How to Treat Chikungunya Virus Symptoms
Medically reviewed by Jordana Haber Hazan, MDMedically reviewed by Jordana Haber Hazan, MD
Chikungunya is a virus (CHIKV) spread by bites from infected mosquitoes. Outbreaks have occurred in most areas of the world, including the Americas, Asia, Africa, Europe, and islands in the Indian and Pacific Oceans. There have been no reported cases of locally acquired chikungunya in the United States or its territories since 2019.
Fever and joint pain are the most common symptoms of chikungunya. Other symptoms may include muscle pain, joint swelling, headache, or rash. Currently, there are no medications to treat chikungunya. The best protection against chikungunya is to take measures to prevent mosquito bites. A vaccine is available in the United States.
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Countries and Origins of Chikungunya Virus
Chikungunya was first identified in 1952 in the United Republic of Tanzania and subsequently in other countries in Africa and Asia. The first recorded urban outbreaks were in Thailand in 1967 and India in the 1970s. Since 2004, there have been more widespread and frequent outbreaks. Chikungunya has been identified in 110 countries in Europe, Africa, Asia, and the Americas.
Chikungunya circulates in tropical and subtropical regions. The name chikungunya comes from a word in the Kimakonde language (spoken in parts of Tanzania), meaning "to become contorted." It alludes to the stooped appearance caused by joint pain.
The United States
Between 2006 and 2013, an average of 28 people per year in the United States tested positive for recent chikungunya virus infection. All of them were people visiting or returning to the United States from affected areas in Asia, Africa, or the Indian Ocean. Chikungunya was rarely identified in U.S. travelers before 2006.
In 2013, Caribbean countries and territories were identified as the sites of the first local transmission (spread through infected mosquitoes in that area) in the Americas.
Chikungunya was reported among U.S. travelers returning from affected areas in the Americas in 2014. Local transmission was identified in Florida, Texas, Puerto Rico, and the U.S. Virgin Islands. Since 2019, no locally acquired chikungunya cases have been reported from U.S. states or territories.
Vaccine
The U.S. Food and Drug Administration (FDA) licensed a vaccine for the chikungunya virus for adults aged 18 years and older in November 2023. Data on the vaccine is being evaluated to determine recommendations for who should receive it, such as those traveling abroad, laboratory workers working with the virus, or people in the United States who have or are at risk of transmitting the virus.
Transmission
The chikungunya virus is part of a group of viruses called alphaviruses. This group includes viruses that cause similar diseases, such as the Mayaro and Ross River viruses.
Mosquitoes transmit chikungunya, most commonly Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus, which can also transmit dengue and Zika viruses. These mosquitoes lay eggs in standing water. Both mosquito species feed outdoors, and Aedes (Stegomyia) aegypti also feeds indoors.
Mosquitoes that spread chikungunya bite during the day and night. They are found in many countries worldwide, including nations in Africa, Asia, the Americas, and islands in the Indian and Pacific Oceans.
Mosquitoes become infected with the virus by biting a person who is infected with the virus. The infected mosquito then transmits the virus by biting another person.
The virus is not spread from person to person. It is blood-borne and not spread through coughing, sneezing, or touching.
It may spread through contact with blood infected with the virus, such as through:
Drawing blood from an infected person
Handling infected blood in a laboratory
Rarely the virus can be transmitted from a pregnant person to the fetus, particularly during the second trimester. The baby can also become infected at birth if the pregnant person is infected around the time of the delivery. This may result in severe disease in the baby.
There have been no reports of infants being infected through breastfeeding or chestfeeding, and the virus has not been found in breast milk.
Where Has Chikungunya Been Found Recently?
As of March 2024, the countries and territories with evidence of chikungunya virus transmission among humans within the last five years are:
Africa:
Burkina Faso
Cameroon
Chad
Democratic Republic of the Congo
Djibouti
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Kenya
Malawi
Mali
Nigeria
Republic of Congo
Senegal
Sudan
Asia:
Cambodia
China
India
Indonesia
Laos
Malaysia
Maldives
Myanmar
Pakistan
Philippines
Taiwan Thailand
Timor Leste
Vietnam
The Americas:
Argentina
Barbados
Belize
Bolivia
Brazil
Colombia
Costa Rica
Ecuador
Guatemala
Jamaica
Mexico
Nicaragua
Panama
Paraguay
Peru
Saint Lucia
Suriname
Uruguay
Venezuela
Start of Chikungunya Rash and Virus Symptoms
Most people who become infected with chikungunya experience some symptoms. Symptoms can appear between two and 12 days after being bitten and last three to 10 days.
The symptoms usually begin three to seven days after a bite from an infected mosquito. Typically, people feel better within a week.
Chikungunya generally starts with an abrupt onset of fever (may be continuous or intermittent), frequently accompanied by severe joint pain that usually lasts a few days. For some, joint pain from chikungunya can become chronic and debilitating and may last for weeks, months, or years.
Other symptoms of chikungunya may include:
Joint swelling
Muscle pain
Nausea/vomiting
Fever
Rash
Back pain
Body ache
Redness around the eyes
Loss of energy
Chikungunya can have mucocutaneous (typical skin and mucous membranes) involvement. These may include a rash that:
Is erythematous (red-appearing, although this may be less apparent on darker skin) and macular (areas of discolored skin) or maculopapular (areas of discolored skin with raised bumps)
Appears during the first two to three days of the illness and subsides within seven to 10 days
Can be patchy or diffuse on the face, trunk, and limbs
Usually lacks other characteristics but may be itchy
May result in postinflammatory areas of discoloration or diffuse pigmentation, most commonly on the face/nose
Chikungunya may also cause:
Painful ulcers (similar to canker sores) predominantly involving the oral mucosa and groin
A vesiculobullous eruption (blisters)
Hemorrhagic (bleeding) lesions
Desquamation (peeling or flaking skin)
A lichenoid eruption (rash of plaques or patches resembling lichen, stuck onto the skin like lichen on a tree)
Secondary bacterial infection
Exacerbation of pre-existing skin disorders such as psoriasis or lichen planus (conditions that cause skin inflammation)
Treatment
Treatment for chikungunya is symptom management. Currently, there are no medications to treat chikungunya.
Typically, chikungunya is self-limiting and doesn't require special treatment other than supportive measures.
Ways to Help Prevent Chikungunya
Preventing mosquito bites is the best way to protect yourself and others from chikungunya.
Use Environmental Protection Agency (EPA)-registered insect repellents with one of these active ingredients:
DEET (N,N-diethyl-meta-toluamide)
Picaridin (known as KBR 3023 and icaridin outside the U.S.)
IR3535
Oil of lemon eucalyptus (OLE)
Para-menthane-diol (PMD)
2-undecanone
Always follow directions. EPA-registered insect repellents are proven safe and effective, even for those who are pregnant or breastfeeding, when used as directed. If also applying sunscreen, apply the sunscreen first, then insect repellent.
Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under 3 years old. Put insect repellent onto your hands and then apply it to your child's face. Avoid applying it on a child's hands, eyes, mouth, cuts, or irritated skin.
Other measures to take include:
Wear long-sleeved shirts and long pants, and dress babies and children in clothing that covers arms and legs.
Treat clothing and gear with permethrin
Cover strollers and baby carriers with mosquito netting.
Stay in lodging with air conditioning and window and door screens.
Use a mosquito net if you are sleeping outside or in a place that can't keep out mosquitoes.
Choose a mosquito net that is white, compact, rectangular, long enough to tuck under a mattress, has 156 holes per square inch, and preferably is treated with permethrin.
If you get bitten, don't scratch (apply over-the-counter anti-itch or antihistamine cream to help relieve itching).
As a community, work to reduce mosquito breeding sites through regularly emptying and cleaning containers that contain water (at least weekly), disposing of waste, and supporting local mosquito control programs.
If recommended by your healthcare provider, consider getting the chikungunya vaccine (IXCHIQ, approved in the United States for people over 18) if you are traveling to an affected area.
How Soon Infection Clears
The chikungunya virus may be detected in the blood during the first week of illness using tests such as reverse transcriptase–polymerase chain reaction (RT–PCR).
After the first week of infection, tests can be performed to detect antibody levels (the body's response to the chikungunya infection). Antibody levels are typically detectable by the first week after the beginning of the illness and can continue to be detected for about two months.
Because the chikungunya virus can be found in the blood during the first week of illness, it is important to prevent mosquito bites. If a mosquito bites you during this time, it can spread the virus to other people.
Research suggests that once you have had chikungunya, you are likely to be immune to future infections of the virus.
Risk Factors for Prolonged Viral Symptoms
Most people make a full recovery from chikungunya, but occasionally, eye, heart, or neurological complications can occur. Chronic joint pain and chronic arthritis following a chikungunya infection can also occur and may be debilitating.
Those at risk for more severe disease include:
Newborns
Adults 65 years and older
People with medical conditions such as diabetes, high blood pressure, or heart disease
Inflammation With Chikungunya Virus
Pain or swelling can occur in multiple joints with chikungunya, most commonly in the hands, feet, wrists, ankles, elbows, and/or knees. This joint pain can last past the initial illness, sometimes for several years. It may also go away after the initial illness and then come back two to three months later.
People experiencing persistent joint pain, swelling, or inflammation should see a rheumatologist (a specialist in inflammatory and joint diseases) for an assessment and treatment options.
How to Ease Symptoms
To help ease symptoms while you recover from chikungunya, you can try measures such as:
Getting rest
Drinking plenty of fluids
Tylenol (acetaminophen) to relieve fever and pain
Emollients, calamine lotion, or low-potency topical steroids may help with itching
Do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil/Motrin (ibuprofen) or Aleve (naproxen) before dengue fever has been ruled out as a cause of your symptoms, to reduce the risk of bleeding.
Summary
Chikungunya is a virus spread by infected mosquitoes. The most common symptoms are fever and joint pain, but other symptoms, such as rash, may be present.
For most people, the illness lasts about a week, and then there is a full recovery. In some cases, joint pain can become long-lasting, chronic, and debilitating. Complications occasionally arise. Newborns, older adults, and people with pre-existing conditions are most at risk for severe illness.
Chikungunya is typically self-limiting and resolves without treatment. Treatment for chikungunya involves symptom relief, such as rest, fluids, and Tylenol for fever and pain.
It is important to take measures, such as insect repellent and mosquito nets, to prevent mosquito bites if you are in affected areas and, if you have a chikungunya infection, to prevent spreading it to others via mosquito bites.
Read the original article on Verywell Health.
