The mosquito-borne alphavirus chikungunya virus is predicted to soon spread to the United States from areas like the Caribbean, Central America, Mexico, and South America but treatment options are limited, reports a review article in the New England Journal of Medicine.

Chikungunya fever is usually characterized by an intense asthenia, arthralgia, myalgia, headache, and rash approximately three days after transmission via a bite from an infected mosquito. Although the infection typically lasts one week, some patients experience severe arthralgias and myalgias that can last from weeks to years. Periarticular edema and acute arthritis may also occur in the interphalangeal joints, wrists, and ankles, along with pain in the ligament insertions. Young children, older adults and people with coexisting conditions such as cardiovascular, neurologic, or respiratory disorders or diabetes are at particular risk for severe disease.

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There are presently no specific FDA-approved therapeutic agents or vaccines for chikungunya and there is no specific assay for assessing chronic signs and symptoms associated with the infection. However, anti-inflammatory drugs are often used to control symptoms and joint swelling. While favipiravir and ribavirin + interferon have been shown to have antiviral activity in vitro, their safety and efficacy have not been demonstrated in clinical trials.

Mosquito reduction and limiting the content between humans and two virus-carrying mosquitoes (Aedes aegypti and Aedes albopictus) are the primary targets for infection control until there is a specific treatment or vaccine, notes co-author Scott Weaver, PhD.

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