Chikungunya Virus Disease among Travelers—United States, 2014–2016

Nicole P. Lindsey Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado

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J. Erin Staples Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado

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Marc Fischer Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado

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Chikungunya virus is a mosquito-borne alphavirus that causes an acute febrile illness with severe polyarthralgia. The first local transmission of chikungunya virus in the Western Hemisphere was reported in December 2013. In the following year, the virus spread throughout much of the Americas and the number of cases among travelers increased substantially. We reviewed the epidemiology of chikungunya virus disease cases reported among U.S. travelers from 2014 to 2016. A total of 3,941 travel-acquired cases were reported from 49 states and the District of Columbia; 3,616 (92%) reported travel to other countries or territories in the Americas; the remaining 8% reported travel to Asia, Africa, or the Western Pacific. The most commonly reported travel destinations were the Dominican Republic, Puerto Rico, and Haiti. The largest number of cases (N = 2,780, 71%) had illness onset in 2014, followed by 2015 (N = 913, 23%) and 2016 (N = 248, 6%). Cases occurred in every month, but 70% of case-patients had illness onset from April to September, the months when mosquitoes are most likely to be active in the continental United States. Travel-acquired chikungunya cases will likely continue to occur and present a risk of introduction of the virus to locations in the continental United States. Clinicians and public health officials should be educated about the recognition, diagnosis, management, and timely reporting of chikungunya cases.

Author Notes

Address correspondence to Nicole P. Lindsey, Arboviral Diseases Branch, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521. E-mail: nplindsey@cdc.gov

Authors’ addresses: Nicole P. Lindsey, J. Erin Staples, and Marc Fischer, Centers for Disease Control and Prevention, Fort Collins, CO, E-mails: nplindsey@cdc.gov, estaples@cdc.gov, and mfischer@cdc.gov.

  • 1.

    Staples J, Breiman R, Powers A, 2009. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis 49: 942948.

  • 2.

    Darsie R, Ward R, 2005. Identification and Geographical Distribution of the Mosquitoes of North America, North of Mexico. Gainesville, FL: University Press of Florida.

    • PubMed
    • Export Citation
  • 3.

    Panning M, Grywna K, van Esbroeck M, Emmerich P, Drosten C, 2008. Chikungunya fever in travelers returning to Europe from the Indian Ocean region, 2006. Emerg Infect Dis 14: 416422.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Rezza G et al. 2007. Infection with chikungunya virus in Italy: an outbreak in a temperate region. Lancet 370: 18401846.

  • 5.

    Lanciotti RS, Kosoy OL, Laven JJ, Panella AJ, Velez JO, Lambert AJ, Campbell GL, 2007. Chikungunya virus in US travelers returning from India, 2006. Emerg Infect Dis 13: 764767.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Laurent P, Le Roux K, Grivard P, Bertil G, Naze F, Picard M, Staikowsky F, Barau G, Schuffenecker I, Michault A, 2007. Development of a sensitive real-time reverse transcriptase PCR assay with an internal control to detect and quantify chikungunya virus. Clin Chem 53: 14081414.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Jupp PG, McIntosh BM, 1988. Chikungunya virus disease. Monath TP, ed. The Arboviruses: Epidemiology and Ecology, Vol. 2. Boca Raton, FL: CRC Press, 137157.

    • PubMed
    • Export Citation
  • 8.

    World Health Organization, 2013. Chikungunya in the French Part of the Caribbean Isle of Saint Martin. Disease Outbreak News. Available at: http://www.who.int/csr/don/2013_12_10a/en/. Accessed September 1, 2015.

    • PubMed
    • Export Citation
  • 9.

    Pan American Health Organization. Chikungunya: PAHO/WHO Data, Maps and Statistics. Available at: http://www.paho.org/hq/index.php?option=com_topics&view=rdmore&cid=6917&Itemid=40931&lang=en. Accessed May 22, 2017.

    • PubMed
    • Export Citation
  • 10.

    Gibney KB, Fischer M, Prince HE, Kramer LD, St George K, Kosoy OL, Laven JJ, Staples JE, 2011. Chikungunya fever in the United States: a fifteen year review of cases. Clin Infect Dis 52: e121e126.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Lindsey NP, Prince HE, Kosoy O, Laven J, Messenger S, Staples JE, Fischer M, 2015. Chikungunya virus infections among travelers – United States, 2010–2013. Am J Trop Med Hyg 92: 8287.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Centers for Disease Control and Prevention, 2014. Notes from the field: chikungunya virus spreads in the Americas—Caribbean and South America, 2013–2014. MMWR Morb Mortal Wkly Rep 63: 500501.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Centers for Disease Control and Prevention. Chikungunya Virus in the United States. Available at: http://www.cdc.gov/chikungunya/geo/united-states.html. Accessed November 9, 2015.

    • PubMed
    • Export Citation
  • 14.

    Centers for Disease Control and Prevention. Arboviral Diseases, Neuroinvasive and Non-neuroinvasive: 2014 Case Definition. Available at: http://wwwn.cdc.gov/nndss/conditions/arboviral-diseases-neuroinvasive-and-non-neuroinvasive/case-definition/2014/. Accessed November 9, 2015.

    • PubMed
    • Export Citation
  • 15.

    Kendrick K, Stanek D, Blackmore C, 2014. Notes from the field: transmission of chikungunya virus in the continental United States–Florida, 2014. MMWR Morb Mortal Wkly Rep 63: 1137.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Pan American Health Organization. Dengue: PAHO/WHO Data, Maps and Statistics: Annual Cases Reported of Dengue. Available at: http://www.paho.org/hq/index.php?option=com_topics&view=rdmore&cid=6290&Itemid=40734&lang=en. Accessed January 5, 2016.

    • PubMed
    • Export Citation
  • 17.

    U.S. Geologic Survey. Arboviral Disease Maps (Legacy Site). Available at: http://diseasemaps.usgs.gov/2013/index.html. Accessed January 6, 2016.

    • PubMed
    • Export Citation
  • 18.

    U.S. Geologic Survey. Arboviral Disease Maps. Available at: http://diseasemaps.usgs.gov/mapviewer/. Accessed January 6, 2016.

    • PubMed
    • Export Citation
  • 19.

    Sharp TM et al. 2014. Chikungunya cases identified through passive surveillance and household investigations–Puerto Rico, May 5–August 12, 2014. MMWR Morb Mortal Wkly Rep 63: 112118.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Staikowsky F, Talarmin F, Grivard P, Souab A, Schuffenecker I, Le Roux K, Lecuit M, Michault A, 2009. Prospective study of chikungunya virus acute infection in the Island of La Réunion during the 2005–2006 outbreak. PLoS One 4: e7603.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Borgherini G, Poubeau P, Jossaume A, Gouix A, Cotte L, Michault A, Arvin-Berod C, Paganin F, 2008. Persistent arthralgia associated with chikungunya virus: a study of 88 adult patients on Reunion Island. Clin Infect Dis 47: 469475.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Couturier E, Guillemin F, Mura M, Léon L, Virion JM, Letort MJ, De Valk H, Simon F, Vaillant V, 2012. Impaired quality of life after chikungunya virus infection: a 2-year follow-up study. Rheumatol 51: 13151322.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Gérardin P, Fianu A, Malvy D, Mussard C, Boussaïd K, Rollot O, Michault A, Gaüzere BA, Bréart G, Favier F, 2011. Perceived morbidity and community burden after a chikungunya outbreak: the TELECHIK survey, a population-based cohort study. BMC Med 9: 5.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Kularatne SA, Weerasinghe SC, Gihan C, Wickramasinghe S, Dharmarathne S, Abeyrathna A, Jayalath T, 2012. Epidemiology, clinical manifestations, and long-term outcomes of a major outbreak of chikungunya in a hamlet in Sri Lanka, in 2007: a longitudinal cohort study. J Trop Med 2012: 639178.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Mohd Zim MA, Sam IC, Omar SF, Chan YF, AbuBakar S, Kamarulzaman A, 2013. Chikungunya infection in Malaysia: comparison with dengue infection in adults and predictors of persistent arthralgia. J Clin Virol 56: 141145.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Moro ML et al. 2012. Long-term chikungunya infection clinical manifestations after an outbreak in Italy: a prognostic cohort study. J Infect 65: 165172.

  • 27.

    Thiberville SD, Boisson V, Gaudart J, Simon F, Flahault A, de Lamballerie X, 2013. Chikungunya fever: a clinical and virological investigation of outpatients on Reunion Island, Southwest Indian Ocean. PLoS NTD 7: e2004.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Win MK, Chow A, Dimatatac F, Go CJ, Leo YS, 2010. Chikungunya fever in Singapore: acute clinical and laboratory features, and factors associated with persistent arthralgia. J Clin Virol 49: 111114.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Borgherini G, Poubeau P, Staikowsky F, Lory M, Le Moullec N, Becquart JP, Wengling C, Michault A, Paganin F, 2007. Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis 44: 14011407.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Staikowsky F, Le Roux K, Schuffenecker I, Laurent P, Grivard P, Develay A, Michault A, 2008. Retrospective survey of chikungunya disease in Réunion Island hospital staff. Epidemiol Infect 136: 196206.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Lakshmi V, Neeraja M, Subbalaxmi MV, Parida MM, Dash PK, Santhosh SR, Rao PV, 2008. Clinical features and molecular diagnosis of chikungunya fever from south India. Clin Infect Dis 46: 14361442.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Grivard P et al. 2007. Molecular and serologic diagnosis of chikungunya virus infection. Pathol Biol (Paris) 55: 490494.

  • 33.

    Caron M, Paupy C, Grard G, Becquart P, Mombo I, Nso BB, Kassa Kassa F, Nkoghe D, Leroy EM, 2012. Recent introduction and rapid dissemination of chikungunya virus and dengue virus serotype 2 associated with human and mosquito co-infections in Gabon, Central Africa. Clin Infect Dis 55: e45e53.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Nkoghe D, Kassa RF, Bisvigou U, Caron M, Grard G, Leroy EM, 2012. No clinical or biological difference between chikungunya and dengue fever during 2010 Gabonese outbreak. Infect Dis Rep 4: e5.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Omarjee R, Prat C, Flusin O, Boucau S, Tenebray B, Merle O, Huc-Anais P, Cassadou S, Leparc-Goffart I, 2012. Importance of case definition to monitor ongoing outbreak of chikunugnya virus on a background of actively circulating dengue virus, St. Martin, December 2013 to 2014. Euro Surveill 19: 20753.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Pan American Health Organization, 2017. Chikungunya: PAHO/WHO Data, Maps and Statistics. Available at: http://www.paho.org/hq/index.php?option=com_topics&view=rdmore&cid=8975&Itemid=40931&lang=en. Accessed May 22, 2017.

    • PubMed
    • Export Citation
  • 37.

    Centers for Disease Control and Prevention, 2017. Chapter 5: Post-travel evaluation. CDC Yellow Book 2018: Health Information for International Travel. New York, NY: Oxford University Press.

    • PubMed
    • Export Citation
  • 38.

    Centers for Disease Control and Prevention, 2015. Dengue clinical and laboratory guidance. Available at: http://www.cdc.gov/dengue/clinicalLab/. Accessed November 9, 2015.

    • PubMed
    • Export Citation
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