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News Article

Chikungunya hits the US as travel-related diseases increase

Fears that virus could take hold in southern US

The explosion of international travel in recent decades has increased the rate at which emerging diseases can spread around the world. We have seen this with the SARS outbreak, which devastated travel and tourism in Asia in 2003. Now the chikungunya virus is setting alarm bells ringing, as a disease which has reached epidemic proportions in parts of the Indian Ocean region this year has been spread to Europe and the US by travellers returning from the region.

The concerns were raised at the 55th Annual American Society of Tropical Medicine and Hygiene conference in late November. "This virus has exploded," said French scientist Philippe Parola, before presenting his findings at the conference. "People must start to pay attention."

Colorado, Louisiana, Maryland, Minnesota and at least a half-dozen other states have reported cases of travelers returning from visits to Asia and East Africa sick with the mosquito-borne virus, according to the U.S. Centers for Disease Control and Prevention. Chikungunya can cause fever, chills, nausea, headache, rash, crippling joint pain and even neurological damage. There is no drug treatment, just bed rest, fluids and mild pain medication.

From the Indian Ocean islands of Mayotte, Reunion and the Seychelles, to 150 provinces of India, chikungunya has infected more than 1.3 million people in just the past 20 months.

Even more alarming, international travel has dramatically increased chikungunya's global reach. According to the most recent edition of the journal Emerging Infectious Diseases, hundreds of visitors to outbreak areas are returning home -- to Europe, South America, Canada and, now, the United States -- infected with a disease unfamiliar to most physicians in the West.

"We believe this type of outbreak could occur in other regions of the world where competent vectors (mosquitoes) are prevalent," wrote Parola in the journal article. He also believes chikungunya could end up being more dangerous to public health than West Nile virus. First appearing in the USA in 1999, West Nile has killed more than 700 people, but for it humans are "dead-end" hosts -- the virus cannot be passed person-to-person by a single mosquito -- whereas with chikungunya they are not.

France has reported 850 cases of travel-associated chikungunya, the United Kingdom 93 and the United States at least a dozen, according to the CDC. Other chikungunya-infected travelers have been diagnosed in Belgium, French Guyana, Hong Kong, Italy, Kenya, Malaysia, Martinique, Norway, Switzerland and Sri Lanka.

Although chikungunya was discovered in East Africa in the 1950s, it has caused only 18 major epidemics since that time. But a disease that was little written about in the textbooks and previously thought to be benign appears now to have increased both in frequency and severity, hallmarks of a re-emerging infectious disease. The outbreak currently occurring has killed over 300 people in Réunion, where the epidemic has devastated the tourism industry.

The fact that most cases in the West are in France, reflects the relationship between France and Réunion, an Overseas Department of France which is a popular holiday spot for the French. In his hometown of Marseille, Parola has treated 46 cases of travel-associated chikungunya this year.

"For us, chikungunya fever was a few lines in a tropical medicine book," said Parola. "Now we see many cases and have noticed that after nine months half the patients are cured, but half still have severe arthritis, especially in their hands, wrists and ankles."

The fear for the US is of the disease emerging in the southern states, where some vector mosquitoes are present all year round. "If they get the virus down there, then it could spread all over the U.S.," said Charles Calisher, a virologist at Colorado State University who was attending the conference in November.

Tourism blow

From the Indian Ocean islands of Mayotte, Reunion and the Seychelles, to 150 provinces of India, chikungunya has infected more than 1.3 million people in just the past 20 months.

Mauritius and the Indian state of Kerala are among the tourism destinations that have mounted campaigns to try and allay fears of the disease. Malaysia issued a travel advisory against visiting infected areas in India, while Mauritius has seen some decrease in visitor arrivals from France, it's leading tourism market. But the main damage has been to the economy of Réunion, the stronghold of the disease. French troops have been helping to spray the whole island with insecticide to try and combat the mosquitoes that spread the disease, but tourism has been devastated over the last year.

At least 200 of the 1,415 infectious diseases known to man are either emerging for the first time or re-emerging. The majority of those are zoonotic, and can be spread from animal to human. The increasing volume of international travel means that it is becoming ever-easier for such diseases to spread around the world. But the travel and tourism industries are also those most vulnerable to impact of disease epidemics, as Reunion has found out.

Article details

  • Author(s)
  • David Simpson
  • Date
  • 13 December 2006
  • Subject(s)
  • Tourism
  • Travel and Technology