
************************************************** **********
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************** **********
Please support ProMED-mail by donating to the 2005 Internet-
a-thon at <http://www.isid.org/netathon2005.shtml>
************************************************** **********
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
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