Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 32-05: Other Systemic Viral Diseases + Key Features Download Section PDF Listen +++ ++ A flaviviral infection transmitted to humans by Aedes aegypti and Aedes albopictus (the "Asian tiger mosquito") In the United States in 2019, there were 115 travel-associated US cases in 26 states (with the largest number of reports from California, New Jersey, and Ohio) Puerto Rico reports the only current locally acquired cases, with 2 cases as of December 5, 2019. The attack rates are often as high as 50% Prevalence is ubiquitous with endemic countries in Africa, the Americas, Asia, and Europe Vertical transmission is documented if the mother is viremic during parturition + Clinical Findings Download Section PDF Listen +++ ++ Incubation period of 1–12 days (average 2–4) Abrupt onset of fever; headache; intestinal complaints; myalgias; and arthralgias/arthritis affecting small, large, and axial joints Joint symptoms persist for 4 months in 33% and linger for years in about 10% A centrally distributed pigmented or pruritic maculopapular rash is reported in 10–40% of patients Mucosal disease occurs in about 15% Facial edema and localized petechiae are reported There are reports of coinfection with yellow fever, plasmodia, Zika virus, and dengue fever Some of the pathology may be immune mediated + Diagnosis Download Section PDF Listen +++ ++ Made epidemiologically and clinically Mild leukopenia occurs as does thrombocytopenia, which is seldom severe Elevated inflammatory markers do not correlate well with the severity of arthritis; radiographs of affected joints are normal Serologic confirmation requires elevated IgM titers or fourfold increase in convalescent IgG levels using an enzyme-linked immunosorbent assay (ELISA) Reverse transcriptase-polymerase chain reaction (RT-PCR) and culture techniques (viral isolation in insect or mammalian cell lines or by inoculation of mosquitoes or mice) are seldom available + Treatment Download Section PDF Listen +++ ++ Largely supportive with nonsteroidal anti-inflammatory drugs and corticosteroids Chloroquine and methotrexate may be useful for managing refractory arthritis Live recombinant measles-virus-based vaccine and a virus-like particle vaccine are in early clinical trials Prevention relies on avoidance of the mosquito vectors Prophylaxis with specific Chikungunya immunoglobulins may be useful for exposed neonates or immunosuppressed persons