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The first known instance of transmission of chikungunya fever by mosquitoes in Europe is currently taking place in northeastern Italy. Previously some travellers from areas where the infection is endemic—parts of Africa, South East Asia, and the Indian subcontinent—had returned home to Europe with the virus. But never before had local transmission taken place.
During August health authorities in the province of Emilia-Romagna detected an unusually high number of cases of febrile illness in two small villages near Ravenna, Castiglione di Cervia and Castiglione di Ravenna. Subsequent analyses confirmed the diagnosis of chikungunya fever.
Between 4 July and 4 September 197 cases were reported of patients experiencing high fever, joint and muscle pains, headaches, rashes, and gastrointestinal problems. The symptoms generally lasted one to two weeks. One death had been reported: an 83 year old man with underlying medical conditions.
The cause of the outbreak is understood to be a visitor from the Indian subcontinent. The person was already infected and developed the symptoms two days after arriving in Italy. The “Asian tiger” mosquito (Aedes albopictus) is thought to be responsible for transmitting the infection in Italy. The height of the epidemic was in the third week of August.
The Stockholm based European Centre for Disease Prevention and Control is working with the Italian health authorities and has issued advice to people visiting or returning from areas where chikungunya fever is present. It emphasises the need to minimise the risk of mosquito bites and recommends that anyone experiencing a fever or unexpected joint pain within 12 days of returning home should seek medical attention. Treatment takes the form of non-steroidal anti-inflammatory drugs or non-salicylic analgesics.
The centre is also encouraging European Union governments to raise awareness among healthcare providers of the current outbreak in Italy, to emphasise the need to consider chikungunya fever as a differential diagnosis, and to implement universal protective precautions when handling samples from patients suspected of having the virus.
The chikungunya virus was first isolated in Tanzania and Uganda in 1953. Its name, which in the Makonde language means “that which bends up,” comes from the posture of its patients. Incubation ranges from one to 12 days. Although most people recover without any consequences, a more chronic phase, with persistent joint pains and lethargy, may occur, lasting several weeks.
The most serious recent outbreak of the fever occurred in the French overseas department of La Réunion. Between March 2005 and June 2006 more than 260000 people (35% of the population) contracted a clinical form of the infection, which caused 254 deaths, mostly among elderly patients with an underlying medical condition.
In addition to Italy outbreaks have occurred this year in Gabon, Indonesia, and Madagascar, while the majority of cases are reported from India.
For a situation update see www.ecdc.europa.eu.