CDC:  “…Since the Americas outbreak began in 2013 on the Caribbean island of St. Martin, the Americas region has reported 2,569,438 cases.

Laboratory-confirmed chikungunya virus disease cases reported to ArboNET by state or territory — United States, 2017 (as of September 19, 2017)

WHO

Chikungunya – Italy

As of 14 September, fourteen autochthonous confirmed cases of chikungunya have been diagnosed in Italy, six in Rome and eight in the coastal area of Anzio (Lazio Region). There are additional cases being investigated.

The date of onset of symptoms of the first case was on 5 August 2017. The dates of onset of the latest cases are between 25 August and 7 September 2017.

Public health response

The following public health measures described in the Italian National Chikungunya Surveillance and Response Plan are implemented:

• Disinfestation and vector control measures in the Anzio and Rome areas;
• Communication to the population about chikungunya and information on protection against mosquito bites. Ministry of Health’s website has pages about chikungunya which can be found here;
• Measures to prevent transmission through blood transfusion;
• Information and guidelines for health care practitioners to manage patients.

The National Health Institute (Istituto Superiore di Sanità) issued a public statement on 8 September 2017 concerning the outbreak.

WHO risk assessment

There is a risk for further transmission. This is due to:

• Aedes albopictus being established throughout the Mediterranean basin;
• this vector having demonstrated the capacity to sustain outbreaks of chikungunya in the past; and
• the area of the current case being highly populated and touristic particularly in summer months.

The disease mostly occurs in Africa, Asia, Americas and the Indian subcontinent. In 2007, transmission was reported for the first time in Europe, in the Emilia Romagna region of north-eastern Italy. There were 217 laboratory confirmed cases during this outbreak and it demonstrated that mosquito-borne outbreaks by Aedes albopictus are possible in Europe. Currently, there is another ongoing autochthonous outbreak in Var Department that started in early August 2017.

WHO advice

Personal protection

Basic precautions should be taken by people within and travelling to this area of Italy. These include wearing long sleeves and pants, use of repellents, and ensuring rooms are fitted with screens to prevent mosquitoes from entering.

Clothing which minimizes skin exposure to the day-biting vectors is advised. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions. Repellents should contain DEET, IR3535, or Icaridin. People should sleep under a mosquito bed net and use air conditioning or window screens to prevent mosquito bites. Mosquito coils or other insecticide vaporizers may also reduce indoor biting.

Vector control

The Aedes albopictus species thrives in a wide range of water-filled containers, including tree-holes and rock pools, in addition to artificial containers such as unused vehicle tires, saucers beneath plant pots, rain water barrels and cisterns, and catch basins.

Prevention and control relies heavily on reducing the number of these natural and artificial water-filled container habitats that support breeding of the mosquitoes. This requires mobilization of affected communities, and strengthening monitoring of the vector mosquito. During outbreaks, indoor space spraying with insecticides may be performed to kill flying mosquitoes along with killing the immature larvae in water-filled containers through source reduction.

About chikungunya

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash. Joint pain is often debilitating and can vary in duration. Hence the virus can cause acute, subacute or chronic disease. There is no cure for the disease and treatment is focused on relieving the symptoms. The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.

BBC

NY Times

“…..The website, ProMED mail, has carried more than a dozen such reports since June, all involving mosquito species known to transmit human diseases.

Most reports have concerned the United States, where, for example, Aedes aegypti — the yellow fever mosquito, which also spreads Zika, dengue and chikungunya — has been turning up in counties in California and Nevada where it had never, or only rarely, been seen.

Other reports have noted mosquito species found for the first time on certain South Pacific islands, or in parts of Europe where harsh winters previously kept them at bay…..”

WHO 

Chikungunya – France

Local transmission of chikungunya has been confirmed in south eastern France, with four cases diagnosed in the Provence-Alpes-Côte d’Azur region as of 23 August 2017. In addition, there is one probable case, and eight suspected cases.

The date of onset of symptoms of the first confirmed case was 2 August 2017. All four confirmed and one probable case had symptom onset during the period, 2 to 17 August 2017.

All 13 patients (four confirmed, one probable and eight suspected) are aged between 3 to 77 years old, and they all are inhabitants of the same district of the commune of Cannet des Maures in Var department, as announced by the Regional Health Authority (ARS).

These are not the first reported cases of chikungunya in France. Two autochthonous cases were recorded in the same area in 2010 and 11 cases in Montpellier in 2014. Nevertheless, chikungunya is an emerging disease in southern Europe, and an outbreak is considered unexpected. The vector Aedes albopictus is establishing itself in large part of the Mediterranean basin and beyond.

Public health response by French national authorities

According to the national response plan, the following actions are being taken:

• Vector control measures around the house and working locations of the patients.
• Blood testing of any suspected case.
• Risk communication as coordinated by the regional health agency.

The entomological investigation on 10 August 2017 confirmed the presence of Aedes albopictus in the affected area. In addition, blood collection has been postponed in the affected area.

WHO risk assessment

There is a potential risk for international spread.

This is based on:

• Aedes albopictus being established throughout the Mediterranean basin.
• This vector having demonstrated capacity to sustain outbreaks of chikungunya in the past.
• The currently affected area being highly touristic particularly in summer months and close to the border with Italy (with established populations of Aedes albopictus).

Chikungunya transmission was reported for the first time in Europe in 2007, in an outbreak in north eastern Italy. There were 205 cases recorded during that outbreak and it confirmed that mosquito-borne outbreaks by Aedes albopictus are plausible in Europe.

Asymptomatic infection with chikungunya can go undetected and therefore also increases the risk for spread. Additionally, excess rainfall in the affected areas in the coming months, could trigger further increase in transmission as observed in 2014.

WHO advice

Prevention of mosquito bites

Basic precautions should be taken by people within and travelling to this area of France to prevent mosquito bites during the day. These include the use of repellents, wearing long sleeves and pants, and ensuring rooms are fitted with screens to prevent mosquitoes from entering.

Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions. Repellents should contain DEET, IR3535, or Icaridin. People should sleep under a mosquito bed net and use air conditioning or window screens to prevent mosquito bites. Mosquito coils or other insecticide vaporizers may also reduce indoor biting.

Vector control

Aedes albopictus thrives in a wide range of water-filled containers, including tree-holes and rock pools, in addition to artificial containers such as unused vehicle tires, saucers beneath plant pots, rain water barrels and cisterns, and catch basins.

Prevention and control relies heavily on reducing the number of these water-filled container habitats that support breeding of the mosquitoes. During outbreaks, indoor space spraying with insecticides may be used to kill flying mosquitoes along with measures to kill the larvae.

WHO also encourages strengthening monitoring of the mosquitoes and implementation of additional control as and when needed through arboviral disease networks within Europe. Awareness should also be raised about re-emerging vector-borne diseases among physicians and through social mobilization efforts in affected communities.

Blood safety

National blood services and/or authorities should monitor epidemiological information and strengthen vigilance to identify any potential transmission of chikungunya virus via transfusion. Appropriate safety precautions in line with measures taken to prevent other mosquito-borne disease transmission via transfusion should be taken based on the epidemiological situation and risk assessment.

Canada

ECDC

“….As of 17 August 2017, France reported two confirmed autochthonous chikungunya cases in the Var district, in southern France. The first case who lives in Cannet-des-Maures in Var district and works in Alpes-Maritimes district had onset of symptoms on 1 August. The diagnostic was confirmed by two PCR tests on 9 an 11 August. The second case, a 67-year-old neighbour of the first case, had onset of symptoms on 8 August and was confirmed on 14 August…..”

Eureka

“A new test is the best-to-date in differentiating Zika virus infections from infections caused by similar viruses. The antibody-based assay, developed by researchers at UC Berkeley and Humabs BioMed, a private biotechnology company, is a simple, cost-effective way to determine if a person’s infection is from the Zika virus or another virus of the same family, such as dengue and West Nile viruses….”

PNAS

“…..This study demonstrates that the antibody-based assay we developed and implemented in five countries has high specificity and sensitivity in the detection of recent and past ZIKV infections. The ZIKV nonstructural protein 1 (NS1) blockade-of-binding ELISA assay is a simple, robust, and low-cost solution for Zika surveillance programs, seroprevalence studies, and intervention trials in flavivirus-endemic areas….”

NIH

NIAID-Sponsored Trial of Experimental Chikungunya Vaccine Begins

A female Aedes aegypti mosquito, one of the two species that spreads chikungunya virus, is shown feeding.CDC

A clinical trial of an experimental vaccine to prevent infection with chikungunya virus is now enrolling healthy adult volunteers at three sites in the United States. The Phase 1/2 trial, which is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is being conducted at several NIAID-funded Vaccine and Treatment Evaluation Units. The candidate vaccine, MV-CHIKV, was developed by Themis Bioscience of Vienna, Austria.

Although chikungunya is rarely fatal, the mosquito-transmitted virus causes an intense inflammatory reaction resulting in severe joint pain, fever, rash and muscle pain. While most symptoms usually resolve in days, the joint inflammation can linger.

“Chikungunya virus can cause debilitating joint pain that can last for months or even longer,” said NIAID Director Anthony S. Fauci, M.D. “A vaccine to prevent infection with this virus would be of considerable benefit to people living in the more than 60 countries where chikungunya transmission has occurred, as well as travelers to those countries.”

Chikungunya virus has been endemic in East Africa since at least the 1950s, when it was first discovered. There it circulates among monkeys and, occasionally, humans. The virus likely arrived in the Caribbean in late 2013, and as of March 2017, may have infected more than two million people in the Americas, according to the Pan American Health Organization (PAHO).

A 2014 Phase 1 trial of the MV-CHIKV vaccine conducted in Austria by Themis Bioscience showed that the experimental vaccine was safe and induced an immune response. The candidate vaccine is a measles vaccine virus modified to produce chikungunya virus proteins. Once inside a human cell, the vaccine induces the production of both measles and chikungunya proteins. The immune system then develops antibodies against those proteins, which may protect the vaccinated person from future infection by chikungunya virus.

Led by principal investigator Patricia Winokur, M.D., of the University of Iowa Carver College of Medicine, the new vaccine study will enroll 180 healthy adults ages 18 to 45 at three sites: the University of Iowa in Iowa City; Baylor College of Medicine in Houston; and Emory University in Atlanta. Participants will receive two injections of either low-dose or high-dose experimental vaccine or placebo. Neither the participants nor the investigators will know whether a volunteer is receiving placebo or investigational vaccine. The volunteers will be assigned at random into different groups that receive the two injections at different intervals (29, 85, or 169 days after the initial injection) in order to help the researchers determine which schedule is most effective.

Clinic staff will follow up with study participants by phone and during clinic visits over the course of 8 to 13 months to monitor for any adverse reactions or safety issues. The participants will provide blood samples to be analyzed for evidence of antibody production, which would indicate that the vaccine is prompting an immune response.

Themis Bioscience is currently conducting a Phase 2 trial in Europe with the same vaccine candidate. Other chikungunya vaccine candidates are also under investigation in different trials, including one that uses virus-like particles (VLPs) to induce an immune response in recipients. NIAID sponsored the Phase 1 trial of the VLP vaccine candidate; a Phase 2 trial began in 2015.

For more information about the MV-CHIKV vaccine study, see ClinicalTrials.gov using the identifier NCT03028441.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health^®

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CIDRAP