As thousands of Americans flock to the sun, sand and warm waters of the southern states of America, the Caribbean and South and Central America, almost everyone is aware that protection from the sun can be easily achieved applying lotions with a high SPF rating. Of course, many will choose a dark tan over their skin's health, but at least they're making a decision knowing the consequences.
Unfortunately, the vast majority of travelers to southern destinations do not know that unless they apply an effective mosquito repellent from dawn to dusk -- and use other repellents and protections throughout the day and night -- they could become partially paralyzed for days, or worse, dead. And there's a recent study that also suggests that severe brain infections including encephalitis can occur as a result of this virus, particularly in infants and people over 65.
Chikungunya is the culprit. It is carried by a particular yet common species of mosquito, although not all mosquitoes can transmit this virus. This is a virus that can have devastating, although not usually fatal, symptoms including agonizing joint pain that can last for months, severe flu-like symptoms that can require complete bed rest between five and ten days and the potential of severe joint pain for years to come. In fact, there is some evidence that chikungunya can develop a persistent infection, with some patients reporting fatigue and joint pain up to three years later.
According to Dr. Ingrid B. Rabe, Medical Epidemiologist at the Centers for Disease Control and Prevention (CDC), since December 2013, there have been almost 1.5 million cases in the Caribbean and the Americas. And the number keeps increasing at an alarming rate. The mortality rate of the virus is approximately 1 in 1,000. So the current estimate is 1,300 deaths with 224 fatalities in the Caribbean and Americas region.
From Nebraska and Indiana to New Jersey and New York, more and more people are being infected, all too frequently unaware of how easy it is to prevent. As of now, most of these cases are from people who have been in the Caribbean, and Central and South America, who then travel back to the northern states. However in 2014, there were 11 transmissions in Florida, local transmissions. And of course, the real troubling aspect of this is that as temperatures rise in the United States, mosquitoes will come further north for longer periods of time.
It is quite remarkable that an epidemic of this size has not been more consistently reported by the national media to alert millions of travelers to the myriad destinations that are now locations with high rates of infection.
Not surprising, destinations are reluctant to billboard a potentially serious deterrent to visitors spending money in their countries that are generally heavily dependent upon tourism for the health of their economies. I understand this fear. And that's why I'm not going to single out any particular country, especially since the virus is now infecting people on almost every island nation and every country in the Americas -- and now in the U/S. too.
However, it is irresponsible to not sound the alarm, and most importantly, the simple and inexpensive -- and very effective -- methods to avoid being bitten.
From January 1 to December 11, 2015, according to the CDC, 189 people from 24 states and the District of Columbia were reported to have measles. And of those 189, "113 cases (60%)] were part of a large multi-state outbreak linked to an amusement park in California." And yet, measles was the on the front pages of almost every newspaper and in the top segment of every electronic broadcast for weeks in early 2015. But 1.4 million cases of Chikungunya --and over two hundred deaths--has never received anything close to the coverage afforded measles last winter.
And therefore, there's been almost no public education, much less medical education of healthcare givers over the course of the last year as this epidemic has intensified. It has been disappointing to the CDC that so few travelers and health care professionals are checking their continually updating travel health notices on their website.
My general practitioner, who is very familiar with tropical infectious diseases and viruses as a result of his extensive overseas work in remote clinics, and who in his NY practice treats patients from throughout the Caribbean, and Central and South America, admitted, "I learned from treating patients who came to me with unusual and unexplainable symptoms including persistent pain in the joints. It's extremely hard to treat. It can last for months that is, the arthritic conditions."
Fortunately, Florida has done a significant number of on-going public announcements. Florida is the gateway in and out of the Caribbean, and it is the first state in America that has verified local transmission.
My wife and I found out about the virus by accident: alerted by two thoughtful employees at a store we shop in. Otherwise we would never have heard of this virus and we would have begun our Caribbean vacation dangerously unaware. Consequently, we literally covered our bodies with mosquito repellent from the moment we woke up to the moment we went to bed. And we ensured that the temperature in our room was sufficiently cold to inhibit mosquitoes from flying about. We also used mosquito coils. (A few months prior to our trip, I had a hip replacement, which according to my surgeon, could have been severely compromised by this virus.) When I returned home I told all of my friends who were traveling to the Caribbean; none of who had heard a word about Chikungunya.
In fact, I took an informal poll last week of nine friends who are traveling to or who had recently traveled to the southern U.S. or to the Caribbean, only one of them had vaguely heard of this mosquito-borne virus. One friend is taking a Caribbean cruise. She told me she was given a "what to bring" list from the cruise company. On the list was mosquito repellant. But she was not told why!
Another friend had already reported to me a very unfortunate experience she had after returning from a Central American country a short while back. As she was passing thru the country's departure area, she saw a large sign warning about the virus and some of its symptoms. Two days after arriving home, she contracted Chikungunya. She told me she went to her doctor, who had never heard of the virus. Fortunately my friend remembered the sign in the departure area of the airport, so she downloaded the symptoms and gave them to her doctor. The doctor told her he would never had thought of this as the cause.
My friend told me it felt as if she had been "run over" because within minutes of feeling ill, she was on the floor, crumpled up in a fetal position with excruciating pain in all her joints. She said, " It felt like my body was on fire!" For 6 days, she was unable to get out of her bed unaided. It was so bad, her mother had to come to take care of her son. And then just as suddenly as the virus slammed her, it was gone. Fortunately she has had no lasing effects.
Worse still, is I also conducted an informal survey of 4 travel agents who themselves travel all over the world. Only one of them had heard of the virus, and then it was anecdotal from a client mentioning that they'd had a friend who contracted it.
I certainly understand that those who are in the travel and lodging business do not want to scare people away. But when there are 1.4 million victims--and climbing steadily--it's not something that can be ignored. Better to advertise the simple prevention methods, and assure travelers that the virus can be avoided.
So what happens if someone contracts the virus? Most will go to their local doctor who may either misdiagnose it as severe flu or not be able to diagnosis it at all because even doctors have not been fully informed or educated about this epidemic. But if a new victim is lucky, they will have either read this posting or have heard of the virus and be able to tell their doctor the likely cause of their symptoms.
On its web site, the CDC updates the geographic locations of the virus and infection rates.
People who are higher risk for serious symptoms include:•People who have arthritis•People with serious underlying medical conditions (such as high blood pressure, heart disease, or diabetes)•People older than 65•Women who are late in their pregnancies, because of the risk to babies born at the time their mother is sick
Here are a few ways the CDC suggests Protecting Yourself from Mosquito Bites:•Use air conditioning or window/door screens to keep mosquitoes outside. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.•Help reduce the number of mosquitoes outside your home or hotel room by emptying standing water from containers such as flowerpots or buckets.•When weather permits, wear long-sleeved shirts and long pants.•Use insect repellents oRepellents containing DEET, picaridin, IR3535, and oil of lemon eucalyptus and para-menthane-diol products provide long lasting protection.oIf you use both sunscreen and insect repellent, apply the sunscreen first and then the repellent.oDo not spray repellent on the skin under your clothing.oTreat clothing with permethrin or purchase permethrin-treated clothing.oAlways follow the label instructions when using insect repellent or sunscreen.
And unfortunately, it's not the mosquitoes that come out at dusk and at night that are the majority problem, but rather those during the day.
But if someone does get bitten and comes down with the virus, it is very important to keep them free of mosquito bites so that their virus is not transmitted by a mosquito bite to someone else. A person can spread the virus to another mosquito for up to one week after infection or as long as symptoms continue. An analogy would be for someone with a sexually transmitted disease whether aware of it or not to wear a condom so that it's not only protecting the host, but also a potential victim.
The only good news is that it is widely believed that once someone has contracted the virus, they are immune.
A BRIEF HISTORY:
Chikungunya was first identified in Tanzania -- Tanganyika then -- in 1955. It has since caused outbreaks in Africa, South Asia, and Southeast Asia.
The current outbreak in the Western Hemisphere was first diagnosed in a cluster of 66 confirmed cases on the island of St. Martin in December 2013.
On July 17, 2014, the first case of Chikungunya from local transmission in the United States was reported in Florida.
What's interesting about this virus is that in areas where the outbreak occurs, between 72 percent and 97 percent of those who are infected become symptomatic.
All travelers should be checking the CDC web site as well as stocking up on the proper repellents. I would not recommend waiting to arrive on a Caribbean island and finding out that either the shelves are short of mosquito repellent or an appropriate proven tested repellent is not available.
So the best gift family members can give one another or to friends who are traveling south is a gallon of the best mosquito repellent available!
Peter V. Emerson Associate-Public Policy, Division on Addiction, & Chairman of College Task Force on College Gambling and Alcohol Police