Health Alert
FIRST CONFIRMED (TRAVEL-RELATED) CASE OF CHIKUNGUNYA IDENTIFIED IN DELAWARE

Summary

The Delaware Division of Public Health (DPH) was notified today of the state’s first confirmed case of chikungunya associated with travel to the Caribbean nation of Haiti. The case, a 51 year old man from Sussex County, sought medical care in early July but did not require hospitalization.

Background

Chikungunya (pronounced chik-en-gun-ye) is a viral disease that is transmitted to people by infected Aedes aegypti and Aedes albopictus mosquitos. According to the Centers for Disease Control and Prevention (CDC), there are approximately 280 cases in the continental US, and only two are not associated with travel. (Florida is the only state that has seen cases that are not related to travel. The state announced last week two cases acquired in residents from local mosquitoes.) All other cases occurred in travelers returning from affected areas in the Caribbean and South America.

The mosquitoes that transmit the virus are found in Delaware. Since chikungunya virus is new to the Americas, most people in the region are not immune. This combination of the presence of the mosquito vector and a non-immune population make it possible that local transmission could occur in the future.

Symptoms of chikungunya usually begin 3-7 days after an individual is bitten by an infected mosquito. The most common symptoms are fever and severe joint pains, often in the hands and feet. Other symptoms may include headache, muscle pain, joint swelling or rash. Most patients feel better within a week, while others may develop longer-term joint pain. People at increased risk for severe disease include newborns exposed during delivery, older adults (65 and over), and people with underlying medical conditions. Deaths as a result from chikungunya infection are rare.

There is no vaccine or medication to prevent or treat chikungunya virus infection. Reducing mosquito exposure is the best prevention against this and other mosquito-borne diseases.

Reporting

All arboviral human infections, including chikungunya, West Nile virus, Eastern Equine encephalitis, St. Louis encephalitis and others, are reportable in Delaware. If you suspect a patient may have chikungunya, or other arboviral infection, please notify the DPH, Office of Infectious Disease Epidemiology at 888-295-5156. Epidemiology staff can assist with coordination of specimen testing since many laboratories do not yet have this testing capability.

Testing

Chikungunya virus diagnostic assays consist of:

• Viral culture
• Reverse transcriptase-polymerase chain reaction (RT-PCR)
• Enzyme-linked immunosorbent assay (ELISA) or immunofluorescence assay (IFA) for immunoglobulin (Ig) M or IgG antibodies
• Plaque reduction neutralization test (PRNT)
• Immunohistochemical staining (IHC)

Optimal timing for use of diagnostic assays:

• Viral culture: ≤3 days after illness onset
• RT-PCR: ≤8 days after illness onset
• IgM antibody tests: ≥4 days after illness onset

Additional Information

• Centers for Disease Control and Prevention:  http://www.cdc.gov/chikungunya/
• DPH, Office of Infectious Disease Epidemiology: 888-295-5156

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