- Mary Elizabeth Wilson, MD
Mary Elizabeth Wilson, MD
- Clinical Professor of Epidemiology and Biostatistics
- School of Medicine, University of California, San Francisco
- Adjunct Professor of Global Health and Population
- Harvard TH Chan School of Public Health
- Deborah J Lenschow, MD, PhD
Deborah J Lenschow, MD, PhD
- Associate Professor, Medicine
- Washington University School of Medicine in St. Louis
- Section Editor
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Elinor L Baron, MD, DTMH
Elinor L Baron, MD, DTMH
- Deputy Editor — Infectious Diseases
- Assistant Clinical Professor of Medicine
- Tufts University School of Medicine
- Paul L Romain, MD
Paul L Romain, MD
- Deputy Editor — Rheumatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
Chikungunya is an arthropod-borne alphavirus transmitted by mosquitoes that causes acute febrile polyarthralgia and arthritis . The name chikungunya is derived from an African language meaning "that which bends up" or "stooped walk" because of the incapacitating arthralgia caused by the disease.
Geographic distribution — The United States Centers for Disease Control and Prevention (CDC) maintains a website summarizing geographic distribution of chikungunya virus.
Chikungunya virus is endemic in certain parts of West Africa; human serosurveys have identified antibodies to chikungunya virus in 35 to 50 percent of the population in some areas [2,3].
Outbreaks of chikungunya disease have occurred in Africa, Asia, Europe, and islands in the Indian and Pacific Oceans and more recently in the Americas. Most outbreaks occur during the tropical rainy season and abate during the dry season. However, outbreaks in Africa have occurred after periods of drought, where open water containers serve as vector-breeding sites.
Chikungunya can cause large outbreaks with high attack rates, affecting one-third to three-quarters of the population in areas where the virus is circulating. An outbreak on Réunion Island in 2005 to 2006 involved approximately 266,000 individuals (34 percent of the island's population) .
- Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med 2015; 372:1231.
- Chevillon C, Briant L, Renaud F, Devaux C. The Chikungunya threat: an ecological and evolutionary perspective. Trends Microbiol 2008; 16:80.
- Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis 2009; 49:942.
- 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.
- Charrel RN, de Lamballerie X, Raoult D. Chikungunya outbreaks--the globalization of vectorborne diseases. N Engl J Med 2007; 356:769.
- Morens DM, Fauci AS. Chikungunya at the door--déjà vu all over again? N Engl J Med 2014; 371:885.
- 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.
- Hochedez P, Jaureguiberry S, Debruyne M, et al. Chikungunya infection in travelers. Emerg Infect Dis 2006; 12:1565.
- 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.
- Lanciotti RS, Kosoy OL, Laven JJ, et al. Chikungunya virus in US travelers returning from India, 2006. Emerg Infect Dis 2007; 13:764.
- Nicoletti L, Ciccozzi M, Marchi A, et al. Chikungunya and dengue viruses in travelers. Emerg Infect Dis 2008; 14:177.
- 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.
- 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.
- 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.
- Rezza G, Nicoletti L, Angelini R, et al. Infection with chikungunya virus in Italy: an outbreak in a temperate region. Lancet 2007; 370:1840.
- 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.
- 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.
- 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.
- Simmons G, Brès V, Lu K, et al. High Incidence of Chikungunya Virus and Frequency of Viremic Blood Donations during Epidemic, Puerto Rico, USA, 2014. Emerg Infect Dis 2016; 22:1221.
- Furuya-Kanamori L, Liang S, Milinovich G, et al. Co-distribution and co-infection of chikungunya and dengue viruses. BMC Infect Dis 2016; 16:84.
- Waggoner JJ, Gresh L, Vargas MJ, et al. Viremia and Clinical Presentation in Nicaraguan Patients Infected With Zika Virus, Chikungunya Virus, and Dengue Virus. Clin Infect Dis 2016; 63:1584.
- 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.
- Reiter P, Fontenille D, Paupy C. Aedes albopictus as an epidemic vector of chikungunya virus: another emerging problem? Lancet Infect Dis 2006; 6:463.
- Charrel RN, de Lamballerie X, Raoult D. Seasonality of mosquitoes and chikungunya in Italy. Lancet Infect Dis 2008; 8:5.
- Gubler DJ. Aedes albopictus in Africa. Lancet Infect Dis 2003; 3:751.
- Tatem AJ, Hay SI, Rogers DJ. Global traffic and disease vector dispersal. Proc Natl Acad Sci U S A 2006; 103:6242.
- 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.
- Schuffenecker I, Iteman I, Michault A, et al. Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med 2006; 3:e263.
- 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.
- 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.
- Couderc T, Gangneux N, Chrétien F, et al. Chikungunya virus infection of corneal grafts. J Infect Dis 2012; 206:851.
- 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.
- Lenglet Y, Barau G, Robillard PY, et al. [Chikungunya infection in pregnancy: Evidence for intrauterine infection in pregnant women and vertical transmission in the parturient. Survey of the Reunion Island outbreak]. J Gynecol Obstet Biol Reprod (Paris) 2006; 35:578.
- Burt FJ, Rolph MS, Rulli NE, et al. Chikungunya: a re-emerging virus. Lancet 2012; 379:662.
- 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.
- 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.
- Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis 2007; 45:e1.
- Rajapakse S, Rodrigo C, Rajapakse A. Atypical manifestations of chikungunya infection. Trans R Soc Trop Med Hyg 2010; 104:89.
- Javelle E, Tiong TH, Leparc-Goffart I, et al. Inflammation of the external ear in acute chikungunya infection: Experience from the outbreak in Johor Bahru, Malaysia, 2008. J Clin Virol 2014; 59:270.
- 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.
- Mahendradas P, Ranganna SK, Shetty R, et al. Ocular manifestations associated with chikungunya. Ophthalmology 2008; 115:287.
- Parola P, Simon F, Oliver M. Tenosynovitis and vascular disorders associated with Chikungunya virus-related rheumatism. Clin Infect Dis 2007; 45:801.
- Centers for Disease Control and Prevention. Yellow Book: Infectious Diseases Related to Travel - Chikungunya. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/chikungunya (Accessed on October 24, 2016).
- Oliver M, Grandadam M, Marimoutou C, et al. Persisting mixed cryoglobulinemia in Chikungunya infection. PLoS Negl Trop Dis 2009; 3:e374.
- 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.
- Blettery M, Brunier L, Polomat K, et al. Brief Report: Management of Chronic Post-Chikungunya Rheumatic Disease: The Martinican Experience. Arthritis Rheumatol 2016; 68:2817.
- Rodríguez-Morales AJ, Cardona-Ospina JA, Fernanda Urbano-Garzón S, Sebastian Hurtado-Zapata J. Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2016; 68:1849.
- Brighton SW, Prozesky OW, de la Harpe AL. Chikungunya virus infection. A retrospective study of 107 cases. S Afr Med J 1983; 63:313.
- Rollé A, Schepers K, Cassadou S, et al. Severe Sepsis and Septic Shock Associated with Chikungunya Virus Infection, Guadeloupe, 2014. Emerg Infect Dis 2016; 22:891.
- Centers for Disease Control and Prevention. Chikungunya virus: Clinical Evaluation & Disease. https://www.cdc.gov/chikungunya/hc/clinicalevaluation.html (Accessed on October 20, 2016).
- Robin S, Ramful D, Le Seach' F, et al. Neurologic manifestations of pediatric chikungunya infection. J Child Neurol 2008; 23:1028.
- Singh SS, Manimunda SP, Sugunan AP, et al. Four cases of acute flaccid paralysis associated with chikungunya virus infection. Epidemiol Infect 2008; 136:1277.
- Wielanek AC, Monredon JD, Amrani ME, et al. Guillain-Barré syndrome complicating a Chikungunya virus infection. Neurology 2007; 69:2105.
- 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.
- Chanana B, Azad RV, Nair S. Bilateral macular choroiditis following Chikungunya virus infection. Eye (Lond) 2007; 21:1020.
- Bhavana K, Tyagi I, Kapila RK. Chikungunya virus induced sudden sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2008; 72:257.
- 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.
- 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.
- 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.
- Beesoon S, Funkhouser E, Kotea N, et al. Chikungunya fever, Mauritius, 2006. Emerg Infect Dis 2008; 14:337.
- Josseran L, Paquet C, Zehgnoun A, et al. Chikungunya disease outbreak, Reunion Island. Emerg Infect Dis 2006; 12:1994.
- Mavalankar D, Shastri P, Bandyopadhyay T, et al. Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India. Emerg Infect Dis 2008; 14:412.
- Gérardin P, Sampériz S, Ramful D, et al. Neurocognitive outcome of children exposed to perinatal mother-to-child Chikungunya virus infection: the CHIMERE cohort study on Reunion Island. PLoS Negl Trop Dis 2014; 8:e2996.
- Centers for Disease Control and Prevention. Is it Chikungunya or Dengue? https://www.cdc.gov/chikungunya/pdfs/poster_chikv_denv_comparison_healthcare_providers.pdf (Accessed on October 24, 2016).
- Centers for Disease Control and Prevention. New CDC Laboratory Test for Zika Virus Authorized for Emergency Use by FDA. http://www.cdc.gov/media/releases/2016/s0318-zika-lab-test.html (Accessed on October 24, 2016).
- Simon F, Savini H, Parola P. Chikungunya: a paradigm of emergence and globalization of vector-borne diseases. Med Clin North Am 2008; 92:1323.
- 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.
- 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.
- Ratsitorahina M, Harisoa J, Ratovonjato J, et al. Outbreak of dengue and Chikungunya fevers, Toamasina, Madagascar, 2006. Emerg Infect Dis 2008; 14:1135.
- 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.
- 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.
- Miner JJ, Aw Yeang HX, Fox JM, et al. Chikungunya viral arthritis in the United States: a mimic of seronegative rheumatoid arthritis. Arthritis Rheumatol 2015; 67:1214.
- 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.
- 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.
- Arroyo-Ávila M, Vilá LM. Rheumatic Manifestations in Patients with Chikungunya Infection. P R Health Sci J 2015; 34:71.
- Bouquillard E, Combe B. A report of 21 cases of rheumatoid arthritis following Chikungunya fever. A mean follow-up of two years. Joint Bone Spine 2009; 76:654.
- Ganu MA, Ganu AS. Post-chikungunya chronic arthritis--our experience with DMARDs over two year follow up. J Assoc Physicians India 2011; 59:83.
- Brunier L, Polomat K, Deligny C, et al. Chikungunya virus infection in patients on biotherapies. Joint Bone Spine 2016; 83:245.
- 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.
- 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.
- 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.
- 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.
- 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.
- Centers for Disease Control and Prevention. Health Information for International Travel, Oxford University Press, New York 2014.
- Jansen CC, Beebe NW. The dengue vector Aedes aegypti: what comes next. Microbes Infect 2010; 12:272.
- https://www.cdc.gov/chikungunya/transmission/index.html (Accessed on October 20, 2016).
- Geographic distribution
- - Mosquito transmission
- - Blood products and organ transplantation
- - Maternal-fetal transmission
- CLINICAL MANIFESTATIONS
- Adults and children with postnatal infection
- - Acute infection
- - Persistent or relapsed disease
- - Severe complications
- Neonatal infection
- DIFFERENTIAL DIAGNOSIS
- Mimics of acute infection
- Mimics of persistent or relapsed disease
- Acute disease
- Persistent or relapsed disease
- - Post-acute disease
- - Chronic disease