Chikungunya update: outbreak in Italy, advice for travellers
The Italian Ministry of Health has reported an outbreak of chikungunya virus infection in Region Emilia Romagna, Italy. This is the first recorded outbreak associated with the transmission of this infection within Italy. As of 4 September 2007, over 150 cases and one death have been reported. Initial reports indicated that almost all of the first 135 cases came from two small villages, Castiglione di Cervia and Castiglione di Ravenna, separated by a river, near Cervia, in the Province of Ravenna. All other cases that are not associated with these two villages appear to have been exposed in the Ravenna Province.
Cases have presented with high fever (38° C or higher), joint pains (arthralgia) and tiredness, however, clinical symptoms have been mild overall. Twenty-seven of the cases have been confirmed by laboratory tests (including 6 by PCR and 21 by IgM serology). The index case is suspected to be an Indian national who had travelled to Kerala, India and became symptomatic on 23 June. The first Italian case was reported on 4 July and the outbreak peaked between 17 and 19 August. The case who died was an 83 year old man with underlying conditions.
Most patients with chikungunya virus infection recover fully over a period of a few weeks, although 5-10% of patients will experience chronic joint pain, stiffness and swelling that can persist. There is no vaccine available to protect against this infection.
The regional health authority in Italy has implemented disinsection in public areas and alerted all clinicians to the symptoms and signs of chikungunya. Other control measures include raising community awareness about personal protective measures against mosquito bites.
Although the two villages where most of the cases have occurred are not tourist destinations themselves, there are many Italian and International tourists in the surrounding areas. There have currently been no cases reported in travellers from the UK.
A large outbreak of chikungunya virus infection was reported in India during 2006, involving over a million cases. Since this time there have continued to be media reports of illness in several states including Kerala, although no confirmed figures have been published.
Travellers to any affected areas are advised to take insect bite precautions, particularly during daylight hours when Aedes mosquitoes are active. Advice can be found on the National Travel Health Network and Centre website.
The outbreak may continue locally and could expand to neighbouring areas as climatic conditions are favourable for the vector, Aedes albopictus, the Asian Tiger mosquito, to remain present for the next 1-2 months. The mosquito is present in at least 12 European countries. However, to date there have been no confirmed reports of the mosquito in the UK and the public health risk of transmission in this country remains low.
Last reviewed: 9 March 2009