Chikungunya in the Caribbean: It's been here before.

Chikungunya in the Caribbean: It's been here before.HT: Crof.

Via Emerging Infectious Diseases: Reappearance of Chikungunya, Formerly Called Dengue, in the Americas. The abstract:

After an absence of ≈200 years, chikungunya returned to the American tropics in 2013. The virus is maintained in a complex African zoonotic cycle but escapes into an urban cycle at 40- to 50-year intervals, causing global pandemics. 

In 1823, classical chikungunya, a viral exanthem in humans, occurred on Zanzibar, and in 1827, it arrived in the Caribbean and spread to North and South America. In Zanzibar, the disease was known as kidenga pepo, Swahili for a sudden cramp-like seizure caused by an evil spirit; in Cuba, it was known as dengue, a Spanish homonym of denga. 

During the eighteenth century, dengue (present-day chikungunya) was distinguished from breakbone fever (present-day dengue), another febrile exanthem. In the twentieth century, experiments resulted in the recovery and naming of present-day dengue viruses. 

In 1952, chikungunya virus was recovered during an outbreak in Tanzania, but by then, the virus had lost its original name to present-day dengue viruses.

Jamaica: Guillain-Barré syndrome cases spike with chikungunya.

Jamaica: Guillain-Barré syndrome cases spike with chikungunya. HT: Crof.

Via the Jamaica Observer: GBS cases spike with CHIKV. Excerpt:

The University Hospital of the West Indies in St Andrew saw about five cases of Guillain-Barré syndrome (GBS) between October and November 2014. According to consultant neurologist Dr Francene Gayle, on average, she has seen one case of GBS per year since she has been at the health facility. 

The consultant neurologist told the Jamaica Observer that the chikungunya virus that swept across the island late last year and has left several with lingering joint pains caused a spike in the number of GBS cases. 

"I must tell you that, on average, since I have been back, I have been home three years, so on average, I see maybe one case of GBS per year at the University Hospital of the West Indies," Dr Gayle disclosed. 

"But with CHIKV, between October and November, we saw about five cases of Guillain-Barré syndrome, so it resulted in a spike in the number of cases that we would normally see annually." 

GBS is a disorder in which the body's immune system attacks part of the peripheral nervous system. The symptoms generally include weakness and tingling in the limbs before spreading, and eventually resulting in paralysis. 

Speaking to Your Health Your Wealth in a recent interview, Dr Gayle said there are a few causes but the commonest cause is post-viral illness. The consultant neurologist explained that influenza as well as a particular bacteria known as campylobacter jejuni can bring on GBS. 

She also spoke specifically to the Jamaican context. "In our Jamaican context, chikungunya virus is also associated with Guillain-Barré syndrome," Dr Gayle said. "Viruses, on a whole, what they do is that your body mounts an attack against the infectious agent and, unfortunately, there are various proteins on the surface of the viruses that your immune system targets. 

"These same proteins have similar proteins on the nerve linings and so the antibodies that are produced to fight these viral infections can actually be mediated against those proteins on the nerves within the body," she continued. "And so the nerves get damaged as a bystander."

Lindsay Lohan battles Chikungunya virus, while the Caribbean are under assault by chikungunya in 2014.

Lindsay Lohan battles Chikungunya virus, while the Caribbean are under assault by chikungunya in 2014.. HT: Crof.


Sounds exotic. And not something you want to catch.

After Lindsay Lohan wrapped up her two-month run in Speed-the-Plow in London at the end of November, she was ready for some rest and relaxation.

She headed for someplace tropical. But the trip to paradise has soured a bit. During her French Polynesian trip with longtime friend Patrick Aufdenkamp, she contracted the Chikungunya virus.

She has been tweeting and Instagramming photos about her trip.

Being sick is no fun. But happy new year everyone. Be safe. Love all. Make a difference and keep your… http://t.co/V7i2F8KnTz
— Lindsay Lohan (@lindsaylohan) December 29, 2014

Before I got chikungunya 😥😰😪 use Big spray please 🙏 God bless. http://t.co/8xg2gNWBz5
— Lindsay Lohan (@lindsaylohan) December 28, 2014

Via Caribbean360.com: 2014 year in review: Caribbean rocked by Chikungunya. Excerpt:

Three general elections and continued socio-economic problems may have made the headlines in the Caribbean in 2014, but it was the Chikungunya virus, the mosquito borne disease that really caught the attention of the region over the past 12 months. 

In addition, while no cases had been recorded, Caribbean countries were putting in place various measures to deal with the deadly Ebola virus that have killed more than 7,000 people in West Africa and spread also by the same mosquito responsible for the Chikungunya virus. 

A crippling mosquito-borne virus with a tongue twisting name, Chikungunya first appeared in the Caribbean towards the end of 2013. But by the end of 2014, every Caribbean Community (CARICOM) country had recorded cases of the virus caused by the aedes aegypti mosquito that causes a dengue-like sickness. 

Symptoms include a sudden high fever, severe pain in the wrists, ankles or knuckles, muscle pain, headache, nausea, and rash. Joint pain and stiffness are more common with Chikungunya than with dengue. The symptoms appear between four to seven days after the bite of an infected mosquito. 

The Trinidad-based Caribbean Public Health Agency (CARPHA) warned the Caribbean has not yet felt the “full impact” of the disease. 

“There is an estimate in excess of 600,000 cases in total, most of those being from the bigger countries like the Dominican Republic and Haiti with 37 deaths in total. So it continues to spread,” said CARPHA’s executive director Dr. James Hospedales. 

Dr. Hospedales said that with a population of 17 million people, the region is still in the early stages of the virus, warning “the full bloom of Chikungunya virus is yet to come. 

“I am saying because everybody in this part of the world and there is no resistance to this virus and we have an abundance of the vector and we have a lot of movement. In six months it has moved to all the islands and we can expect further increases in levels of cases because of what has happened elsewhere in the world where in some countries you find a 30 per cent attack rate of the entire population within a year or so.”

More in detail info on Chikungunya can be read here. 

Mexico detects first case of mosquito-borne chikungunya virus

Mexico detects first case of mosquito-borne chikungunya virus. HT: Crof.

Via Reuters: Mexico detects first case of mosquito-borne chikungunya virus. Excerpt:

Mexico has detected its first domestic case of the painful mosquito-borne viral disease chikungunya in the southwest of the country, the state government of Chiapas said on Saturday. 

Chikungunya is spread by two mosquito species, and is typically not fatal. But it can cause debilitating symptoms including fever, headache and severe joint pain lasting months. 

The government of Chiapas, which borders Guatemala, said an 8 year old girl became the first person to contract the disease in Mexico, and that she was treated in hospital in the town of Arriaga. The girl has since been released. 

There is no commercial vaccine for the virus, which was detected for the first time in the Americas late last year. 

Chikungunya has already appeared in much of the Caribbean, Central America and the United States. A handful of people have had the virus in Mexico, having contracted it abroad. 

In September, El Salvador said it had detected nearly 30,000 cases of the virus. In the United States, locally transmitted infections - as opposed to infections in Americans traveling abroad - were reported for the first time this year.

WHO on chikungunya in France, 4 cases of chikungunya locally-acquired infection.

WHO on chikungunya in France, 4 cases of chikungunya locally-acquired infection. HT: Crof.

WHO has published Chikungunya – France. Excerpt:

On 21 October 2014, WHO was notified by the National IHR Focal Point for France of 4 cases of chikungunya locally-acquired infection in Montpellier, France. The cases were confirmed by tests conducted by the French National Reference Laboratory for arboviruses on 20 October 2014. This is the first time that locally-acquired transmission of chikungunya has been detected in France since 2010. 

The 4 cases of chikungunya infection occurred within the same family, with symptoms onset between 20 September and 12 October. The cases live in Montpellier in the vicinity of a chikungunya case imported from Cameroon. The cases have no history of travel out of their district of residence in the 15 days prior to the onset of symptoms.

Chikungunya is a viral disease that is rarely fatal and is transmitted to humans by infected mosquitoes. Symptoms of chikungunya include high fever and headache, with significant pains in the joints (ankles, wrists), which can persist for several weeks.

The symptoms appear between 4 and 7 days after the patient has been bitten by an infected mosquito.

The name, chikungunya derives from a word in Makonde language roughly meaning “that which bends up”, reflecting the physique of a person suffering from the disease.

First local chikungunya case reported in Costa Rica.

First local chikungunya case reported in Costa Rica. HT: Crof.

Via The Costa Rican Times: 1st Indigenous Case of Chikungunya in Costa Rica Reported. Excerpt:

This afternoon I went to do my dishes and in one of my plastic cups was a dead Aedes mosquito. It was the first time I had actually seen one not in a picture. Dengue & Chikungunya are the only things that frighten me about living in Costa Rica. 

The first reported case of the Chikungunya virus that was confirmed to originate within the borders of Costa Rica has come to pass. 

There have been other Chikungunya victims, but they all acquired the virus overseas before coming to Costa Rica. 

The first case of the Chikunguna Virus being caught on Costa Rican soil occurred  in Parrita in the Puntarenas Province which is located about 30 minutes from Jaco. 

The woman who tested positive for the first indigenous case of the virus was tended to by officials of the Costa Rican Social Security Fund. The Costa Rican Institute for Research and Education on Nutrition and Health performed the test. 

The other 15 victims found to have the virus in Costa Rica came from the Dominican Republic and Haiti. The local woman became sick after hosting a Dominican at her home. This guest was sick but the symptoms went unaddressed. 

The government plans to spray in areas where the patient was, to kill the mosquitoes that might infect others.

Hmmm....I've been posting quite a bit about Chikungunya these last months because i see a huge threat to the US, when this arrives in the US Wetlands.More on chik-V here and here.

Eurosurveillance: "Unprecedented" concurrent outbreaks of dengue, chikungunya, Zika virus in the Pacific

Eurosurveillance: "Unprecedented" concurrent outbreaks of dengue, chikungunya, Zika virus in the Pacific. HT: Crof.

Via Eurosurveillance: Concurrent outbreaks of dengue, chikungunya and Zika virus infections - unprecedented epidemic wave of mosquito-borne viruses in the Pacific 2012-2014. The abstract:

Since January 2012, the Pacific Region has experienced 28 new documented outbreaks and circulation of dengue, chikungunya and Zika virus. 

These mosquito-borne disease epidemics seem to become more frequent and diverse, and it is likely that this is only the early stages of a wave that will continue for several years. 

Improved surveillance and response measures are needed to mitigate the already heavy burden on island health systems and limit further spread to other parts of the world. 

Hmmm....In case you are wondering which mosquitoes carry Chikungunya....The same type that carry West Nile virus, north America be warned!

Hmmm....I've been posting quite a bit about Chikungunya these last months because i see a huge threat to the US, when this arrives in the US Wetlands. More on chik-V here and here.

PAHO: Almost 800,000 chikungunya case as of October 17 (it says here)

The Pan American Health Organization has posted its regular Friday update on chikungunya in the Caribbean and neighboring nations. 

We are now up to epidemiological week 42, but some countries are weeks if not months behind. If not for Ebola taking all the attention, this would be a big scandal.


The regional total is 759,742 suspected cases, plus 12,327 confirmed, plus 1,708 imported. But the Dominican Republic is still at week 38 (486,306 suspected cases, just 84 confirmed). Next door, Haiti hasn't bothered to report since week 28, so we know of only 64,695 cases when the true number must be closer to a million.

So it goes, week after week with no explanation. Download the PDF if you like, but don't bother to print it out. Paper is more valuable.

Jamaica: 10-year-old dies from chikungunya complications.

Jamaica: 10-year-old dies from chikungunya complications. HT: Crof.

Chikungunya continues to spread in the Caribbean. The Jamaicans are taking it especially badly, and have invented their own term for it. Via the Jamaica Observer: 10-year-old dies from ChikV complications.

A 10-year-old student of the Alpha Primary School in Kingston died Friday as a result of complications brought on by the chikungunya virus, the Education Ministry has confirmed. 

A ministry release Friday afternoon said that Akaliah Anderson, who had reported to school for only one day (September 1, 2014), had revealed symptoms of the chikungunya virus. 

It was reported that her condition had not improved and she was subsequently admitted to the hospital. She reportedly developed further complications including a swollen spleen and liver. 

Little Akaliah died Friday. 

The Education Ministry said it was saddened by Akaliah’s death and extended condolences to her family and school community.  

A team of counsellors from the ministry will be providing emotional support to Akaliah’s family, students, teachers and administrative staff at the institution, the release said. 

“This incident brings into sharp focus the need for school administrators, parents and the entire citizenry of Jamaica to begin the clean-up process in our communities – home, school, workplaces – in order to eliminate the spread of the ChikV caused by the Aedes aegypti mosquitoes,” Education Minister Ronald Thwaites said.

Hmmm....I've been posting quite a bit about Chikungunya these last months because i see a huge threat to the US, when this arrives in the US Wetlands. More on chik-V here and here.

Update:

PAHO: Almost 800,000 chikungunya case as of October 17 (it says here)

The Pan American Health Organization has posted its regular Friday update on chikungunya in the Caribbean and neighboring nations. 

We are now up to epidemiological week 42, but some countries are weeks if not months behind. If not for Ebola taking all the attention, this would be a big scandal.


The regional total is 759,742 suspected cases, plus 12,327 confirmed, plus 1,708 imported. But the Dominican Republic is still at week 38 (486,306 suspected cases, just 84 confirmed). Next door, Haiti hasn't bothered to report since week 28, so we know of only 64,695 cases when the true number must be closer to a million.

So it goes, week after week with no explanation. Download the PDF if you like, but don't bother to print it out. Paper is more valuable.

Jamaica in "national emergency" due to chikungunya outbreak

Jamaica in "national emergency" due to chikungunya outbreak. HT: Crof.

I've been aware of this problem, but Ebola keeps crowding it out. Via the Caribbean Journal: Jamaica in “National Emergency” Due to Chikungunya Virus Outbreak. Excerpt:

Jamaica Prime Minister Portia Simpson Miller says the country is in a “national emergency” over the outbreak of the mosquito-borne Chikungunya virus in the country. 

The virus, which is similar in symptoms to Dengue fever, often leads to fever and severe joint pain that can last from a few days to, in some cases, for years, though it is rarely fatal. 

The disease has spread across the Caribbean region after initially appearing in St Martin in late 2013, but has hit Jamaica particularly hard. 

“I want to stress that we are in a NATIONAL emergency,” Simpson Miller said at a briefing on Tuesday. “I have therefore, assumed a lead role in mobilizing the nation and national resources.” 

She said she sympathized with those across Jamaica who had come down with the painful illness. 

“I understand that some MPs even as we speak are out with the virus,” she said. “I want to commend MPs, Mayors and Councillors who have been active in encouraging your constituents to get involved in the only sustainable way to control and reduce the epidemic – which is, to destroy and reduce mosquito breeding sites.” 

She said the government had called on about $4.5 million USD in state resources for national health emergency response, with the objective of reducing mosquito breeding sites by starting with the worst-affected areas. 

“This is our country,” she said. “We all have a stake and a vested interest in protecting it and in keeping our people safe and healthy.”

According to PAHO, Jamaica last week had just 325 suspected cases, plus 52 confirmed and 2 imported. It sounds as if far more cases are involved than those. Hmmm....I've been posting quite a bit about Chikungunya these last months because i see a huge threat to the US, when this arrives in the US Wetlands.More on chik-V here and here.

Pan American Health organization 748,403 chikungunya cases as of October 10

Pan American Health organization 748,403 chikungunya cases as of October 10. HT: Crof.

PAHO has updated its Chikungunya numbers. (Click through the link and download the PDF in the upper right corner of the page.) It's becoming an increasingly irrelevant document.

Ostensibly this brings us up to week 41, and the total is now 748,403 (suspected) cases. They're suspected because no one bothers to test for it now.

But they're also suspect numbers because so many of them are weeks or even months behind.

The US *is at week 41, all right, with 11 locally acquired cases and 1,326 imported. But Canada hasn't troubled to report since week 32, when it had 8 imported cases.

Where the disease is rapidly spreading, the Dominican Republic counts 486,306—as of week 38. Haiti next door remains The Land That Time Forgot, stubbornly stuck in week 28 and 64,695 cases.

So it goes: Cuba, week 33; Puerto Rico, week 37; Dominica, week 28; Grenada, week 26. Colombia is almost up to date at week 40 and 6,092 cases, as is Ecuador with just one imported case. Jamaica's at week 40 with 325 cases, but given the "Chik-V" political uproar there, the real number must be much higher.

The disparity in updates might be tolerable if PAHO at least bothered to explain why some countries don't report promptly. 

Three-quarters of a million cases since last December? I wouldn't be surprised if the true number were double that or even higher.

*Hmmm.....Just think when Chik-V gets hold in the U.S. Wetlands.

Haiti: 50% of the population could be affected by the chikungunya epidemic

Haiti: 50% of the population could be affected by the chikungunya epidemic. HT: Crof.

Via HaitiLibre.com: 50% of the population could be affected by the chikungunya epidemic. Excerpt and then a comment:

The chikungunya epidemic, which began in late 2013 in the Americas, was detected for the first time in Haiti in May and its rapid spread has led the Haitian government to officially declare a medical emergency. 

To date, Haiti has recorded more than 65,000 cases of chikungunya and those responsible for public health, estimate that up to 50% of the population could be affected by the epidemic. 

Unlike many other diseases transmitted by mosquitoes, no vaccine is available to prevent chikungunya. Common symptoms include fever and joint pain, which can be severe and disabling. 

On Wednesday, the First Lady, Sophia Martelly, visited accompanied by Dr. Florence Guillaume, Minister of Public Health and Population (MSPP) and Dr. George Dubuche, the Director General of the Ministry, went to the Direct Relief warehouse in Port-au-Prince, where drugs to treat one million people will be distributed to 904 public health sites to the population, and others Direct Relief partner hospitals. 

The shipment contains more than 6.1 million Defined Daily Doses of pain relievers, oral rehydration packs, antibiotics, IV solution, malaria tablets, and mosquito spray. This distribution comes in the midst of a rainy season, expected to cause a wave of new cases.

In other words, over five million people could fall ill with chikungunya in Haiti.

Others affected would be the family members who depend on the income and care of relatives who fall ill. Economically, chikungunya may do more damage than cholera has after almost four years: at least 706,291 cases and 8,584 deaths. (Typically, those are MSPP's latest numbers—from August 27.)

Hmmm....I know i'm one of the few who posts about Chikungunya, but if this gets hold in the US wetlands you'll see an epidemic of biblical proportions. Read up on it and prepare.

Chikungunya: 659,554 cases as of Sept 5, not as lethal as Ebola but spreading way faster.

Chikungunya: 659,554 cases as of September 5, not as lethal as Ebola but spreading way faster.HT: Crof.

Chikungunya is a viral disease transmitted by the bite of infected mosquitoes such as Aedes aegypti and Aedes albopictus.

It can cause high fever, join and muscle pain, and headache. Chikungunya does not often result in death, but the joint pain may last for months or years and may become a cause of chronic pain and disability.

There is no specific treatment for chikungunya infection, nor any vaccine to prevent it. 

Pending the development of a new vaccine, the only effective means of prevention is to protect individuals against mosquito bites.

PAHO has published its weekly Friday update on its Chikungunya page.

Click through to download the PDF. We're now in week 36, and as usual, some countries are weeks behind in reporting.

The Dominican Republic, as of week 34, has 429,421 cases; 

Haiti, as of week 28, had 64,695 (very likely a severe undercount).

PAHO now tallies 659,554 suspected and confirmed cases. Hmmmm....As i warned before,  once this disease gets foothold in America's wetlands and swamps you'll have an unstoppable disease on your hands.

CDC: Chikungunya officially in the US as of July 22.

CDC: Chikungunya officially in the US as of July 22. HT: Croft.

Via the CDC: United States Geographic Distribution | Chikungunya virus. Click through for the full report and a map. The key points, with my bolding:

• Chikungunya is not a nationally notifiable disease in the United States. However, chikungunya cases can be reported to ArboNET, the national surveillance system for arthropod-borne diseases. 

• From 2006‒2013, studies identified an average of 28 people per year in the United States with positive tests for recent chikungunya virus infection (Range 5‒65 per year). All were travelers visiting or returning to the United States from affected areas, mostly in Asia. Only a quarter of the cases were reported to ArboNET. 

• Beginning in 2014, cases have been identified in travelers returning from the Caribbean. As of July 22, a total of 497 chikungunya cases have been reported to ArboNET from U.S. states and territories (Table). One hundred ninety-seven locally-transmitted cases have been reported from Florida, Puerto Rico, and the US Virgin Islands. All other cases occurred in travelers returning from affected areas in the Caribbean and South America (N=295), the Pacific Islands (N=4), or Asia (N=1). 

• With the recent outbreaks in the Caribbean and the Pacific, the number of chikungunya cases among travelers visiting or returning to the United States from affected areas will likely increase. These imported cases could result in additional local spread of the virus in the continental United States.

Chikungunya in the Caribbean   

Most of the areas previously involved continue to report increasing case numbers. The situation is particularly severe on the island of Hispaniola (Haiti and the Dominican Republic) and in Guadeloupe. Both Costa Rica and Venezuela have reported confirmed cases, but it is not clear if they are imported or autochthonous. The United States reported the first locally acquired cases of chikungunya in Florida, one in Miami-Dade County, the other in Palm Beach County. According to media reports, Puerto Rico health officials declared a chikungunya epidemic, due to a rapidly rising number of cases there.   

An outbreak of chikungunya virus infection has been ongoing in the Caribbean since December 2013. There have been more than 350 000 probable and confirmed cases in the region with at least 21 fatalities reported. Many countries are reporting imported cases from the affected areas.   

ECDC published a risk assessment on 25 June and an epidemiological update on 30 June. 

Chikungunya is Coming to a neighborhood near you. Prognosis 40,000 Killed first year!

Chikungunya is Coming to a neighborhood near you! HT: Croft.

Via Chapelboro.com, Jeff Danner writes: Chikungunya is Coming Part II. I linked to his first post on July 13. Excerpt from the new post:

While it seems clear to me that the southeastern United States is about to experience an epidemic of chikungunya (the first two locally-transmitted cases occurred this week in Florida), what is unclear is its likely extent.  The current epidemic in the Dominican Republic may provide some insight.  Since chikungunya struck the Dominican Republic in early April, there have been almost 200,000 cases, an incidence rate of 20 per thousand for this nation of 10 million people.  

If the Southeast, with a population approximately 80 million, had the same incidence rate as the Dominican Republic, we would expect 1.5 million cases in the first 100 days of an epidemic.  However, due to widespread availability of insect repellent here and our stay-inside-the-air-conditioned-space lifestyles, our incidence rate is likely to be lower.  

For the sake of argument, let’s assume our incidence rate will be 1/3 that of the Dominican Republic.  This would translate to a half a million cases in the first hundred days, and we would then project approximately 10 million cases in the first year.  With chikungunya’s fatality rate of 0.4%, an epidemic of this scale would kill 40,000, with fatalities being disproportionately among the very old and very young. 

To put those 40,000 deaths in perspective, this is about the same number of annual deaths we see in the U.S. from each of the following causes: influenza, car accidents, suicides, and shootings.  While we have become somewhat desensitized to deaths stemming from these familiar hazards, I anticipate that public reaction to an epidemic from a new and unfamiliar disease with a strange name will be something approaching widespread panic.  Let me try to explain why.  

First of all, nothing about the current level of function in either our state or federal government suggests that they could effectively coordinate either communications or logistics in a public health crisis.  Now add to this the fact that a large portion of the public seems to have developed rather extreme anti-science views, for example the anti-vaccine and intelligent design communities. I think we can anticipate a fair number of non-productive conspiracy theories to arise from these factions and distract from addressing the problem. 

Furthermore, I think we can also safety assume the epidemic will be politicized almost immediately.  Given that chikungunya has reached Florida already, we can only be hours away from claims that this epidemic is President Obama’s fault and that the public is being put at risk by “liberals” who valued salamanders over humans by banning DDT.  I expect calls for the return of DDT as well. (1) 

So what can or should we do here locally to prepare for chikungunya?  Epidemics are all about math.  In this case the key variables are the number of currently infected people, the number of mosquitoes that can transmit the virus, and the number of mosquito bites.  As time passes, a fourth variable, the number of people who are immune from having had chikungunya already, will become a factor. 

We can collectively help to slow the spread of chikungunya by reducing the overall rate of mosquito bites in the county through common sense measures of which you are already aware; using bug repellent, wearing clothing the covers the body, minimizing pools of standing water near your home, and not going out at dusk and other times of day that mosquitoes are most active. 

In addition, the Orange County Health Department should start making preparations.  Cases of chikungunya will occur in geographic clusters.  People who get the disease need anti-inflammatory and pain reducing medications as well as fluids to fend off dehydration.  

Unfortunately, the United States is currently experiencing a shortage of sterile saline which is used to treat dehydration.  In addition, if we had a cluster of cases in Orange County we could easily run out of hospital beds. We need to have a plan in place – and we may already have one – for a temporary clinic for hospital overflow, and we should work to build an inventory of saline solution.  We also need a communications plan so that, at least here locally, people will have accurate information.

Pan American Health Organization: 436,586 chikungunya cases in the Americas...This is just the beginning.

Pan American Health Organization: 436,586 chikungunya cases in the Americas...This is just the beginning.HT: Croft.

PAHO has published this week's statistics on its Chikungunya page for week 29 (click on Last Update: July 18, 2014 in the upper right-hand corner of the page). 

These report are very patchy, with some countries weeks behind others.  But we now have 436,586 "suspected" cases (no one bothers to test any more), which gives us a weekly increase of 86,006 over July 11.

The Dominican Republic has seen an increase from 193,395 to 251,880. Haiti, going from week 26 to 27, went from 51,830 to 62,422. The true Haitian numbers are likely over a million. Guadeloupe saw a rise from 52,000 in week 26 to 63,000 in week 28.

The US has 236 cases; no distinction between imported and locally acquired cases. 

By the end of the summer chikungunya is likely to be uncountable in the Americas.Hmmm.....I can't even imagine Obama care dealing with something of this magnitude, once it gets hold in the U.S. wetlands.

American mosquitoes for the first time are spreading the chikungunya virus, might be the end of Obama care.

Just imagine life once Chikungunya gets hold in the US Swamps!

American mosquitoes for the first time are spreading the chikungunya virus, might be the end of Obama care. (RT).

American mosquitoes for the first time are spreading the chikungunya (chik-en-GUN-ye) virus that was once confined to the Caribbean and tropical Americas. There is presently no cure for the infection, which causes symptoms similar to dengue fever, including severe joint pain and swelling, muscle aches, headaches and fever.

Incurable chikungunya spreads in US

Health officials say the introduction in Florida of the painful disease, which has infected thousands across the Caribbean this year, is the first time that individuals in the continental United States are believed to have contracted the virus without traveling abroad.

"The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens," said Roger Nasci of the Centers for Disease Control and Prevention (CDC), in a prepared statement.

The two infected Floridians were described as a 41-year-old woman in Miami-Dade County who first noticed symptoms on June 10, and a 50-year-old man in Palm Beach County, who experienced symptoms on July 1. Officials said both are doing well.

Florida Department of Health confirms first locally acquired cases of Chikungunya Fever: http://t.co/g4N0RJUGPH #DrainAndCover#CHIKV
— Florida Dept. Health (@HealthyFla) July 17, 2014

With so many people traveling between the US and the tropical Americas, medical officials said it was only a matter of time before the virus arrived in the continental United States.

“We’ve been anticipating this for some time,” Nasci said. “We don’t expect widespread sweeping outbreaks, but we do expect some local limited outbreaks to occur. What we don’t know is how many cases there will be.”

The infections occurred after a person was bitten by a mosquito carrying the chikungunya virus in the Caribbean. The person then traveled to Florida, where the individual was bitten by an uninfected mosquito, thereby allowing the illness to spread further.

On a truly amazing news day, Lisa Schnirring at CIDRAP has a fine report: US reports first locally acquired chikungunya cases. After summarizing the situation, the report continues:

The announcement today comes about 7 months after the first chikungunya cases were detected in the Western Hemisphere, the CDC said. The outbreak in the Caribbean region has sickened more than 355,000 people, with the number of new infections continuing to grow by roughly 40,000 cases each week. 

As a ripple effect, the United States—especially in Florida—and several other countries have reported a rising number of cases in travelers returning from outbreak areas, and health officials have boosted surveillance for the disease and warned that an infected patient can transmit the virus to mosquitoes, which can then transmit the disease to others through a bite.

This is not spread person-to-person. Hmmm.....I've been posting for months about chikungunya, if this gets hold and spreads like in the Caribbean it might 'break' the back of Obama care.

Chikungunya in North America: "one million cases in the first ninety days!"

Chikungunya in North America: "one million cases in the first ninety days!" HT: Croft.

Via chapelboro.com, a thought-provoking post by Jeff Danner: Chikungunya is Coming: Part I. Click through to read the whole thing. Excerpt, with the author's graphics:

The first ever recorded case of locally-transmitted chikungunya in North or Central America occurred on the island of St. Martin in December of 2013. Since then, an epidemic has spread like wild fire, particularly in the Dominican Republic. The Graph below shows the number of infections reported during the first ninety days of the epidemic in the Dominican Republic, with day zero being April 1 of 2014. 

 In the first 90 days of the epidemic, this nation of 10 million people had 135,000 cases! If the behavior of this epidemic follows the pattern of the outbreak on Reunion Island in the India Ocean from 2005-2006, the Dominican Republic can expect approximately two to four million cases of chikungunya to occur within a year. 

To put it lightly, an epidemic of this proportion will be very challenging and disruptive to the citizens and economy of the Dominican Republic. Overall, there have been over a quarter of a million cases in the Caribbean, including Puerto Rico and the U.S. Virgin Islands, in the first six months of 2014. 

Now let’s consider the probability of a chikungunya outbreak in the continental United States. For starters, essentially zero percent of the population of the United States is immune to chikungunya. Next consider the maps below showing the current ranges of Aedes aegypti and Aedes albopictus in the U. S.   

As you can clearly see, both species of mosquito are resident in large portions of the country, including North Carolina. 

For the purposes of the calculations below I estimated that approximately 25% of the U.S. population lives within the current range of one or both of these mosquitoes. All that is needed for an epidemic to get started is for one or more infected people to arrive here on boats or planes and the mosquitoes to bite them at the right time. 

The data on this front is not encouraging. According to the Centers for Disease Control (CDC), so far this year there have been 138 confirmed cases of people arriving in the continental US, primarily returning vacationers, with a chikungunya infection acquired while abroad. This number is unprecedented. So far we have been extremely lucky that there have been no reported cases of local transmission. 

While my position is that current conditions make a near-term chikungunya epidemic in the U.S. almost certain, the statement made by the CDC on their website is more measured. Their position is, “There is a risk that the virus will be imported to new areas by infected travelers.” Therefore, either I am being alarmist or they are too concerned about creating a panic to be more forthright about the risk. 

If I am correct and the Southeastern United States is about to have an epidemic similar to the one in the Dominican Republic, we’d have one million cases in the first ninety days! That would make for a few headlines. 

So is there anything we can do to prevent this? Should we have been more prepared that we are? For my thoughts on that, you need to come back next week. In the meantime, I’d think about stocking up on insect repellent.

Hmmm.....Could be the death of Obama care.

France health minister warns of epidemic after 33 chikungunya deaths

France health minister warns of epidemic after 33 chikungunya deaths. HT: Channel NewsAsia,

an AFP report: France warns of epidemic after chikungunya deaths.

PARIS: France's health minister warned Thursday of a serious epidemic in the Antilles and French Guiana after 33 deaths were reported in connection with the chikungunya virus. 

"This is a major epidemic, with about 5,000 new cases every month," Marisol Touraine told BFMTV. "The disease has indirectly caused 33 deaths in vulnerable elderly people, affected nearly 100,000 people and resulted in 1,000 hospitalisations in the French Americas." 

Touraine said she was going to the region next week to deal with what she called "a major public health issue". 

The Antilles, also known as the French West Indies, are a group of Caribbean islands under French sovereignty, while French Guiana is a territory on the north Atlantic coast of South America, bordered by Brazil and Suriname. 

The mosquito-born chikungunya virus has been spreading through the Caribbean and Central America. 

The virus -- rarely fatal, but nevertheless serious -- sparks high fevers and severe joint aches, as well as headaches, nausea and extreme fatigue. 

It does not kill directly but in combination with other illnesses can lead to death.

Break Your Bones – Mortality and Morbidity Associated with Haiti’s Chikungunya Epidemic.

Break Your Bones – Mortality and Morbidity Associated with Haiti’s Chikungunya Epidemic. HT: Croft.

In December 2013, chikungunya, a deadly dengue-like virus spread by mosquitos, was first diagnosed in the Americas on the island of St. Martin. The disease quickly spread to neighboring islands and on May 7 the Haitian Ministry of Health confirmed 14 cases. A week later that number had increased to more than 1,500. Within two weeks of its purported arrival, it had risen to more than 5,500 cases. Epidemiologists report that chikungunya is likely to keep spreading.   

Although most Caribbean nations were able to control and respond to the outbreak, chikungunya has been merciless in Haiti. Lack of basic infrastructure, poor mosquito control measures, and deep social and economic disparities hampered prevention and treatment efforts. 

Shortly after the outbreak was announced, an Igarape Institute-led research team was dispatched to conduct a nationwide survey to determine the risks and protective factors for infection with chikungunya. The Institute has coordinated similar assessments of spread of cholera, food security after the hurricanes, and violence and victimization.  

Between May 19 and 30 2014, a total of 2,807 randomly sampled households (accounting for 13,760 individuals) from all ten geographic departments were included in the study, as were 446 randomly sampled tourists departing the Port-au-Prince airport. An additional survey of market conditions was conducted in Port-au-Prince and the seaside town of Jacmel. A qualitative component to the study included five focus groups (ten participants in each group) and 27 in-depth interviews. The qualitative interviews and focus groups were conducted in Jacmel and the greater Port-au-Prince area.  

And here are some of the findings:

•Clear signs of rapid, uncontrolled spread. "The virus had infected 9.2% of individuals in the study, affecting 14.3% of households (n=402)."

•Both children and adults are susceptible to the virus: 493 adults (8.6% of all adults) and 767 children (9.6% of all children) registered symptoms of chikungunya.

• Several statistically significant risk factors: Having a household member with chikungunya, living in a displaced persons camp, a past diagnosis of dengue in the household, and rice farming.

• Evidence-based preventive practices not being followed: Relatively few use treated mosquito nets; open water containers found outside most rural home, half of urban and peri-urban homes.

• Preference for traditional means of treatment: Some 77.1% of chikungunya victims were treated using traditional medicine, often in conjunction with biomedical treatment.

• High level of resignation: Over half those surveyed (52.2%) agreed or strongly agreed with the statement, "even if I spend a lot of time and money trying to prevent it, I will still get chikungunya."

Hmmm......'Chikungunya'....Remember this name in coming years you'll be assaulted by it....oce it gets hold in America's wetlands, and i don't mean 'IF' it gets hold.

Related: 

Dominican Republic: Chikungunya "has exposed the reality of the health system"

Switzerland: "Significantly more" cases of chikungunya, dengue

Dr. Halverson talks about chikungunya, Just imagine life once Chikungunya gets hold in the US Swamps!

Jamaica: Committee established to monitor chikungunya...“No problem mon”.

Via the Jamaica Observer: Committee established to monitor Chikungunya. Excerpt:

KINGSTON, Jamaica -- The Ministry of Health has established a committee to monitor the threat of the Chikungunya virus to the island. 

The committee is headed by Director, Emergency, Disaster Management and Special Services, Dr Marion Bullock Duccasse, and meets weekly to discuss that and other matters, Minister of Health, Dr Ferguson said while speaking at a recent post-Sectoral debate press conference at the Office of the Prime Minister in Kingston. 

Dr Fergsuon said that while the virus has not been detected in Jamaica, given international travel and trade, it is likely that it will be introduced into the island. 

He appealed to Jamaicans to take precautions against its spread of the virus by destroying mosquito breeding sites in and around homes, places of business, worship and schools, thus eliminating areas where water can settle. 

“Keep water containers tightly covered, fill old tyres with dirt, keep drums and water tanks covered, and punch holes in cans before disposing of them,” Dr Ferguson urged.