Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Chikungunya fever

Mary Elizabeth Wilson, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Chikungunya is an arthropod-borne virus (arbovirus) endemic to West Africa that causes acute febrile polyarthralgia and arthritis. The name chikungunya is derived from a local language of Tanzania meaning "that which bends up" or "stooped walk" because of the incapacitating arthralgia caused by the disease.

Multiple outbreaks beyond West Africa have been described. Since 2004, chikungunya has spread broadly, causing massive outbreaks with explosive onset in the Indian Ocean region, India, and other parts of Asia [1-3]. Chikungunya had traditionally been perceived as a tropical disease until an outbreak in Italy in 2007. In addition, thousands of cases have been identified in travelers returning from outbreak areas [4]. The distribution of mosquito vectors capable of transmitting chikungunya virus is wide; since late 2013, chikungunya virus infections have spread widely in the Americas [5,6].


The United States Centers for Disease Control (CDC) maintains a page with reported current or previous local transmission of chikungunya virus.

Endemic areas — Chikungunya virus is endemic in parts of West Africa, where it appears to be maintained in a cycle involving humans, Aedes mosquitoes, primates, and perhaps other animals [7,8]. Serosurveys of humans in parts of West Africa have identified antibodies to chikungunya virus in 35 to 50 percent of the population in the absence of recognized outbreaks.

Spread and resurgence — Chikungunya virus spreads by means of travel of infected individuals between regions where competent mosquitoes exist for perpetuation of local transmission [6]. Imported cases have been described in many Asian and European countries as well as in the Americas and Australia [9-16]. Rapid spread in some locations may also be related to a viral mutation that enhances replication efficiency in the Aedes albopictus mosquito. (See 'Transmission' below and 'Mutation of virus and vector replication' below.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jul 28, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Charrel RN, de Lamballerie X, Raoult D. Chikungunya outbreaks--the globalization of vectorborne diseases. N Engl J Med 2007; 356:769.
  2. Mavalankar D, Shastri P, Raman P. Chikungunya epidemic in India: a major public-health disaster. Lancet Infect Dis 2007; 7:306.
  3. Morens DM, Fauci AS. Chikungunya at the door--déjà vu all over again? N Engl J Med 2014; 371:885.
  4. Enserink M. Infectious diseases. Chikungunya: no longer a third world disease. Science 2007; 318:1860.
  5. Pan American Health Organization. Preparedness and response for chikungunya virus: introduction into the Americas. Washington, DC: PAHO; 2011. http://new.paho.org/hq/index.php?option=com_content&task=view&id=6464&itemid=1926 (Accessed on October 05, 2012).
  6. Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med 2015; 372:1231.
  7. Chevillon C, Briant L, Renaud F, Devaux C. The Chikungunya threat: an ecological and evolutionary perspective. Trends Microbiol 2008; 16:80.
  8. Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis 2009; 49:942.
  9. Parola P, de Lamballerie X, Jourdan J, et al. Novel chikungunya virus variant in travelers returning from Indian Ocean islands. Emerg Infect Dis 2006; 12:1493.
  10. Hochedez P, Jaureguiberry S, Debruyne M, et al. Chikungunya infection in travelers. Emerg Infect Dis 2006; 12:1565.
  11. Panning M, Grywna K, van Esbroeck M, et al. Chikungunya fever in travelers returning to Europe from the Indian Ocean region, 2006. Emerg Infect Dis 2008; 14:416.
  12. Lanciotti RS, Kosoy OL, Laven JJ, et al. Chikungunya virus in US travelers returning from India, 2006. Emerg Infect Dis 2007; 13:764.
  13. Nicoletti L, Ciccozzi M, Marchi A, et al. Chikungunya and dengue viruses in travelers. Emerg Infect Dis 2008; 14:177.
  14. Centers for Disease Control and Prevention (CDC). Chikungunya fever diagnosed among international travelers--United States, 2005-2006. MMWR Morb Mortal Wkly Rep 2006; 55:1040.
  15. Centers for Disease Control and Prevention (CDC). Update: chikungunya fever diagnosed among international travelers--United States, 2006. MMWR Morb Mortal Wkly Rep 2007; 56:276.
  16. Gibney KB, Fischer M, Prince HE, et al. Chikungunya fever in the United States: a fifteen year review of cases. Clin Infect Dis 2011; 52:e121.
  17. Salje H, Cauchemez S, Alera MT, et al. Reconstruction of 60 Years of Chikungunya Epidemiology in the Philippines Demonstrates Episodic and Focal Transmission. J Infect Dis 2016; 213:604.
  18. Sergon K, Njuguna C, Kalani R, et al. Seroprevalence of Chikungunya virus (CHIKV) infection on Lamu Island, Kenya, October 2004. Am J Trop Med Hyg 2008; 78:333.
  19. Renault P, Solet JL, Sissoko D, et al. A major epidemic of chikungunya virus infection on Reunion Island, France, 2005-2006. Am J Trop Med Hyg 2007; 77:727.
  20. Sissoko D, Malvy D, Giry C, et al. Outbreak of Chikungunya fever in Mayotte, Comoros archipelago, 2005-2006. Trans R Soc Trop Med Hyg 2008; 102:780.
  21. Yergolkar PN, Tandale BV, Arankalle VA, et al. Chikungunya outbreaks caused by African genotype, India. Emerg Infect Dis 2006; 12:1580.
  22. Lakshmi V, Neeraja M, Subbalaxmi MV, et al. Clinical features and molecular diagnosis of Chikungunya fever from South India. Clin Infect Dis 2008; 46:1436.
  23. AbuBakar S, Sam IC, Wong PF, et al. Reemergence of endemic Chikungunya, Malaysia. Emerg Infect Dis 2007; 13:147.
  24. Wu D, Wu J, Zhang Q, et al. Chikungunya outbreak in Guangdong Province, China, 2010. Emerg Infect Dis 2012; 18:493.
  25. Rezza G, Nicoletti L, Angelini R, et al. Infection with chikungunya virus in Italy: an outbreak in a temperate region. Lancet 2007; 370:1840.
  26. Gould EA, Gallian P, De Lamballerie X, Charrel RN. First cases of autochthonous dengue fever and chikungunya fever in France: from bad dream to reality! Clin Microbiol Infect 2010; 16:1702.
  27. World Health Organization. Global Alert and Response: Chikungunya - France. http://www.who.int/csr/don/23-october-2014-chikungunya/en/ (Accessed on October 23, 2014).
  28. Pialoux G, Gaüzère BA, Jauréguiberry S, Strobel M. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis 2007; 7:319.
  29. Centers for Disease Control and Prevention. Chikungunya in the Caribbean. http://wwwnc.cdc.gov/travel/notices/watch/chikungunya-saint-martin (Accessed on June 02, 2014).
  30. Pan American Health Organization, World Health Organization. Chikungunya. http://www.paho.org/hq/index.php?option=com_content&view=article&id=9053&Itemid=39843 (Accessed on July 21, 2014).
  31. Fischer M, Staples JE, Arboviral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC. Notes from the field: chikungunya virus spreads in the Americas - Caribbean and South America, 2013-2014. MMWR Morb Mortal Wkly Rep 2014; 63:500.
  32. Centers for Disease Control and Prevention. CDC newsroom - press release. First Chikungunya case acquired in the United States reported in Florida. http://www.cdc.gov/media/releases/2014/p0717-chikungunya.html (Accessed on July 18, 2014).
  33. Florida Health. Florida Department of Health confirms first locally acquired cases of chikungunya fever. http://newsroom.doh.state.fl.us/wp-content/uploads/newsroom/2014/05/071714-Locally-Aquired-Chikungunya.pdf (Accessed on July 18, 2014).
  34. Centers for Disease Control and Prevention. Chikungunya virus in the United States. http://www.cdc.gov/chikungunya/geo/united-states.html (Accessed on July 18, 2014).
  35. Kendrick K, Stanek D, Blackmore C, Centers for Disease Control and Prevention (CDC). Notes from the field: Transmission of chikungunya virus in the continental United States--Florida, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1137.
  36. Sharp TM, Roth NM, Torres J, et al. Chikungunya cases identified through passive surveillance and household investigations--Puerto Rico, May 5-August 12, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1121.
  37. Nunes MR, Faria NR, de Vasconcelos JM, et al. Emergence and potential for spread of Chikungunya virus in Brazil. BMC Med 2015; 13:102.
  38. Roth A, Mercier A, Lepers C, et al. Concurrent outbreaks of dengue, chikungunya and Zika virus infections - an unprecedented epidemic wave of mosquito-borne viruses in the Pacific 2012-2014. Euro Surveill 2014; 19.
  39. ProMED mail. Invasive mosquito - USA (California). http://www.promedmail.org/post/3905373 (Accessed on January 14, 2016).
  40. Reiter P, Fontenille D, Paupy C. Aedes albopictus as an epidemic vector of chikungunya virus: another emerging problem? Lancet Infect Dis 2006; 6:463.
  41. Enserink M. Entomology. A mosquito goes global. Science 2008; 320:864.
  42. Rochlin I, Ninivaggi DV, Hutchinson ML, Farajollahi A. Climate change and range expansion of the Asian tiger mosquito (Aedes albopictus) in Northeastern USA: implications for public health practitioners. PLoS One 2013; 8:e60874.
  43. Gubler DJ. Aedes albopictus in Africa. Lancet Infect Dis 2003; 3:751.
  44. Tatem AJ, Hay SI, Rogers DJ. Global traffic and disease vector dispersal. Proc Natl Acad Sci U S A 2006; 103:6242.
  45. Caron M, Paupy C, Grard G, et al. Recent introduction and rapid dissemination of Chikungunya virus and Dengue virus serotype 2 associated with human and mosquito coinfections in Gabon, central Africa. Clin Infect Dis 2012; 55:e45.
  46. Tesh RB, Gubler DJ, Rosen L. Variation among goegraphic strains of Aedes albopictus in susceptibility to infection with chikungunya virus. Am J Trop Med Hyg 1976; 25:326.
  47. Reiskind MH, Pesko K, Westbrook CJ, Mores CN. Susceptibility of Florida mosquitoes to infection with chikungunya virus. Am J Trop Med Hyg 2008; 78:422.
  48. Vazeille M, Jeannin C, Martin E, et al. Chikungunya: a risk for Mediterranean countries? Acta Trop 2008; 105:200.
  49. Charrel RN, de Lamballerie X, Raoult D. Seasonality of mosquitoes and chikungunya in Italy. Lancet Infect Dis 2008; 8:5.
  50. Tsetsarkin KA, Vanlandingham DL, McGee CE, Higgs S. A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog 2007; 3:e201.
  51. Brouard C, Bernillon P, Quatresous I, et al. Estimated risk of Chikungunya viremic blood donation during an epidemic on Reunion Island in the Indian Ocean, 2005 to 2007. Transfusion 2008; 48:1333.
  52. Simmons G, Bres V, Lu, et al. High Incidence of Chikungunya Virus and Frequency of Viremic Blood Donations during Epidemic, Puerto Rico, USA, 2014. Emerg Infect Dis 2016; 22.
  53. Couderc T, Gangneux N, Chrétien F, et al. Chikungunya virus infection of corneal grafts. J Infect Dis 2012; 206:851.
  54. Gérardin P, Barau G, Michault A, et al. Multidisciplinary prospective study of mother-to-child chikungunya virus infections on the island of La Réunion. PLoS Med 2008; 5:e60.
  55. Ramful D, Sampériz S, Fritel X, et al. Antibody kinetics in infants exposed to Chikungunya virus infection during pregnancy reveals absence of congenital infection. J Infect Dis 2014; 209:1726.
  56. LUMSDEN WH. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. II. General description and epidemiology. Trans R Soc Trop Med Hyg 1955; 49:33.
  57. Simon F, Savini H, Parola P. Chikungunya: a paradigm of emergence and globalization of vector-borne diseases. Med Clin North Am 2008; 92:1323.
  58. Lidbury BA, Rulli NE, Suhrbier A, et al. Macrophage-derived proinflammatory factors contribute to the development of arthritis and myositis after infection with an arthrogenic alphavirus. J Infect Dis 2008; 197:1585.
  59. Schuffenecker I, Iteman I, Michault A, et al. Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med 2006; 3:e263.
  60. Bordi L, Carletti F, Castilletti C, et al. Presence of the A226V mutation in autochthonous and imported Italian chikungunya virus strains. Clin Infect Dis 2008; 47:428.
  61. Burt FJ, Rolph MS, Rulli NE, et al. Chikungunya: a re-emerging virus. Lancet 2012; 379:662.
  62. Simon F, Parola P, Grandadam M, et al. Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases. Medicine (Baltimore) 2007; 86:123.
  63. Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis 2007; 45:e1.
  64. Borgherini G, Poubeau P, Staikowsky F, et al. Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis 2007; 44:1401.
  65. Mahendradas P, Ranganna SK, Shetty R, et al. Ocular manifestations associated with chikungunya. Ophthalmology 2008; 115:287.
  66. Parola P, Simon F, Oliver M. Tenosynovitis and vascular disorders associated with Chikungunya virus-related rheumatism. Clin Infect Dis 2007; 45:801.
  67. Oliver M, Grandadam M, Marimoutou C, et al. Persisting mixed cryoglobulinemia in Chikungunya infection. PLoS Negl Trop Dis 2009; 3:e374.
  68. Schilte C, Staikowsky F, Couderc T, et al. Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study. PLoS Negl Trop Dis 2013; 7:e2137.
  69. Brighton SW, Prozesky OW, de la Harpe AL. Chikungunya virus infection. A retrospective study of 107 cases. S Afr Med J 1983; 63:313.
  70. Chen W, Foo SS, Rulli NE, et al. Arthritogenic alphaviral infection perturbs osteoblast function and triggers pathologic bone loss. Proc Natl Acad Sci U S A 2014; 111:6040.
  71. Robin S, Ramful D, Le Seach' F, et al. Neurologic manifestations of pediatric chikungunya infection. J Child Neurol 2008; 23:1028.
  72. Singh SS, Manimunda SP, Sugunan AP, et al. Four cases of acute flaccid paralysis associated with chikungunya virus infection. Epidemiol Infect 2008; 136:1277.
  73. Wielanek AC, Monredon JD, Amrani ME, et al. Guillain-Barré syndrome complicating a Chikungunya virus infection. Neurology 2007; 69:2105.
  74. Gérardin P, Couderc T, Bintner M, et al. Chikungunya virus-associated encephalitis: A cohort study on La Réunion Island, 2005-2009. Neurology 2016; 86:94.
  75. Chanana B, Azad RV, Nair S. Bilateral macular choroiditis following Chikungunya virus infection. Eye (Lond) 2007; 21:1020.
  76. Bhavana K, Tyagi I, Kapila RK. Chikungunya virus induced sudden sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2008; 72:257.
  77. Torres JR, Córdova LG, Saravia V, et al. Nasal Skin Necrosis: An Unexpected New Finding in Severe Chikungunya Fever. Clin Infect Dis 2016; 62:78.
  78. Paquet C, Quatresous I, Solet JL, et al. Chikungunya outbreak in Reunion: epidemiology and surveillance, 2005 to early January 2006. Euro Surveill 2006; 11:E060202.3.
  79. Economopoulou A, Dominguez M, Helynck B, et al. Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005-2006 outbreak on Réunion. Epidemiol Infect 2009; 137:534.
  80. Beesoon S, Funkhouser E, Kotea N, et al. Chikungunya fever, Mauritius, 2006. Emerg Infect Dis 2008; 14:337.
  81. Josseran L, Paquet C, Zehgnoun A, et al. Chikungunya disease outbreak, Reunion Island. Emerg Infect Dis 2006; 12:1994.
  82. Mavalankar D, Shastri P, Bandyopadhyay T, et al. Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India. Emerg Infect Dis 2008; 14:412.
  83. Queyriaux B, Simon F, Grandadam M, et al. Clinical burden of chikungunya virus infection. Lancet Infect Dis 2008; 8:2.
  84. Watanaveeradej V, Endy TP, Simasathien S, et al. The study transplacental chikungunya virus antibody kinetics, Thailand. Emerg Infect Dis 2006; 12:1770.
  85. Lee VJ, Chow A, Zheng X, et al. Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. PLoS Negl Trop Dis 2012; 6:e1786.
  86. Hochedez P, Canestri A, Guihot A, et al. Management of travelers with fever and exanthema, notably dengue and chikungunya infections. Am J Trop Med Hyg 2008; 78:710.
  87. Gould LH, Osman MS, Farnon EC, et al. An outbreak of yellow fever with concurrent chikungunya virus transmission in South Kordofan, Sudan, 2005. Trans R Soc Trop Med Hyg 2008; 102:1247.
  88. Ratsitorahina M, Harisoa J, Ratovonjato J, et al. Outbreak of dengue and Chikungunya fevers, Toamasina, Madagascar, 2006. Emerg Infect Dis 2008; 14:1135.
  89. Nayar SK, Noridah O, Paranthaman V, et al. Co-infection of dengue virus and chikungunya virus in two patients with acute febrile illness. Med J Malaysia 2007; 62:335.
  90. Ezzedine K, Cazanave C, Pistone T, et al. Dual infection by chikungunya virus and other imported infectious agent in a traveller returning from India. Travel Med Infect Dis 2008; 6:152.
  91. Javelle E, Ribera A, Degasne I, et al. Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012. PLoS Negl Trop Dis 2015; 9:e0003603.
  92. Simon F, Javelle E, Cabie A, et al. French guidelines for the management of chikungunya (acute and persistent presentations). November 2014. Med Mal Infect 2015; 45:243.
  93. Briolant S, Garin D, Scaramozzino N, et al. In vitro inhibition of Chikungunya and Semliki Forest viruses replication by antiviral compounds: synergistic effect of interferon-alpha and ribavirin combination. Antiviral Res 2004; 61:111.
  94. Savarino A, Cauda R, Cassone A. On the use of chloroquine for chikungunya. Lancet Infect Dis 2007; 7:633.
  95. Labadie K, Larcher T, Joubert C, et al. Chikungunya disease in nonhuman primates involves long-term viral persistence in macrophages. J Clin Invest 2010; 120:894.
  96. Edelman R, Tacket CO, Wasserman SS, et al. Phase II safety and immunogenicity study of live chikungunya virus vaccine TSI-GSD-218. Am J Trop Med Hyg 2000; 62:681.
  97. Akahata W, Yang ZY, Andersen H, et al. A virus-like particle vaccine for epidemic Chikungunya virus protects nonhuman primates against infection. Nat Med 2010; 16:334.
  98. Roy CJ, Adams AP, Wang E, et al. Chikungunya vaccine candidate is highly attenuated and protects nonhuman primates against telemetrically monitored disease following a single dose. J Infect Dis 2014; 209:1891.
  99. Chang LJ, Dowd KA, Mendoza FH, et al. Safety and tolerability of chikungunya virus-like particle vaccine in healthy adults: a phase 1 dose-escalation trial. Lancet 2014; 384:2046.
  100. Ramsauer K, Schwameis M, Firbas C, et al. Immunogenicity, safety, and tolerability of a recombinant measles-virus-based chikungunya vaccine: a randomised, double-blind, placebo-controlled, active-comparator, first-in-man trial. Lancet Infect Dis 2015; 15:519.
  101. Fric J, Bertin-Maghit S, Wang CI, et al. Use of human monoclonal antibodies to treat Chikungunya virus infection. J Infect Dis 2013; 207:319.
  102. Centers for Disease Control and Prevention. Health Information for International Travel, Oxford University Press, New York 2014.