Chikungunya A92.0

An endemic-epidemic alphavirus infection caused by the chikungunya virus (CHIKV), which is an arbovirus infection. The name "chikungunya" is derived from a Tanzanian word for "the one who walks bent over" to describe how severely affected patients often assume a massively stooped appearance due to debilitating pain.

Enveloped double-stranded RNA virus of the genus Alphavirus in the family Togaviridae, belonging to the Semliki Forest virus complex.

First described in Tanzania and Uganda (1952), occurs in East and West Africa, India, Southeast Asia, Philippines, Pacific and Indian Ocean islands. 2005 major outbreak in La Reunion and Mauritius. 2006 outbreak in India (approximately 1.25 million infected).

Also occurred for the first time in Italy in 2007 (Ravenna) with approximately 197 cases.

Deaths have been described (exact numbers are missing).

Urban (human-human) and sylvatic cycles (animal-human). Reservoir animals are monkeys and rodents. Transmission of the virus through the bite of Aedes aegypti and albopictus mosquitoes (Asian tiger mosquito); Culex, Anopheles and Mansonia mosquitoes are also under discussion. Transmission from person to person (diaplacental transmission has also been described).

Incubation period: 3-7 (maximum 2-12) days, biphasic course:

• Abrupt onset with high fever, chills, fatigue, severe pain in joints and muscles (lasting approx. 1-7 days)
• Remission (lasting 2 days).
• Renewed increase in fever, severe arthralgia of the small joints, headache, maculo-papular exanthema with healing and scaling, petechiae on the hard palate, conjunctivitis, swelling of the lymph nodes, gastrointestinal symptoms.
• Healing after 1-2 weeks, but arthralgias can persist for months.

Long-lasting immunity.

Lymphopenia, thrombocytopenia, anemia, elevation of CRP, LDH, AST, ALT, CK.

Serology (ELISA): Detection of IgM and IgG antibodies (5 days and later after symptom onset).

PCR (in the blood): < 5 days after symptom onset.

Cell culture.

O'nyong-nyong and dengue fever as well as other alpha and flaviviruses; COVID-19 infections, rheumatoid arthritis, autoimmune diseases.

Persistent arthralgias

pericarditis, myocarditis

Neurological disorders, meningitis

Hepatitis

very rarely hemorrhagic fever.

Only symptomatic therapy: non-steroidal anti-inflammatory drugs, chloroquine.

Synergistic effects of interferon-alpha and ribavirin are described in the treatment.

Mechanical mosquito protection, especially repellents (e.g. Icaridin, Zanzarin); insecticides.

When traveling to a current outbreak area, the STIKO recommends the use of one of the two available vaccines against Chikungunya in a 1-dose schedule. Available are:

• The live attenuated vaccine ^Icchiq® for people aged 12-59 years. Contraindicated in pregnancy, immunosuppression.
• The inactivated vaccine ^Vimkunya® for all persons aged 12 and >12 years,

Note! Pathogen detection according to § 7 of the Infection Protection Act must be reported, as Ereger can be a possible trigger of hemorrhagic fever; obligation to report by the doctor in case of suspicion only in the presence of hemorrhagic fever.

Remember! Chikungunya means in the Bantu language: "the one who walks bent over".

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2. Charrel RN et al (2006) Toscana virus RNA in Sergentomyia minuta files. Emerg Infect Dis 12: 1299

3. Charrel RN et al (2007) Chikungunya outbreaks--the globalization of vectorborne diseases. N Engl J Med 356: 769

4. Mourya DT, Mishra AC (2006) Chikungunya fever. Lancet 368: 186

5. Pialoux G et al (2007) Chikungunya, an epidemic arbovirosis. Lancet Infect Dis 7: 319

6. Simon F et al (2007) Chikungunya Infection: An Emerging Rheumatism Among Travelers Returned From Indian Ocean Islands. Report of 47 Cases. Medicine (Baltimore) 86: 123