Chikungunya Notebook: The Basics

aedes aegypti mosiquito

Some questions and hopefully helpful answers based on my understanding after reading a number of sources.  Let’s go…

What is chikungunya?

Chikungunya is a virus transmitted by mosquitoes.

This disease name sounds fool fool.  Where it come from? 

After an outbreak in 1952 in what is now Tanzania, the name “chikungunya” was given to the name of the illness that caused a lot of joint pain and contorted posture.  The word means “that which bends up” in the Makonde language.  Evidence suggests that chikungunya first appeared as early as the 1700s.

Chikungunya is endemic – or common – in southeastern Africa and is known throughout India and Southeast Asia.

What causes chikungunya?

Chikungunya is caused by a virus carried by the same mosquitoes that carry dengue.  

PAHO Chikungunya fact sheet

PAHO Chikungunya fact sheet

How do I know if I have chikungunya?

Usually you will get a fever and severe joint pain, especially in your hands and feet.  Remember the root of the name of this virus so expect very painful joint pain that actually makes you double over.  You may also feel very tired and nausea, and you may also have muscle pain as if you have the flu.  Sometimes people develop a rash (in the palm, soles of your feet, and on your torso and feet) and the rash may blister + you may become sensitive to light, vomit a lot, and have chills.

How can I catch chikungunya?

The virus is spread by the mosquito.  Only the Aedes aegypti and Aedes albopictus mosquitoes spread chikungunya.  these mosquitoes usually bite in the daytime.  They have distinctive white markings on their legs (like in the picture above).  The strain now in Jamaica and the rest of the Caribbean is mostly likely being spread only by the Aedes aegypti mosquito.

Does the virus live in the mosquito?

Sort of.  Mosquitoes spread the chikungunya virus by biting an infected person and then moving on to another person to suck blood.  According to the European Centre for Disease Control and Prevention (ECDC) “humans are the major source, or reservoir, of chikungunya virus.”  Once the mosquito gets the virus from an infected human, the virus replicates in the mosquito’s stomach giving the annoying insect a good supply of the virus to transmit to its next food source. Once the mosquito bites another human the virus replicates in that person’s blood, infects, and the human may begin to show symptoms soon.

How soon after being bitten by the mosquito will I know if I have chikungunya?

Usually you will begin to feel symptoms 2 – 3 days after being bitten by an infected mosquito, but the incubation period (that is the time before the virus begins to show itself) can last anywhere from 1 – 12 days.

How should I treat chikungunya? Should I go to the doctor? 

How do you feel? If you are in a lot of pain and feel very uncomfortable then it may be best to go to the doctor if only to ease your mind.  The usual recommended treatment is to ease symptoms.  According to the U.S. Centers for Disease Control (CDC):

  • Get plenty of rest
  • Drink fluids to prevent dehydration
  • Take medicines, such as ibuprofen, naproxen, acetaminophen, or paracetamol, to relieve fever and pain.

Chikungunya symptoms are similar to dengue and the flu so you may want to check with your doctor or nurse to see if they can diagnose the difference. Dengue can be fatal because it can cause bleeding and chikungunya usually is not fatal.  A doctor will be able to make the best assessment to distinguish between the two illnesses and give you appropriate instructions for your care.

More importantly: if you are already sick – the flu, a cold, and especially high blood pressure, heart disease, diabetes (sugar), or sickle-cell disease – an illness like chikungunya will affect you differently so you must be extra careful.  High fevers can also be very dangerous, especially in children and the elderly so it’s best to see a doctor at an office, hospital, or clinic for a proper check up.

The CDC recommends that people diagnosed with chikungunya or who likely have it should NOT take aspirin (and medications like Cataflam) for the pain.

This REALLY HURTS.  How much pain medication can I take?

The drugs meant to treat chikungunya – ibuprofen, naproxen, acetaminophen, and paracetamol – must be taken carefully because improper use can cause a lot of harm.  Some kinds of harm caused by taking too much of these medicines include internal bleeding, liver damage, and stomach ulcers.  Follow the recommended dosage on the packaging or ask someone to help you if it’s confusing.

This rash is very annoying.  How can I ease the itching?

Apparently calamine lotion helps to relieve the itching.  Antihistamine medication (like DPH) or topical corticosteroids can also relieve the itching.  Talk to your doctor or at least a pharmacist about what is appropriate for you to use, and take them according to the directions. Too much ah anyting nuh good.

Can chikungunya kill me?

Deaths from chikungunya are rare so it is unlikely that you will die from chikungunya but you should still take the illness seriously.  Follow approved or recommended treatment and be aware of any changes in how you feel.

Is there a cure for chikungunya?

No.  And there is no vaccine.  The best way to prevent the virus is to decrease the breeding sites for mosquitoes that spread it, and to wear protective clothing.  The best way to treat the virus is to rest, take the right kinds of pain medications, and drink lots of fluids.

The mosquito is dangerous and effective. Don't let its small size fool you. (Source: Gates Notes. Click to ENLARGE.)

The mosquito is dangerous and effective. Don’t let its small size fool you. (Source: Gates Notes. Click to ENLARGE.)

My doctor says I don’t need the test.  Should I take the test?

Can you afford it?  The test is expensive and results apparently take up to 3 weeks.  If you want to take the test and can afford it then ask your doctor to test you.  Taking the test and getting a result may help to ease your mind, which can go a long way to your ability to heal.

Taking the blood test to verify that you have chikungunya is a difficult decision because it’s expensive, the test results take a long time, and you’re probably in pain that needs treatment immediately.  Talk it through with your doctor and decide what is best for your specific case.  Remember that tests can say what something is as well as rule something out.

How can one likkle mosquito spread such a disease? How can we prevent them from breeding and spreading disease?

Mosquitoes are small but they are effective disease carriers because they can move (relatively) quickly, bite often without us knowing, and breed easily. Mosquitoes breed in stagnant water and, according to the CDC mosquito eggs can avoid destruction for several months “which means that even if all larvae, pupae, and adults were eliminated at some point in time, repopulation will occur as soon as the eggs in the containers are flooded with water.”  During one mosquito’s lifetime it can lay eggs up to 5 times and an adult mosquito can live up 5 – 6 months.  Translation: do not create mosquito breeding sites and get rid of mosquito breeding sites.  Check your home, work, and general community’s surroundings carefully and regularly to get rid of any stagnant water.

The mosquito is a deadly animal.  Though they have a place in our environment as food for bigger animals, mosquitoes carry a lot deadlier and debilitating diseases than chikungunya like malaria and West Nile virus.

How can I protect myself against chikungunya?

  1. Clean up. Because mosquitoes breed quickly, it is important to decrease the places where mosquitoes can breed.  
  2. Wear protective clothing.  Long sleeves are helpful; keep covered.  DEET-treated clothing and spray-on insect repellents are also useful.  Some say that neem oil-based lotions or oil mixtures may also be useful.  As with anything use in moderation and test a small amount on your skin to determine if you’re allergic.
  3. Clean up.  Yes I’m repeating myself.  That old toilet or old tire chilling in the backyard? Your child’s tow car sitting outside, half filled with water? Plastic bag lying around after a heavy rain? Get rid of them or turn them so that no water can collect in them.  Your dog’s water bowl?  Empty it often so that the water does not become stagnant. Water your potted plants and then check back shortly after to empty the saucer.  Get the point? Do not allow any water to settle and become either a breeding ground for the mosquitoes or to activate eggs a mosquito has already laid. Every single medical source about treating and preventing chikungunya states that the number one risk factor for getting the illness is how close we are to mosquito breeding sites.  Cleaning up and keeping things clean is important to controlling this disease.
Pay attention to possible breeding sites in your yard. (Source: West Baton Rouge Council)

Pay attention to possible breeding sites in your yard. (Source: West Baton Rouge Council)

Mi tiyad ah dis.  How long will I feel sick?

It depends.  Some people feel better after about a week but some people have the symptoms for weeks.  Some people may have the joint pains for months or years.

Will there be long-term effects from having chikungunya?

There may be an increased risk for developing arthritis later in life.  The World Health Organization (WHO) reports that sometimes there are eye, neurological, gastrointestinal (stomach and digestive system), or heart problems.  Watch your health carefully in the months after you recover from chikungunya; be vigilant and careful.

Can I get chikungunya again? 

After you get chikungunya you will develop an immunity to it and it is unlikely that you will get it again.

Can I get chikungunya from touching someone or sharing food or a drink, or by touching something that an infected person has touched?

No.

Can I get chikungunya if I touch someone’s open wound or cut?

Maybe but very unlikely.  The virus is carried in the blood so it may be possible to transmit the chikungunya virus in this way.  It’s rare but possible that chikungunya can spread from mother to child during childbirth but it depends on when the mother contracted the virus.

Well there’s no cure so why bother to go to the doctor?

The decision to go to the doctor is ultimately up to you.  Educate yourself and pay attention to your body.  My personal opinion is that you should go to the doctor.  At the very least, keep in contact with friends or family to help with your care.  Keep an eye on your neighbours, especially the elderly.  No one should be alone when they’re sick.

Isn’t chikungunya the same as dengue?

No.  They are similar diseases and they are transmitted by the same type of mosquito but the illness are different.  Specifically, chikungunya is more painful and the pain is concentrated in the joints and tendons. Click here for a comparison chart.  Also dengue is actually more dangerous than chikungunya because it can cause bleeding + other complications can develop once the fever drops.  So that’s one more reason to go to the doctor: dengue requires a little more vigilance because bleeding is possible.

What about my children or elderly parents or grandparents? Do they need special attention?

Yes.  Old people and children have fragile immune systems.  Also, chikungunya causes severe joint pains.  For an old person who may already have difficulty walking, severe joint pain may make walking impossible or even dangerous.  Older people may also take longer to recover from chikungunya.  Babies and toddlers cannot always express that they are in pain or having a high fever.  Pregnant women are also vulnerable to more severe effects of chikungunya so they should take special care.  Pay special attention to them and consult a doctor.

Is there a vaccine for chikungunya?

No.

Showing the spread and of chikungunya through the Americas.  The shaded areas indicate countries in which chikungunya has been diagnosed.  (Source: Adapted from a PAHO/WHO map)

The spread and of chikungunya throughout the Americas. The purple shaded areas indicate countries in which chikungunya has been diagnosed. (Source: Adapted from a PAHO/WHO map).  Click to ENLARGE.

I see mosquitoes all the time in Jamaica. Why is chikungunya appearing in Jamaica now? Why is it spreading so fast?

Chikungunya has been in the Caribbean (St. Maarten) since December 2013.  Because of how mosquitoes are — small, mobile, easy breeders with eggs that can survive destruction — it’s not too surprising that the virus eventually made its way around the Caribbean.  There may also be other factors affecting the appearance of chikungunya  like climate (it’s getting warmer and that may positively affect mosquito breeding habits), travel patterns (we travel a lot more and much easier than in past outbreaks), and an increased number of breeding sites for the kinds of mosquitoes that transmit chikungunya because of poor garbage disposal and collection habits.  

Remember too that chikungunya and dengue fever are spread by the same mosquito and that dengue is common in Jamaica around this time.  The mosquitoes can carry and transmit both viruses at the same time.  Basically one disease carrier can now carry two diseases…a bothersome two-for-one special.  Jamaica is not the only island dealing with a chikungunya outbreak; several Central and South American countries (like Nicaragua, El Salvador, Venezuela, Colombia and Brazil) are also going through chikungunya outbreaks.  By September 2014 chikungunya cases had been reported across the Caribbean – in the British Virgin Islands, Guadeloupe, Martinique, the Dominican Republic, St. Lucia, Haiti St. Vincent & the Grenadines, Antigua & Barbuda, – as well several states in the United States.

This is the first time that chikungunya has appeared and been diagnosed in the western Hemisphere as being caused by an infected mosquito population.  That means that most of this part of the world has no immunity (or protection) against chikungunya.  In Jamaica this lack of immunity helps to explain why the virus is spreading so rapidly and widely: we’ve never seen it before so our bodies have to figure out how to fight it and protect against it.  Think about all the juk up juk up booster shots you get as a child: it’s the safest way we know of giving our bodies a small amount of an illness so that our bodies learns to recognize an illness and how to protect against it; that’s one important way our bodies build immunity.  

So the Jamaican population has a weakness: its ability to naturally defend against chikungunya.  In Jamaica, chikungunya and its carriers the mosquitoes don’t have the barrier of immunity and it exploiting that weakness.  One important way to prevent the virus and mosquitoes from having the upper hand is to attack them by destroying their breeding sites and the ideal conditions in which they can thrive. Fogging alone will not help because it attacks (mainly) the flying adult mosquito but does not as easily attack young growing mosquitoes or mosquito eggs.

I’ve heard that paw paw leaf can be used to treat chikungunya and dengue.  Is this true? Is it safe?

I do not know.  Some people say so and some have used paw paw (papaya) leaf in smoothies or crushed by itself and said that they feel better. There have been some studies (for example here and here) that say something in paw paw leaves helps to increase the platelet count in the blood.  Platelets are blood cells that help to stop bleeding. (That scab you get after a cut? Platelets at work.)  People with a low platelet count also can become very tired and weak, indicating that platelets have something to do with supplying the body with oxygen or energy/nutrients. When there is an infection or injury in the body, platelets quickly go the site of the infection or injury and, apparently, help to control the inflammation.    So if paw paw leaf helps to increase blood platelet count and chikungunya causes severe joint pain because the virus is interfering with blood flow, then it is possible that paw paw leaf will help to alleviate chikungunya symptoms.

I do not know if this treatment is safe.  But personally and given my experience with my mother’s bush woman preferences, I know that there is healing power in plants.  If you would like to use the “alternative” treatment for chikungunya then talk to your doctor especially because it could interact badly with other medication you’re taking.  As with all treatment for an illness, it’s probably best to use whatever paw paw leaf drink or juice in moderation.

What about bissy/bizzy tea? Can that treat chikungunya and dengue? Is it safe?

Again, I have no idea.  Some people say they have gotten some relief by drinking bizzy/bissy tea.

As with the paw paw leaf remedy, I do not know if a bissy tea treatment is safe.  But personally and given my experience with my mother’s bush woman preferences, I know that there is healing power in plants.  If you would like to use the “alternative” treatment for chikungunya then talk to your doctor especially because it could interact badly with other medication you’re taking.  As with all treatment for an illness, it’s probably best to use whatever tea in moderation.  

 —————–

Of course you should educate yourself about this disease because you best know your body and your routines so you will be able to identify any changes in how you’re feeling.  With your education on this illness and knowledge of your body and how you are feeling, you should consult your own doctor or a nurse for specific advice about any symptoms you’re experiencing. The information in this blog post is not meant to be medical advice. I am not a doctor.

—————–

Sources

WHO: http://www.who.int/mediacentre/factsheets/fs327/en/

CDC: http://www.cdc.gov/chikungunya/index.html

ECDC

Pan American health Organization (PAHO): 

Wikipedia – Chikungunya: http://en.wikipedia.org/wiki/Chikungunya

Wikipedia – 2013-2014 Chikungunya Outbreak: http://en.wikipedia.org/wiki/2013%E2%80%9314_chikungunya_outbreak#Spread_of_the_chikungunya_virus

West Baton Rouge Council – http://www.wbrcouncil.org/Images/Interior/mosquito%20abatement/yard-smaller.jpg

Gates Notes: http://www.gatesnotes.com/Health/Most-Lethal-Animal-Mosquito-Week

U.S. National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071726/

The College of General Practitioners of Sri Lanka: http://cgpsl.org/wp-content/uploads/2013/11/119.pdf

About.com – Mosquito Facts: http://insects.about.com/od/flies/a/10-facts-about-mosquitoes.htm

DermNet NZ: http://dermnetnz.org/viral/chikungunya.html

News articles

Comments
16 Responses to “Chikungunya Notebook: The Basics”
  1. Plum says:

    Very informative, thank you!

  2. slimting says:

    It’s very informative information. Thanks

  3. Vera cruz says:

    Ihave had chik vfor the past nine months…my ankles and knees hurt all the time…I also feel light headed at times.I have been to the doctor but that didn’t help….I am more concerned with the lightheaded feeling.I am 71yrs old….any suggestions,,,thank you

  4. Vera cruz says:

    this is the worst illness I’ve ever experienced in my long life…..be careful old people

  5. Rosita says:

    Very informative, thanks! I’m Brazilian and I had it. It’s very bad, look like your bones are breaking😦 I had it during five months and these months were bad, but I DON’T had to go to the hospital, so, my situation wasn’t too horrible. I DON’T had the rash neither vomits or diarrhea. I only had two days of high fever and five months of joint pains, and I WASN’T ABLE TO WRITE!!!! It was bad, but I drunk so much coconut water to stay hydrated, and I think it made me feel better😉 and I simply LOVE coconut water, like most persons of tropical countries hahaha but, serious, chikungunya is bad and it have moderated cases (like me) and also serious cases, and in severe cases I think that the person have to go to the hospital.

  6. SRINIVAS says:

    I was affected by chikungunya last 3 months back. Now I feel OK. But, Suddenly I got Pain in Legs Joint. Slghtly on Hands Thumb. What is the Reason. It is because of Cold Climate or any othrer reasons.

  7. sharadha says:

    can a person have both chikungunya and typhoid.

  8. Emily in MT says:

    After 8 months of Chikunguna symptoms, I’m almost completely back to my former self, except for a touch of arthritis in hands, feet, knees. For anyone suffering, I’d recommend keeping body inflammation down by eating a whole foods plant-based diet, doing what keeps you sane but little else. Recovery takes time and energy. Don’t waste your calorie intake on anything that doesn’t provide nutrition. Don’t waste your energy on non-essential stuff.

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