0627. Possibility of chikungunya fever in visitors to Mauritius

Reports of epidemics of chikungunya emanated from the Indian Ocean islands of Reunion, Mauritius and Seychelles in 2005 and 2006.  Reunion was affected to a greater extent than the others with some 230000 cases reported.  These islands are all popular tourist resorts, and the economic consequences of reduced tourist trade resulted in Seychelles in particular denying that any tourists had been infected.  The denials led to an upsurge in reports from Europe, and several countries have reported cases in people returning from these islands. The majority of these have been in France (160 cases) but cases have also been found in Germany, Switzerland, Italy and Norway.  A recent issue of the Lancet draws attention to the problem in the UK.  The infection presents as fever with severe arthralgia, myalgia, headache, often with a maculopapular rash.  In a few cases the joint involvement persists, sometimes for years.   Treatment is essentially symptomatic.  During the recent epidemic in the Indian Ocean islands, twelve cases of meningoencephalitis were confirmed and six cases were diagnosed in neonates whose mothers had contracted the virus shortly before giving birth.  Some 200 deaths have been recorded, but most have been in elderly patients with serious comorbidities.  Some investigators have suggested that the present strain is more virulent than those causing previous epidemics, and in fact changes in the virus genome have been observed that might be responsible for changes in morbidity associated with the disease.  With Mauritius being a particularly popular holiday destination for South Africans, doctors should be aware of the possibility of this diagnosis in symptomatic patients who have recently visited the island, but it is also important to inform travelers about personal preventive measures in order to avoid mosquito bites, taking into account that the responsible Aedes aegypti mosquito vector is active at night and during the day.  The authors of the Lancet article strongly discourage pregnant women, families with young children, people older than 70 years, and those with significant comorbidity from travelling to the affected islands.

Read more:
Lancet 2006; 368: 258 and 186-7
Eurosurveillance at http://www.eurosurveillance.org
PLoS Med 2006; 23: e263