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March 2015

ChikungunyaEmerging Threat to the United States

Author Affiliations
  • 1Program in Infectious Diseases, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Dermatol. 2015;151(3):257-258. doi:10.1001/jamadermatol.2014.2034

Until recently, most Americans had never heard of chikungunya, a mosquito-transmitted disease caused by the chikungunya virus (CHIKV). This has changed as a result of an explosive outbreak of chikungunya throughout the Caribbean that has affected more than 580 000 people since December 2013.1 Although cases of chikungunya have been reported this year in the United States (eg, North Carolina, Florida, Indiana, Nebraska, Tennessee), these have virtually all been in travelers returning from the Caribbean or from chikungunya-endemic areas of Africa or Asia.1 However, various data suggest that it is only a matter of time until CHIKV transmission is autochthonous in the continental United States and chikungunya becomes a public health problem.24 The likelihood of this scenario is heightened because of the presence of (1) CHIKV replication-competent mosquito vectors (ie, Aedes albopictus and Aedes aegypti); (2) a temperate climate, particularly in the southeastern United States, that is conducive to the establishment of endemic foci of chikungunya; (3) a highly susceptible population with no preexisting immunity to the virus; and (4) a large influx of viremic travelers returning from the Caribbean, coupled with the seasonal synchronicity of vector activity.

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