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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
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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
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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
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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