Continuing Education
Chikungunya Virus: A Rising Health Risk in the United States and How Nurse Practitioners Can Help Address and Reduce the Risk

https://doi.org/10.1016/j.nurpra.2016.02.020Get rights and content

Highlights

  • The chikungunya virus (CHIKV) is spreading in the Caribbean through infected mosquitoes and has been diagnosed in the United States.

  • CHIKV leads to severe arthralgia, which remains in 20% to 60% of all infected persons more than 1 year after infection.

  • Prevention steps can be taken to reduce the risk of a mosquito bite.

  • Nurse practitioners need to stay current with CHIKV trends and symptoms in order to reach a proper diagnosis and treatment plan.

Abstract

Chikungunya virus (CHIKV) is not widely known or understood in the United States, although it is rapidly increasing in its global reach and prevalence. Most nurse practitioners and other medical staff have never seen a case of CHIKV, and its similarities to other viruses may cause it to be overlooked. However, the chronic effects and worldwide spread of this virus require us to become familiar with CHIKV, how it spreads, and what prevention and treatment options are available. This article summarizes the history, symptoms, diagnosis, and treatments for CHIKV and offers guidelines for nurse practitioners to promote education and prevention.

Section snippets

CHIKV and Fever

CHIKV is a single-stranded, RNA, arbovirus/alphavirus belonging to the Togaviridae family. Partial sequences of NS4 and E1 genes revealed 3 groups of CHIKV: the West African, East-Central South African, and Asian virus. Alphavirus refers to how the disease presents symptom-wise. Alphaviruses causing fever, rash, and arthralgia are typical of CHIKV and dengue, whereas alphaviruses producing fever, malaise, and headache are more common with encephalitis. Arbovirus or arboviral is an acronym for

Method of Virus Transmission and Migratory Path

CHIKV is primarily transmitted from human to human via mosquitoes. Typically, a mosquito bites an infected human and acquires the virus for the rest of the mosquito’s life. The mosquito then transmits the virus by biting other humans. Chikungunya is highly symptomatic, with over 70% of infected persons developing symptoms, compared with only about 25% of people infected by dengue fever.4 A single human case has a mean retransmission rate of 2 to 4 other people, meaning that once a mosquito

Chikungunya in the US

For many years, the US remained isolated from CHIKV. Between 1995 and 2005, there were only 3 reported cases in the US; all were travelers returning from infected areas. The South Asian outbreak developed in 2006 to 2009. During this time, an average of 26 cases were diagnosed annually in the US.8 This number grew slightly between 2010 and 2013, with a mean of 29 cases in those years.15 All of the cases involved persons who had traveled to regions at risk, and most returned back to the US while

Diagnosis and Treatment Plans

Awareness of CHIKV is an important first step in diagnosing the virus and taking steps to stop transmission. Because of its rarity, only a few medical professionals practicing in the US have seen a case of CHIKV. Like the Ebola virus, a lack of experience with the virus may cause medical personnel to misdiagnose cases or fail to initiate the proper steps for treatment. Some cases may be overlooked and assigned to dengue, yellow fever, or influenza because these diseases are more familiar in

Discussion of Arboviruses

CHIKV and dengue fever may be included in the differential diagnosis because the coexistence of these 2 viruses has been reported in the literature and may complicate diagnosis and treatment. The CHIKV and dengue viruses are transmitted with the same vectors being the primary methods for spreading. Both viruses cause patients to present with high fever, headache, body pains, and a rash. However, the fever usually lasts longer with CHIKV. Dengue has a greater incidence of shock, hemorrhagic

Prevention and Risk Reduction

In the meantime, what protective steps can be taken to reduce the probability and extent of CHIKV in the US? Individuals, travelers, the travel industry, and health care personnel can help limit risk. Individuals may have the greatest control over whether they acquire CHIKV or cause it to spread to others. By taking certain precautions, individuals greatly reduce the potential of acquiring this virus. International travelers should be aware of regions where the CHIKV is endemic or currently

Summary

CHIKV is an arbovirus/alphavirus genus of the Togaviridae family transmitted by several species of mosquitos including A. aegyptia and A. albopictus. CHIKV is a serious health concern in much of the world because of the current outbreaks originating in India and Southeast Asia and now affecting over 1 million people in the Americas. It can spread very effectively and efficiently because of increased global travel and the geographic range of the primary vector mosquitoes. Without a vaccine or an

Doris Evans, MSN, FNP, works at Flagler Hospital in St. Augustine, FL. She can be reached at [email protected].

References (27)

  • F. Simon et al.

    French guidelines for the management of chikungunya (acute and persistent presentations)

    Med Mal Infect

    (2015)
  • Nateson S, Chandrasekar P. Chikungunya virus. http://emedicine.medscape.com/article/2225687-overview. 2015. Accessed...
  • P. Gerardin et al.

    Multidisciplinary prospective study of mother-to-child chikungunya virus infections on the island of La Reunion

    PLoS Med

    (2008)
  • P. Gerardin 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)
  • P.H. Tither

    Preventing dengue and chikungunya fever among international travelers

    J Am Assoc Nurse Pract

    (2014)
  • S. Cauchemez et al.

    Local and regional spread of Chikungunya fever in the Americas

    Euro Surveill

    (2014)
  • Centers for Disease Control and Prevention. Chikungunya virus: clinical evaluation & disease....
  • S. Zyga et al.

    Emerging and re-emerging infectious diseases: a potential pandemic threat

    Health Sci J

    (2011)
  • M.A. Johansson et al.

    Nowcasting the spread of chikungunya virus in the Americas

    PLoS One

    (2014)
  • K.B. Gibney et al.

    Chikungunya fever in the United States: a fifteen year review of cases

    Clin Infect Dis

    (2011)
  • P. Poletti et al.

    Transmission potential of Chikungunya virus and control measures: the case of Italy

    PLoS One

    (2011)
  • S.C. Weaver et al.

    Chikungunya: evolutionary history and recent epidemic spread

    Antiviral Res

    (2012)
  • Kuehn, BM. (2014). Chikungunya virus transmission found in the United States: US health authorities brace for wider...
  • Cited by (3)

    • The medicinal chemistry of Chikungunya virus

      2017, Bioorganic and Medicinal Chemistry
      Citation Excerpt :

      Basically, treatment has been limited to antipyretics, analgesics, corticosteroids, and non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate the symptoms.4,37 In addition, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulphasalazine can be used in severe cases when NSAIDs are not effective.30,43,44 Moreover, co-infection with Dengue (DENV), CHIKV, and Zika (ZIKV) has been reported in patients9,45,46 Although, co-infection with ZIKV and CHIKV does not appear to increase the severity of the disease or the duration of arthritis.47

    Doris Evans, MSN, FNP, works at Flagler Hospital in St. Augustine, FL. She can be reached at [email protected].

    Jan L. Meires, EdD, FNP-BC, is a professor at Brooks College of Health at the University of North Florida.

    In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

    View full text