Chikungunya

What Is Chikungunya? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Barbara Kean
By Medically Reviewed by 
Reviewed:
Medically Reviewed

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It is caused by the chikungunya virus and is characterized by sudden fever and joint pain that can be severe and debilitating.

The name “chikungunya” derives from a word in the Kimakonde language that translates to “that which bends up,” referring to the contorted appearance of sufferers with joint pain.

The disease was first described during an outbreak in southern Tanzania in 1952.

Although chikungunya had previously been detected in countries in Africa, Asia, Europe, and the Indian and Pacific Ocean regions, local transmission of the virus was first detected in the Caribbean in 2013. Since then, the virus has spread throughout most of the Americas, including the United States.

Signs and Symptoms of Chikungunya

The first sign of chikungunya will typically be a fever, followed by a rash. After the bite of an infected mosquito, onset of illness usually occurs 4 to 8 days later (but the range can be 2 to 12 days).

Symptoms include:

  • Sudden onset of high fever (typically above 102 degrees F)
  • Joint pains
  • Headache
  • Myalgia
  • Conjunctivitis
  • Nausea
  • Vomiting
  • Rash
While the majority of people infected with the virus will have symptoms, 3 to 28 percent of people infected with chikungunya will remain asymptomatic, according to the Centers for Disease Control and Prevention (CDC).

Causes and Risk Factors of Chikungunya

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It is caused by the chikungunya virus (CHIKV).

An infected person cannot directly transmit the virus to another person. The disease is spread when a mosquito feeds on a person with the virus circulating in their blood. The mosquito can pick up the virus and spread it to another person through its bite.

According to the CDC, no infants have been found to have been infected with chikungunya virus through breastfeeding.

Chikungunya virus is most often spread to people by Aedes aegypti and Aedes albopictus mosquitoes. These are the same mosquitoes that transmit dengue virus.

CHIKV epidemics in Africa and Asia have been primarily associated with the urban mosquito A. aegypti. But since an outbreak on Réunion in 2005, A. albopictus has been introduced as a second major spreader of CHIKV.

A. albopictus is more widely distributed and has the ability to survive in temperate climates. This is unlike A. aegypti, which live predominantly in tropical and subtropical areas.

Proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.

How Is Chikungunya Diagnosed?

If you have recently returned from an area with known virus transmission and are experiencing high fever and joint pain, your doctor might recommend a series of blood tests to detect the presence of chikungunya virus or antibodies.

Several methods can be used for diagnosis of chikungunya virus infection.

Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies.

Chikungunya virus antibodies normally develop toward the end of the first week of illness. IgM antibody levels are highest three to five weeks after the onset of illness and persist for about two to three months. IgG antibodies appear about two weeks after onset of symptoms and can persist for years.

The virus may be directly detected in the blood during the first few days of infection as well. Samples collected during the first week of illness are tested by both serological and virological methods.

Blood tests can also look for similar viruses like dengue and Zika, which have similar symptoms.

Test results are normally available 4 to 14 days after a specimen is received by the lab.

Prognosis of Chikungunya

Most patients recover fully from the infection, but in some cases joint pain may persist for several months, or even years.

According to the CDC, some patients will have a relapse of rheumatologic symptoms such as polyarthralgia, polyarthritis, tenosynovitis, or Raynaud’s syndrome in the months after acute illness. Studies have reported that anywhere from 5 to 80 percent of patients may experience persistent joint pain, as well as prolonged fatigue, for months or years after their illness.

Once an individual is recovered, they are likely to be immune from future infections.

Severe cases and deaths from chikungunya are very rare and are almost always related to other existing health problems. People at risk for more severe disease include newborn babies infected around the time of birth, adults over the age of 65, and people with medical conditions like high blood pressure, diabetes, or heart disease.

Duration of Chikungunya

Fevers typically last from several days to a week. The fever can also be biphasic, meaning it may come in two stages.

Treatment and Medication Options for Chikungunya

There is no specific antiviral drug for chikungunya, so treatment involves relieving the symptoms. Treatment includes:

  • Antipyretics to reduce fever
  • Analgesics for pain relief and to reduce fever
  • Drinking plenty of fluids
  • Rest
Given the similarity of symptoms between chikungunya and dengue, in areas where both viruses circulate, suspected chikungunya patients should avoid using aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) until a dengue diagnosis is ruled out (this is because these medicines can increase the risk of bleeding with dengue).

Once a diagnosis is established, patients with persistent joint pain can use nonsteroidal anti-inflammatory drugs and corticosteroids, including topical preparations. Physical therapy may help lessen the symptoms.

Prevention of Chikungunya

There is no vaccine or preventive drug for chikungunya, so the best way to avoid infection is to prevent mosquito bites. But there are potential vaccines being evaluated in clinical testing.

Basic precautions should be taken by people traveling to high risk areas, including:

  • Wearing long sleeves, long pants, and other clothing that minimizes skin exposure
  • Using insect repellents on skin or clothing
  • Making sure indoor spaces have adequate screens to keep mosquitoes out
  • Using insecticide-treated mosquito nets over your bed if you sleep in the daytime
  • Wearing mosquito netting over your face and neck, in addition to using gloves or repellents, if you spend a lot of time outdoors in areas with mosquitoes
  • Avoiding travel to areas experiencing a chikungunya outbreak
  • Using mosquito coils and insecticide vaporizers during the daytime

Reducing the number of places that mosquitos breed around your home can cut down the population significantly. Some simple actions include:

  • Emptying water from containers, such as the saucers under potted plants, vases, buckets, and rain gutters
  • Covering water containers that cannot be emptied, such as tanks or reservoirs that provide household water
  • Getting rid of old tires that may be left outside
  • Keeping garbage in closed plastic bags and other closed containers

If you have been diagnosed with chikungunya, you should take care to prevent mosquito bites during the first week of your illness, when the virus can be passed to a mosquito and then to another person.

Complications of Chikungunya

Serious complications are not common, but occasionally infection can lead to serious problems of the skin, eyes, kidneys, heart, or nervous system.

Rare but serious complications include:

  • Myocarditis (inflammation of the heart)
  • Ocular disease (uveitis, retinitis)
  • Hepatitis
  • Acute renal disease
  • Severe, blistering rash
  • Neurologic disease such as meningoencephalitis, Guillain-Barré syndrome, myelitis, or cranial nerve palsies

Research and Statistics: How Many People Get Chikungunya?

Because of the challenges in accurate diagnosis for chikungunya, there is no real estimate for the number of people affected by the disease on an annual basis.

Outbreaks can be large and can lead to a significant percentage of a population in a certain contracting the disease.

Past outbreaks include:

  • 2005–2006 More than 272,000 were infected in the Indian Ocean islands of Réunion and Mauritius.
  • 2006 More than 1,500,000 were reported to be infected in India.
  • 2007 197 cases were reported in a coastal village in Italy.
  • 2014–2016 4,339 confirmed cases were reported in Puerto Rico (official surveillance reported 28,327 suspected cases).

  • 2020 The CDC reported significant outbreaks in Chad and Ethiopia.

According to the CDC, before 2006, chikungunya virus disease was rarely identified in U.S. travelers.

From 2006?2013, studies identified an average of 28 people per year in the United States with positive tests for recent chikungunya virus infection (with a range of 5 to 65 cases per year). All were travelers visiting or returning to the United States from affected areas in Asia, Africa, or the Indian Ocean.

Beginning in 2014, chikungunya virus disease cases also began to occur through local transmission (which means that mosquitos in the area have been infected with the virus and are spreading it to people). In recent years, there have been no cases of locally transmitted cases.

Related Conditions of Chikungunya

The symptoms of chikungunya are similar to those of dengue and Zika, diseases spread by the same mosquitoes that transmit chikungunya. Chikungunya can be misdiagnosed in areas where the three diseases are common. Dengue fever is more lethal than chikungunya, and prompt recognition and treatment of it can be lifesaving.

Chikungunya can evolve into a long-lasting, debilitating rheumatic disorder with symptoms that mimic rheumatoid arthritis. Researchers are still trying to understand the exact mechanism by which the chikungunya virus induces persistent arthritis. One theory is that chikungunya alters the immune response. It’s also thought that persistence of viral antigens could be a contributing factor to the development of chronic chikungunya arthritis.

Resources We Love

ClinicalTrials.gov

A great resource from U.S. National Library of Medicine where you can search a database of more than 360,000 research studies in all 50 states and 219 countries. If you are interested in participating in a clinical trial, you can find information here about studies that are currently or soon to be recruiting including eligibility criteria, details on how they are being conducted and length of participation. The database also includes details of completed studies that may provide you with information about treatments and therapies soon to be in the pipeline.

Genetic and Rare Diseases Information Center (GARD)

A program of the National Center for Advancing Translational Sciences (NCATS), GARD offers reliable information on more than 6,500 conditions, including chikungunya. In addition to up-to-date information on the diseases, you can search a database of orphan drugs (treatments the U.S. Food and Drug Administration has approved for rare diseases) to learn more about available treatments. If you can’t find the information you are looking for on the site, you can contact one of their information specialists by phone or email for answers to your questions.

National Organization for Rare Disorders (NORD)

This patient advocacy organization has a mission to improve the lives of individuals and families affected by rare diseases, including chikungunya. On NORD’s website you will find detailed information about your disease or disorder as well as guidelines to help you locate an experienced specialist.

Additional reporting by Ingrid Strauch.

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