MedCity Influencers

Chikungunya Virus: How Accurate Are The Numbers?

Chikungunya virus has been very much in the news recently. It is a virus that is transmitted to humans through mosquito bites. The most common symptoms of this virus are high fevers and joint pains but can also include headache, rash, diarrhea, and myalgias. At the end of 2013, it was the first time this […]

Chikungunya virus has been very much in the news recently. It is a virus that is transmitted to humans through mosquito bites. The most common symptoms of this virus are high fevers and joint pains but can also include headache, rash, diarrhea, and myalgias. At the end of 2013, it was the first time this virus was found in the Americas on islands in the Caribbean. Large numbers of people have been affected on those islands.
The CDC has been tracking the course of Chikungunya to the U.S. It has now been discovered that local transmission of the virus is occurring through mosquitoes in Florida and Texas. There have been cases reported in other states but these were all in travelers returning from endemic areas. Where I practice in NJ, there have been 25 confirmed cases. But, these were all in patients returning from the Caribbean.

Why the numbers of reported Chikungya cases may not be accurate?
1. This virus can mimic other viruses such as influenza. Many patients simply do not come in to get tested or treated. Since this is a self-limited disease, the patients recover and there is no way of knowing how many there are.
2. There are some doctors who have not been testing for it in highly suspicious patients because there is no treatment available. Having a positive test result is not going to make much of a difference for that individual patient.
3. Testing guidelines are not standard. Some states have their health department run the tests and some of them are sent to the CDC. When I called the lab regarding a recent patient, it took more than an hour on the phone to find out how the specimen should be collected and handled. The lab courier would then pick up the specimen and the lab would send it on to the health department. This was a very time consuming endeavor for something that is not going to change my treatment recommendations to the patient.
4. Patients are usually tied in to a specific lab based on their insurance plan. Those labs are not necessarily prepared to process these samples as noted above.
5. While the CDC did send out information to healthcare providers, not everyone has read them or kept up to date on the recent outbreak. When I called the lab to ask about running this test, the clerk had never heard of this virus. In order to do epidemiologic tracking, all in the healthcare field should be kept abreast of the recommendations coming out from the CDC.

In fact, there may be many more infected than we are made aware of. And, although Chikungunya is a self-limiting disease, it is very important to do surveillance on it to see how it spreads. There is no vaccine or treatment available for it, and it is generally not severe. However, it will give us helpful information on how mosquito transmitted disease have the potential to spread and how it can appear in the U.S. And, it is disease we have not seen in the U.S. before so it is very important to learn as much as we can about it. Keeping track of those numbers can be helpful in reaching these goals. While a physician, or even the patient, may be reluctant to do the testing for the reasons noted above, it is imperative that we all do our part in helping those tracking this disease. It may seem a waste or a frustration, but perhaps the next infectious disease reaching our shores will not be so mild.

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