Snowy Owl
Retired in 2010, In Memoriam
Genome Microevolution of Chikungunya Viruses Causing the <?xml:namespace prefix = st1 /><st1
lace><?xml:namespace prefix = u1 /><u1lace><u1lace>Indian Ocean</u1lace></u1lace></st1lace> Outbreak<?xml:namespace prefix = o /><o></o>
lace><?xml:namespace prefix = u1 /><u1lace><u1lace>Indian Ocean</u1lace></u1lace></st1lace> Outbreak<?xml:namespace prefix = o /><o></o><o></o>
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Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, et al. (2006) Genome Microevolution of Chikungunya Viruses Causing the Indian Ocean Outbreak. PLoS Med 3(7): e263 (PLoS Website)
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Introduction <o></o>></o>Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus belonging to family Togaviridae [1,2]. It was isolated for the first time from a Tanzanian outbreak in 1952 [3]. It is responsible for an acute infection of abrupt onset, characterized by high fever, arthralgia, myalgia, headache, and rash [4,5]. Poly-arthralgia, the typical clinical sign of the disease, is very painful. Symptoms are generally self-limiting and last 1?10 d. However, arthralgia may persist for months or years. In some patients, minor hemorrhagic signs such as epistaxis or gingivorrhagia have also been described.
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CHIKV is geographically distributed in... (Download Full Article PDF)
<o
></o> CHIKV is geographically distributed in... (Download Full Article PDF)
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- d Newsline
Sun, 18 Feb 2007 18:05:00 GMT - British High Commission pitches in - Seychelles Nation
Sun, 04 Feb 2007 05:51:00 GMT - Authorities step up vector-control activities - Hindu
Wed, 07 Feb 2007 08:46:00 GMT - Early warning system for malaria to be set up at Nirma varsity - Expressindia.com
Wed, 07 Feb 2007 20:21:00 GMT - No need for a General Election - Healthcare Minister - Columbo Daily News
Mon, 12 Feb 2007 20:36:00 GMT - Relieving Pharma launches Insecticidal Nets in Sri Lanka - Asian Tribune
Tue, 30 Jan 2007 17:54:00 GMT - Guarding health and safety in a flood - Jakarta Post
Wed, 14 Feb 2007 04:34:00 GMT
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></o>Chikungunya in the south west Indian Ocean <o
></o>Chikungunya in Mauritius, Seychelles, Mayotte Reunion
Study shows why CHIKV started (see full text)<o
></o>
CHIKV - (Chikungunya) Audio Part l <o
></o>- CHIKV - Chikungunya ) Audio Part ll <o></o>
- Travel Alert - CHIKV International Travelers<o></o>
- CHIKV Outbreaks - African Genotype, <u1:country-region><u1lace>India</u1lace></u1:country-region>
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</TD><TD language=JAVASCRIPT class=MainNavOriginal onmouseover="this.className='MainNavMouseOver'" title="Although there have been historic epidemics of chikungunya, particularly in Africa, it is the recent epidemics in Asia that certainly are cause for alarm. Since late 2004 there has been an enormous outbreak in the countries bordering the Indian Ocean. The numbers of cases have been staggering. The French Island of Reunion (pop. 770,000) has had 244,000 cases and 200 deaths. One of every three people infected with the virus! More recently the epidemic spread to several states in India. The Indian State of Karnataka Bangalore has reported 78,000 cases and Andhra Pradesh reported ca. 200,000 cases. Cases also occurred in the Indian State of Maharashtra, and on the Indian Ocean islands of Mayotte, Mauritius, Seychelles, Madagascar, and Comoros. Humans develop a high viremia and therefore the mosquito-man-mosquito cycle can spread the virus. Literally 100s of thousands of people have been infected in this region. It is certainly of concern that France has reported 307 imported chikungunya cases from travelers returning to France from these regions. Although the animal reservoirs for CHIKV are jungle primates (monkeys and baboons) that are unlikely to directly spread to the U. S., it would not be difficult for CHIKV to gain a foothold with the arrival of a human infected traveler wherever there are Ae. aegypti or Ae. albopictus; hence the reason why the U. S. is at real risk." onmouseout="this.className='MainNavOriginal'" vAlign=top align=middle bgColor=#f36927>Where is CHIKV <o></o><o></o>
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</TD><TD language=JAVASCRIPT class=MainNavOriginal onmouseover="this.className='MainNavMouseOver'" title="How do humans become infected with chikungunya virus?CHIKV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on a person infected with CHIKV. Monkeys, and possibly other wild animals, may also serve as reservoirs of the virus. Infected mosquitoes can then spread the virus to other humans when they bite.
Aedes aegypti (the yellow fever mosquito), a household container breeder and aggressive daytime biter which is attracted to humans, is the primary vector of CHIKV to humans. Aedes albopictus (the Asian tiger mosquito)may also play a role in human transmission is Asia, and various forest-dwelling mosquito species in Africa have been found to be infected with the virus. " onmouseout="this.className='MainNavOriginal'" vAlign=top align=middle bgColor=#f36927></TD><TD bgColor=white>
</TD><TD language=JAVASCRIPT class=MainNavOriginal onmouseover="this.className='MainNavMouseOver'" title="The name is derived from a word meaning to become contorted, and signifies the cause of a contortion or folding. Some say the word is from the phrase ?to walk bent over.? From these phrases alone readers should realize this is not something to be treated cavalierly ? you do not want this disease. The disease has an incubation period of 4-7 days and then there is a sudden onset of the symptoms. Patients often develop painful inflammation of the joints that result in a stooped posture. The other symptoms can include fever (>104?F), headache, vomiting, nausea and a skin rash (ca. 80% of cases have the rash). The symptoms here can easily be confused with dengue. Although rarely fatal, children can develop neurological problems. Symptoms usually subside within 3-5 days. However, the joint pain can persist for many months or even years after the other symptoms have subsided. Approximately 12% of cases develop chronic joint symptoms. There is no vaccine and no specific therapies for treatment. The vectors unfortunately, and this should send a chill through U. S. mosquito control and public health workers, are Aedes aegypti and Aedes albopictus." onmouseout="this.className='MainNavOriginal'" vAlign=top align=middle bgColor=#f36927></TD><TD bgColor=white>
</TD><TD language=JAVASCRIPT class=MainNavOriginal onmouseover="this.className='MainNavMouseOver'" title="How is chikungunya virus infection treated?No vaccine or specific antiviral treatment for chikungunya fever is available. Treatment is symptomatic--rest, fluids, and ibuprofen, naproxen, acetaminophen, or paracetamol may relieve symptoms of fever and aching. Aspirin should be avoided
Infected persons should be protected from further mosquito exposure (staying indoors and/or under a mosquito net during the first few days of illness) so that they can't contribute to the transmission cycle." onmouseout="this.className='MainNavOriginal'" vAlign=top align=middle width=11 bgColor=#f36927></TD><TD bgColor=white>
</TD><TD language=JAVASCRIPT class=MainNavOriginal onmouseover="this.className='MainNavMouseOver'" title="What can people do to prevent becoming infected with chikungunya virus?The best way to avoid CHIKV infection is to prevent mosquito bites. There is no vaccine or preventive drug. Prevention tips are similar to those for dengue or West Nile virus:
Use insect repellent containing an DEET or another EPA-registered active ingredient on exposed skin. Always follow the directions on the package.
Wear long sleeves and pants (ideally treat clothes with permethrin or another repellent).
Have secure screens on windows and doors to keep mosquitoes out.
Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used.
Additionally, a person with chikungunya fever or dengue should limit their exposure to mosquito bites in order to avoid further spreading the infection. The person should stay indoors or under a mosquito net" onmouseout="this.className='MainNavOriginal'" vAlign=top align=middle width=12 bgColor=#f36927></TD></TR></TBODY></TABLE>
And Just When You Thought It Was Safe Out There, Along Comes Chikungunya CHIKV)!
<o
></o> Emerging pathogens are always in the news ? <st1
lace><u1lace><u1lace>West Nile</u1lace></u1lace></st1lace>, SARS, Flu and more to come. The recent development of an Emerging Pathogens Initiative (EPI) at the University of Florida (UF) is <?xml:namespace prefix = u2 /><u2:state><u2lace><u1:state><u1lace><st1:state><st1lace>Florida</st1lace></st1:state></u1lace></u1:state></u2lace></u2:state>?s effort to address emerging pathogens. Mosquito-borne pathogens and the resulting diseases they cause are one of the concerns of Florida Mosquito Control. Emerging pathogens are the priority issues to be addressed by the EPI and the reason why the Florida Mosquito Control Association played an important role in supporting UF to obtain the State funds to support the EPI. <st1:state><st1
lace><u2:state><u2lace><u1:state><u1lace>Florida</u1lace></u1:state></u2lace></u2:state></st1lace></st1:state> mosquito control, the FMEL, and PHEREC have a long history of addressing <u2:state><u2lace><u1:state><u1lace><st1:state><st1lace>Florida</st1lace></st1:state></u1lace></u1:state></u2lace></u2:state>?s mosquito borne pathogens, all of which can be considered as emerging. Mosquito-borne pathogens emerge periodically to cause outbreaks in <u2:state><u2lace><u1:state><u1lace><st1:state><st1lace>Florida</st1lace></st1:state></u1lace></u1:state></u2lace></u2:state>. Our goal, reiterated often in previous Buzz Words, is to provide an ability to predict outbreaks in time and space well in advance of human cases so targeted effective control measures can be implemented. Our <u2:state><u2lace><u1:state><u1lace><st1:state><st1lace>Florida</st1lace></st1:state></u1lace></u1:state></u2lace></u2:state> sentinel surveillance system is set up with this objective as the primary goal. The topic on our plate the past few years has been <u2lace><u1lace><st1lace>West Nile</st1lace></u1lace></u2lace> virus. But of course we also have been aware of St. Louis encephalitis virus, Eastern equine encephalitis virus, dengue virus, malaria, yellow fever virus, and we have even heard papers at our Mosquito Control Association meetings on Rift Valley fever virus. And then along comes chikungunya virus (CHIKV)!
Why the concern over CHIKV? Chickungunya is a disease that was first described in 1952 in <u2:country-region><u2
lace><u1:country-region><u1lace></u1lace></u1:country-region></u2lace></u2:country-region><st1:country-region><st1lace>Tanzania</st1lace></st1:country-region>. The name is from the Makonde language (it is not Swahili as has been reported in the press and some articles) (see information at http://research.yale.edu/swahili/learn/?q=en/chikungunya_makonde). The name is derived from a word meaning to become contorted, and signifies the cause of a contortion or folding. Some say the word is from the phrase ?to walk bent over.? From these phrases alone readers should realize this is not something to be treated cavalierly ? you do not want this disease. The disease has an incubation period of 4-7 days and then there is a sudden onset of the symptoms. <o></o>Patients often develop painful inflammation of the joints that result in a stooped posture. The other symptoms can include fever (>104?F), headache, vomiting, nausea and a skin rash (ca. 80% of cases have the rash). The symptoms here can easily be confused with dengue. Although rarely fatal, children can develop neurological problems. Symptoms usually subside within 3-5 days. However, the joint pain can persist for many months or even years after the other symptoms have subsided. Approximately 12% of cases develop chronic joint symptoms. There is no vaccine and no specific therapies for treatment. The vectors unfortunately, and this should send a chill through U. S. mosquito control and public health workers, are Aedes aegypti and Aedes albopictus.
Where is CHIKV?<o
></o>Although there have been historic epidemics of chikungunya, particularly in <u2
lace><u1lace><st1lace>Africa</st1lace></u1lace></u2lace>, it is the recent epidemics in <u2lace><u1lace><st1lace>Asia</st1lace></u1lace></u2lace> that certainly are cause for alarm. Since late 2004 there has been an enormous outbreak in the countries bordering the <u2lace><u1lace><st1lace>Indian Ocean</st1lace></u1lace></u2lace>. The numbers of cases have been staggering. The <u2lace><u2lacename><u1lace><u1lacename><st1lace><st1lacename>French</st1lacename></st1lace></u1lacename><st1lacetype><u2lacetype><u1lacetype>Island</u1lacetype></u2lacetype></st1lacetype></u1lace></u2lacename></u2lace> of <u2lace><u1lace><st1lace>Reunion</st1lace></u1lace></u2lace> (pop. 770,000) has had 244,000 cases and 200 deaths. One of every three people infected with the virus! More recently the epidemic spread to several states in <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>India</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region>. The <u2lace><u2lacename><u1lace><u1lacename><st1lace><st1lacename>Indian</st1lacename></st1lace></u1lacename><st1lacetype><u2lacetype><u1lacetype>State</u1lacetype></u2lacetype></st1lacetype></u1lace></u2lacename></u2lace> of Karnataka <u2:city><u2lace><u1:city><u1lace><st1:city><st1lace>Bangalore</st1lace></st1:city></u1lace></u1:city></u2lace></u2:city> has reported 78,000 cases and Andhra Pradesh reported ca. 200,000 cases. Cases also occurred in the <u2lace><u2lacename><u1lace><u1lacename><st1lace><st1lacename>Indian</st1lacename></st1lace></u1lacename><st1lacetype><u2lacetype><u1lacetype>State</u1lacetype></u2lacetype></st1lacetype></u1lace></u2lacename></u2lace> of <u2lace><u1lace><st1lace>Maharashtra</st1lace></u1lace></u2lace>, and on the <u2lace><u1lace><st1lace>Indian Ocean</st1lace></u1lace></u2lace> islands of <u2lace><u2:city><u1lace><u1:city><st1lace><st1:city>Mayotte</st1:city></st1lace></u1:city></u1lace>, <u2:country-region><u1:country-region><st1:country-region>Mauritius</st1:country-region></u1:country-region></u2:country-region></u2:city>, <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>Seychelles</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region>, <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>Madagascar</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region>, and <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>Comoros</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region>. Humans develop a high viremia and therefore the mosquito-man-mosquito cycle can spread the virus. Literally 100s of thousands of people have been infected in this region. It is certainly of concern that <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>France</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region> has reported 307 imported chikungunya cases from travelers returning to <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>France</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region> from these regions. Although the animal reservoirs for CHIKV are jungle primates (monkeys and baboons) that are unlikely to directly spread to the <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>U. S.</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region>, it would not be difficult for CHIKV to gain a foothold with the arrival of a human infected traveler wherever there are Ae. aegypti or Ae. albopictus; hence the reason why the <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>U. S.</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region> is at real risk. Why chikungunya, and why now? Some light on this may have been provided by a recent paper by Schuffenecker et al. (2006. Genome microevolution of chikungunya viruses causing the <u2
lace><u1lace><st1lace>Indian Ocean</st1lace></u1lace></u2lace> outbreak. PLoS Med. 2006 July; 3) that can be accessed on line at http://www.pubmedcentral.gov/articlerender.fcgi?artid=1463904. The authors provide the complete sequence for 6 viral isolates from the outbreak obtained from patients in different areas and times. They also sequenced the viral gene E1 from 121 other patients because this gene was useful in establishing relationships in several previous studies going back to 1982. The authors show that the <u2lace><u1lace><st1lace>Indian Ocean</st1lace></u1lace></u2lace> strains were derived from <u2lace><u1lace><st1lace>East Africa</st1lace></u1lace></u2lace>, and that the East African strain quickly diverged into distinct variants in the <u2lace><u1lace><st1lace>Indian Ocean</st1lace></u1lace></u2lace> epidemic. There are several regions of the genome that diverged but the authors point to one segment on the E1 protein that is common to all the epidemic isolates. This change is in a region of the virus genome known to be important in forming the virus outer shell. The authors speculate that this change may have made this variant more efficient in replicating itself in the mosquito vector and this is the reason for the rapid and widespread outbreak. Of course this is speculation and this hypothesis will need to be tested directly. CHIKV has caused an enormous epidemic in <u2
lace><u1lace><st1lace>Asia</st1lace></u1lace></u2lace> possibly the result of some genetic changes in the virus. The mosquito vectors responsible for this epidemic are already present in the U. S., and of course in <u2:state><u2lace><u1:state><u1lace><st1:state><st1lace>Florida</st1lace></st1:state></u1lace></u1:state></u2lace></u2:state>. Imported human cases have already appeared in <u2lace><u1lace><st1lace>Europe</st1lace></u1lace></u2lace>. This is not good. Stay tuned; be watchful for a chikungunya outbreak in the <u2:country-region><u2lace><u1:country-region><u1lace><st1:country-region><st1lace>U. S.</st1lace></st1:country-region></u1lace></u1:country-region></u2lace></u2:country-region> And now there is CHIKV.
Walter J. Tabachnick, Ph.D., Director and Professor
Florida Medical Entomology Laboratory
Department of Entomology and <u2
lace><u2lacename><u1lace><u1lacename><st1lace><st1lacename>Nematology</st1lacename></st1lace></u1lacename><st1lacetype><u2lacetype><u1lacetype>University</u1lacetype></u2lacetype></st1lacetype></u1lace></u2lacename></u2lace></u2lace> of <u2:state><u2lace><u1:state><u1lace><st1:state><st1lace>Florida</st1lace></st1:state></u1lace></u1:state></u2lace></u2:state>/IFAS/<u2:city><u1lace><u1:city><st1lace><st1:city>Vero Beach</st1:city></st1lace></u1:city></u1lace>, <u1:state><st1:state>Florida</st1:state></u1:state></u2:city><u2:city><u1:state><st1:state></st1:state></u1:state></u2:city>
<u2:city><u1:state><st1:state>
A propos de la maladie
<o
></o> Le virus Chikungunya (qui signifie en swahili "marcher courb?", en raison des fortes douleurs articulaires qu?il provoque) est un arbovirus transmis par un moustique du genre Aedes. Il circule surtout en Afrique de l?Est, en Asie du Sud-est et dans le sous-continent indien. <o
></o>Environ 4 ? 7 jours apr?s la piq?re de moustique infectante, une fi?vre ?lev?e appara?t brutalement. S?y associent alors typiquement d?importantes douleurs articulaires et musculaires touchant les extr?mit?s des membres (poignets, chevilles, phalanges), des oed?mes, des c?phal?es et, parfois, une ?ruption cutan?e. Des h?morragies b?nignes ? type d??pistaxis et de gingivorragies peuvent survenir, surtout chez les enfants.
<o
></o> L??volution spontan?e de la maladie est le plus souvent favorable. Des formes chroniques existent cependant, caract?ris?es par des arthralgies persistantes, r?cidivantes et parfois invalidantes. Aucun cas mortel d?infection ? Chikungunya n?avait ?t? rapport? lors des ?pid?mies pr?c?dant <u1:city><u1
lace>celle</u1lace></u1:city> de la R?union. La prise en charge th?rapeutique repose essentiellement sur la prescription d?anti-inflammatoires non st?ro?diens afin de soulager les douleurs.<o></o>
<o
></o> La surveillance est bas?e sur un r?seau de m?decins sentinelles qui permet de suivre au mieux les tendances de l??pid?mie.<o></o>
Depuis le d?but de l??pid?mie (mars 2005), 4044 cas ont ?t? notifi?s par les m?decins du r?seau sentinelle de l??le de la R?union, dont 3 au cours de la semaine 26 de 2006.
<o></o>
Une estimation ? partir d?un mod?le math?matique, bas? sur les s?ries historiques, permet d??valuer le nombre total de cas de Chikungunya depuis le d?but de l??pid?mie ? un peu plus de 266 000. Ce nombre correspond au total des personnes ayant pr?sent?, ? un moment ou ? un autre depuis mars 2005, une forme clinique de la maladie, qu?elles aient ou non consult? un m?decin. Il ne correspond pas au nombre de personnes actuellement malades. Le m?me mod?le math?matique permet d?estimer ? 200 le nombre de nouveau cas survenus dans la semaine du 26 juin au 02 juillet 2006.
<o></o>
Par ailleurs, une enqu?te ? Chikungunya, une semaine donn?e ? a ?t? mise en ?uvre aupr?s de l?ensemble des m?decins g?n?ralistes de l??le auxquels il a ?t? demand? de signaler l?int?gralit? des cas suspects de chikungunya vus en consultation et ayant pr?sent? une symptomatologie r?cente (apparition des signes cliniques apr?s le 15 juin 2006). Au 06 juillet 2006, 202 m?decins sur 725 ont particip? ? l?enqu?te (28%) et ont signal? un total de 81 cas dont 41 qui ont d?but? la maladie semaine 26.
<o></o>
Apr?s avoir atteint un pic lors de la semaine du 6 au 12 f?vrier, le nombre de cas hebdomadaire a ensuite fortement diminu? jusqu?? la mi-mars. Depuis, la diminution s?est poursuivie et se confirme en semaine 26.<o></o>
L??volution de l??pid?mie demeure impr?visible en raison d??v?nements climatiques inopin?s qui peuvent contribuer ? modifier l??cologie du moustique vecteur de la maladie.
<o></o>
La transmission de la maladie a ?t? tr?s active dans toutes les communes de l??le. Actuellement, le nombre de cas le plus ?lev? est signal? dans les communes de Saint-Paul et <u1:city><u1lace>Saint-Denis</u1lace></u1:city>. Cette information doit cependant ?tre interpr?t?e avec pr?caution car elle d?pend du niveau de participation des m?decins au syst?me de surveillance, variable selon les communes.<o></o>
Formes graves et atypiques ></o>Depuis le d?but de l??pid?mie (mars 2005), 4044 cas ont ?t? notifi?s par les m?decins du r?seau sentinelle de l??le de la R?union, dont 3 au cours de la semaine 26 de 2006.
<o
></o> Une estimation ? partir d?un mod?le math?matique, bas? sur les s?ries historiques, permet d??valuer le nombre total de cas de Chikungunya depuis le d?but de l??pid?mie ? un peu plus de 266 000. Ce nombre correspond au total des personnes ayant pr?sent?, ? un moment ou ? un autre depuis mars 2005, une forme clinique de la maladie, qu?elles aient ou non consult? un m?decin. Il ne correspond pas au nombre de personnes actuellement malades. Le m?me mod?le math?matique permet d?estimer ? 200 le nombre de nouveau cas survenus dans la semaine du 26 juin au 02 juillet 2006.
<o
></o> Par ailleurs, une enqu?te ? Chikungunya, une semaine donn?e ? a ?t? mise en ?uvre aupr?s de l?ensemble des m?decins g?n?ralistes de l??le auxquels il a ?t? demand? de signaler l?int?gralit? des cas suspects de chikungunya vus en consultation et ayant pr?sent? une symptomatologie r?cente (apparition des signes cliniques apr?s le 15 juin 2006). Au 06 juillet 2006, 202 m?decins sur 725 ont particip? ? l?enqu?te (28%) et ont signal? un total de 81 cas dont 41 qui ont d?but? la maladie semaine 26.
<o
></o> Apr?s avoir atteint un pic lors de la semaine du 6 au 12 f?vrier, le nombre de cas hebdomadaire a ensuite fortement diminu? jusqu?? la mi-mars. Depuis, la diminution s?est poursuivie et se confirme en semaine 26.<o
></o>L??volution de l??pid?mie demeure impr?visible en raison d??v?nements climatiques inopin?s qui peuvent contribuer ? modifier l??cologie du moustique vecteur de la maladie.
<o
></o> La transmission de la maladie a ?t? tr?s active dans toutes les communes de l??le. Actuellement, le nombre de cas le plus ?lev? est signal? dans les communes de Saint-Paul et <u1:city><u1
lace>Saint-Denis</u1lace></u1:city>. Cette information doit cependant ?tre interpr?t?e avec pr?caution car elle d?pend du niveau de participation des m?decins au syst?me de surveillance, variable selon les communes.<o></o>
<o
></o> Au total, depuis le d?but de l??pid?mie, 246 personnes avec une infection ? Chikungunya confirm?e biologiquement ont eu une expression clinique grave de la maladie (formes neurologiques, h?patiques, ?) n?cessitant une hospitalisation en r?animation.
De plus, 40 cas d?infections materno-n?onatales ont ?t? confirm?es biologiquement chez des nouveaux n?s de moins de 10 jours. Un d?c?s a ?t? constat? parmi ces derniers.
<o></o>
Par ailleurs, les m?decins signalent un risque de d?compensation li? aux effets de l?infection aigue sur l??tat g?n?ral des personnes vuln?rables, en particulier les personnes ?g?es, les nouveaux n?s, les personnes immunod?prim?es?.<o></o>
D?c?s De plus, 40 cas d?infections materno-n?onatales ont ?t? confirm?es biologiquement chez des nouveaux n?s de moins de 10 jours. Un d?c?s a ?t? constat? parmi ces derniers.
<o
></o> Par ailleurs, les m?decins signalent un risque de d?compensation li? aux effets de l?infection aigue sur l??tat g?n?ral des personnes vuln?rables, en particulier les personnes ?g?es, les nouveaux n?s, les personnes immunod?prim?es?.<o
></o>
<o
></o> Depuis janvier 2006, 239 certificats de d?c?s dans lesquels le Chikungunya est mentionn? ont ?t? recens?s. La majorit? des d?c?s est enregistr?e chez des individus ?g?s de plus de 68 ans, avec pr?s de 75% des d?c?s. Le pic des d?c?s s?est situ? entre les semaines 7 et 9.<o></o>
></o>Situation ? Mayotte
<o
></o>Depuis le d?but de l?ann?e, ? la date du 02 juillet 2006, 7090 cas suspects d?infection aigue ? Chikungunya ont ?t? rapport?s par les m?decins ? Mayotte, dont 35 cas d?clar?s ayant pr?sent? les premiers sympt?mes au cours de la semaine 25 et 20 cas au cours de la semaine 26. L??pid?mie semble marquer le pas depuis la mi-mars et en fin de semaine 26, la diminution du nombre hebdomadaire de cas d?clar?s se poursuit ? l?exception des deux communes de Sada et Chiconi (C?te Ouest) o? est enregistr?e une augmentation du nombre de cas d?clar?s.
<o></o>
Si ces chiffres permettent de suivre les tendances de l??pid?mie, ils ne refl?tent toutefois pas son ampleur r?elle de car de nombreux patients n?ont pas recours aux services m?dicaux et ne sont donc pas comptabilis?s. En effet, une enqu?te r?cemment men?e dans la population g?n?rale par l?InVS a montr? que moins de la moiti? des personnes interrog?es qui d?claraient avoir pr?sent? des sympt?mes compatibles avec le chikungunya (26% de l??chantillon) ont eu un contact avec les services de soins ?officiels?. Beaucoup de ces patients avaient eu recours ? l?autom?dication et/ou ? la m?decine traditionnelle.
<o></o>
A Mayotte, au 02 juillet 2006, aucune infection materno-n?onatale ni aucune forme grave constat?e chez des patients de plus de 10 jours n?ont ?t? confirm?es en semaines 25 et 26. Quant aux formes ?mergentes caract?ris?es par un tableau clinique moins s?v?re, 30 cas de personnes ?g?es de plus de 10 jours ont ?t? enregistr?es depuis le d?but de l??pid?mie.
<o></o>
A ce jour, aucun certificat de d?c?s portant la mention ? Chikungunya ? n?a ?t? re?u par la Dass de Mayotte. Cependant, il a ?t? rapport? le cas d?un enfant de 10 jours d?c?d? en f?vrier 2006 d?une m?ningite bact?rienne et infect? de fa?on concomitante par le virus du chikungunya. <o></o>
<o
></o> Si ces chiffres permettent de suivre les tendances de l??pid?mie, ils ne refl?tent toutefois pas son ampleur r?elle de car de nombreux patients n?ont pas recours aux services m?dicaux et ne sont donc pas comptabilis?s. En effet, une enqu?te r?cemment men?e dans la population g?n?rale par l?InVS a montr? que moins de la moiti? des personnes interrog?es qui d?claraient avoir pr?sent? des sympt?mes compatibles avec le chikungunya (26% de l??chantillon) ont eu un contact avec les services de soins ?officiels?. Beaucoup de ces patients avaient eu recours ? l?autom?dication et/ou ? la m?decine traditionnelle.
<o
></o> A Mayotte, au 02 juillet 2006, aucune infection materno-n?onatale ni aucune forme grave constat?e chez des patients de plus de 10 jours n?ont ?t? confirm?es en semaines 25 et 26. Quant aux formes ?mergentes caract?ris?es par un tableau clinique moins s?v?re, 30 cas de personnes ?g?es de plus de 10 jours ont ?t? enregistr?es depuis le d?but de l??pid?mie.
<o
></o> A ce jour, aucun certificat de d?c?s portant la mention ? Chikungunya ? n?a ?t? re?u par la Dass de Mayotte. Cependant, il a ?t? rapport? le cas d?un enfant de 10 jours d?c?d? en f?vrier 2006 d?une m?ningite bact?rienne et infect? de fa?on concomitante par le virus du chikungunya. <o
></o>Situation Internationale<o
></o>Le virus Chikungunya circule dans tout l?Oc?an Indien depuis le d?but de l?ann?e 2006.
<o
></o> ? Les Seychelles (80 000 habitants) et Maurice (1,2 Millions d?habitants) ont signal? plusieurs milliers de cas entre janvier et mars 2006.
Les donn?es r?centes sur l??pid?mie aux Seychelles montrent un recul important du nombre de cas depuis la mi-f?vrier 2006 avec une stabilisation de l?incidence hebdomadaire ? environ 30 cas par semaine.
Des informations indiquent que l??pid?mie est ?galement moins intense ? Maurice.<o
></o>? Des cas ont aussi ?t? identifi?s ? Madagascar(Toamasina) et aux Comores (Anjouan). <o
></o>? L??pid?mie de chikungunya s?vit en Inde dans les Etats d?Andar Pradesh, du Maharasthra, du Karnataka et du Tamil Nadu.
Les estimations les plus r?centes datant de mai et juin 2006 faisaient ?tat de plus de 450 000 cas suspects de chikungunya, parmi lesquels 691 cas confirm?s. Une ?pid?mie de dengue s?vit ?galement dans les Etats voisins.
<o
></o> ? Une ?pid?mie (200 cas) a ?t? signal?e en Malaisie, touchant la c?te de l??tat du P?rak, au nord de Kuala Lumpur. <o
></o>Mesures de lutte<o
></o>A la R?union, en d?pit de la baisse de l?intensit? de l??pid?mie enregistr?e depuis la mi-f?vrier 2006 et de l?approche de l?hiver austral, la transmission du virus demeure active et est comparable ? celle occasionn?e en semaine 26 de l?ann?e 2005. Il est important de rappeler que cette transmission s??tait poursuivie au cours de l?hiver austral 2005 avant d?augmenter brutalement au retour de conditions climatiques favorables. Afin de continuer ? suivre les tendances de l??pid?mie, l?adaptation du dispositif de surveillance ? la situation ?pid?miologique actuelle est en cours de mise en ?uvre.
<o
></o> Dans ce contexte, il convient de rappeler avec force l?importance d?adopter des comportements individuels visant ? se prot?ger des piq?res de moustique et de contribuer ? la destruction des g?tes larvaires.
<o
></o> Il n?existe ni vaccin ni traitement pr?ventif contre l?infection ? Chikungunya. Les mesures de contr?le reposent donc sur les efforts coupl?s de lutte antivectorielle et de lutte communautaire afin d??liminer les g?tes de moustiques.
<o
></o> Depuis la fin de l?hiver austral 2005, les mesures de lutte antivectorielle ont ?t? consid?rablement renforc?es, mais doivent venir en compl?ment des mesures de lutte communautaire ?galement indispensables. L?ensemble de la population est concern? et doit poursuivre les actions quotidiennes de destruction des g?tes potentiels autour des habitations (eau stagnante dans les soucoupes, vases, seaux, d?tritus?.).
<o
></o> Dans ces conditions, les mesures de pr?vention individuelle contre les piq?res de moustique sont tr?s importantes et doivent ?tre prises de fa?on quotidienne: spray et cr?mes, diffuseurs ?lectriques, serpentins, v?tements longs et moustiquaires?
Les femmes enceintes et les tr?s jeunes enfants doivent faire l?objet de mesures particuli?rement renforc?es et adapt?es.
Le moustique vecteur pique surtout la journ?e, essentiellement ? l?ext?rieur des maisons, avec une activit? plus importante en d?but de matin?e et en fin de journ?e.
Pour en savoir plus<o></o>
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