Today we are covering the chikungunya virus, including how it impacts people, what FDA-approved treatment options are available, and what guidelines may be helpful to consult in relation to patients infected with the virus.
But first, to better understand the virus, let's take a look at how chikungunya virus can affect people in real time.
Chikungunya Virus in Real Time
- 2 – 12 Days after infected mosquito bite: Symptoms may present during this time.
- 4 – 8 Days is the average window that symptoms can present.
- A few days are usually how long any residual joint pain from the infection lasts.
- First week of infection: Blood samples can be collected using RT-PCR to test for chikungunya virus. Infected patients are advised to avoid coming into contact with mosquitoes during this time to avoid spreading the virus to other mosquitoes that can then become infected and potentially spread the virus to more people.
- First few weeks to two months of infection: Chikungunya virus can be detected in immune response tests by detecting antibody levels for around two months.
- 4 weeks or more: Severe cases of chikungunya virus can result in joint pain that lasts months or years.
- Months following birth: Newborns are one of the two most at-risk age groups for the virus, the other being the elderly.
What To Know About the Chikungunya Virus
The chikungunya virus can cause fever, severe joint pain or swelling, headache, muscle pain, or rash. The virus is spread through the bite of female mosquitoes that are infected with the virus. People living in and visiting tropical regions that experience mosquitoes are at risk of becoming infected with the virus. Additionally, infected people can unwittingly transfer the virus to other people through coming into contact with an uninfected mosquito, infecting the mosquito when it feeds on the infected person, and having that mosquito transfer the virus to another person.
Because the onset is usually 2–12 days after infection, some people may not know they have been infected until days after they are home from traveling. In these cases, they should share with their healthcare provider the regions they traveled to so they can be screened for the virus.
While there is no specific medication to treat chikungunya virus, vaccinations are available. People traveling to regions with chikungunya virus present should be vaccinated against the virus. IXCHIQ, from Valneva, and VIMKUNYA, from Bavarian Nordic, are the two FDA-approved vaccines. However, the FDA and CDC recommend that IXCHIQ not be administered to patients 60 years and older due to cardiac and neurologic complications that can develop.
FDA-approved Vaccinations for Chikungunya Virus
| Vaccine | Indications | Approved | Contraindications |
|---|---|---|---|
| IXCHIQ | Indicated for the prevention of disease caused by chikungunya virus (CHIKV) in individuals 18 years of age and older who are at increased risk of exposure to CHIKV. | November 2023 | Immunocompromised individuals. Individuals with a history of sever allergic reaction (e.g., anaphylaxis) to any component of IXCHIQ. |
| VIMKUNYA | Indicated for the prevention of disease caused by chikungunya virus (CHIKV) in individuals 12 years of age and older. | February 2025 | Do not administer VIMKUNYA to anyone with a history of a severe allergic reaction (e.g., anaphylaxis) to any component of VIMKUNYA. |
Relevant Guidelines for Chikungunya Virus
Guidelines on Clinical Management of Chikungunya Fever
In 2008 the World Health Organization (WHO) released guidelines focused on the clinical management of chikungunya fever. Some key takeaways of the guidelines are:
- There is no specific antiviral drug against chikungunya virus.
- Treatment is symptomatic.
- Paracetamol is the drug of choice with the use of other analgesics if paracetamol does not provide relief.
The guidelines also recommend that anti-mosquito measures be taken, including keeping the infected within mosquito netting and maintaining community awareness of mosquito population control tactics.
Adverse Reactions to Vaccines Practice Parameter 2012 Update
In 2012, the American Academy of Allergy, Asthma & Immunology published updated guidelines focused on patients who may or have had adverse reactions to vaccines. Because vaccines are recommended to prevent chikungunya virus, it’s worth considering adverse reactions that patients may have to vaccines.
While these guidelines point out that anaphylactic reactions occur in 1 out of every 1 million doses, any patient with a suspected allergy to vaccine components should be first evaluated by an allergist or immunologist.
2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host
In 2013, the Infectious Diseases Society of America published guidelines focused on immunocompromised adults and children receiving vaccines. Patients who are immunocompromised and planning to travel to regions that experience chikungunya virus outbreaks may benefit from these guidelines.
These guidelines provide recommendations for patients who have primary immunodeficiency disorders, HIV, cancer, organ transplants, chronic inflammatory diseases, and more.
Chikungunya virus prevention should be a priority for individuals traveling to or living in tropical regions like Central and South America, Africa, the Caribbean, Asia, and parts of the Pacific and Europe. Building awareness of the virus is key to preventing infected patients from further spreading it.
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