Chikungunya : few months after the attack

En mayo del 2014 se anunció en el editorial de la Rev.MVZ Córdoba la advertencia de la inevitable llegada del virus de chikungunya a Colombia y especialmente en el Caribe por sus condiciones climáticas del trópico húmedo, así como con la presencia del conocido vector competente del dengue: Aedes aegypti (1). La abundante población de este mosquito en el Caribe permitió una adaptación rápida del virus chikungunya y facilitó su diseminación en toda la costa Atlántica. La OPS y el Ministerio de Salud de Colombia conocían de su inminente llegada y destinaron recursos para controlar el vector y mitigar el impacto epidemiológico de este nuevo arbovirus. Sin embargo, se ha observado que las campañas de fumigación no fueron sistemáticas e incluso en algunas poblaciones rurales de la costa Atlántica no se realizaron.

En mayo del 2014 se anunció en el editorial de la Rev.MVZ Córdoba la advertencia de la inevitable llegada del virus de chikungunya a Colombia y especialmente en el Caribe por sus condiciones climáticas del trópico húmedo, así como con la presencia del conocido vector competente del dengue: Aedes aegypti (1).La abundante población de este mosquito en el Caribe permitió una adaptación rápida del virus chikungunya y facilitó su diseminación en toda la costa Atlántica.La OPS y el Ministerio de Salud de Colombia conocían de su inminente llegada y destinaron recursos para controlar el vector y mitigar el impacto epidemiológico de este nuevo arbovirus.Sin embargo, se ha observado que las campañas de fumigación no fueron sistemáticas e incluso en algunas poblaciones rurales de la costa Atlántica no se realizaron.
In May of 2014, the editorial of the MVZ Cordoba magazine announced the warning of the inevitable arrival of the Chikungunya virus to Colombia, especially in the Caribbean region given its climatic conditions of tropical humidity, as well as the presence of the well known competent vector of dengue: Aedes aegypti (1).The abundant population of this mosquito in the Caribbean allowed a quick adaptation of the Chikungunya virus and facilitated its dissemination throughout the entire Atlantic coast.The OPS (Pan-American Health Organization) and the Ministry of Health of Colombia knew of its imminent arrival and allocated resources to control the vector and mitigate the epidemiologic impact of this new arbovirus.However, it has been observed that the fumigation campaigns were not systematic and did not even take place in some rural populations of the Atlantic coast.
From the phylogenetic point of view, the Chikungunya virus that entered Colombia, is the same strain of that of the Virgin Islands and Saint Martin (unpublished data) in December of 2013 and confirms the findings of Lancioti and Valadere (2).With relation to the clinical presentation of the disease, this has been as expected, with some differences to the ones observed in Africa and Asia.Here in the Colombian Caribbean there have been few cases of myalgia, diarrhea, conjunctivitis and hemorrhagic manifestations; the arthritis and fever are still pathognomonic.Nevertheless, neurologic manifestations such as encephalitis and Guillan Barr'e syndrome in some patients (data not published).It seems that there are some cases of hepatitis that could be linked to the viral infection by Chikungunya with elevation of the hepatic enzymes, casuistic which has been reported in literature (3,4).E s t a s o b s e r va c i o n e s r e q u i e r e n p o r parte de las autoridades sanitarias una vigilancia más estricta de los casos postchikungunya.No se sabe tampoco cómo es la coinfección con el dengue y si su asociación con el chikungunya lo hace mas letal o puede formar inmuncomplejos que aceleren o modifiquen su presentación clínica.Se han presentado casos letales asociados a chikungunya pero no se tiene certeza que sea la causa del deceso o si existe una coinfección con otro virus como el dengue (5).
These observations require stricter post-Chikungunya surveillance from the sanitary authorities.It is also not known how coinfection with dengue is and if its association with Chikungunya makes it more lethal or can form immunocomplex that accelerate or modify its clinical presence.Some lethal cases associated with Chikungunya have been observed, but there is no certainty whether it is the cause of decease or if there is co-infection with another virus such as dengue (5).
On the other hand, there has been no quantification of labor and school days lost due to the disease; the economic impact of this pathology is undoubtedly greater that seasonal colds and even dengue itself.Leaves of up to 7 days have been recorded in the Atlantic coast area, arthralgia with or without edema in some patients seem to persist for months in older adults (data not published).
The Ministry of Health frequently points out in the media that the impact of the disease has been lower than expected, with only 57.000 cases (6).However, it has been observed that great part of the population of the states of the Caribbean region are not heading to the hospitals or health centers, because by observing the clinical triage: exanthema -fever-arthralgia, they are selfmedicating with acetaminophen.Maybe that is the apparent reason for the low casuistic and probably also the reason for lack of the medication.
Finally, the perception of the population regarding the disease is curious and interesting at the same time.Some believe that it is the mosquito and not the virus of the etiological agent of the pathology, others consider it to be contagious because they have observed members of the same household get sick.Other have associated mortality to ingestion of alcohol postchikungunya infection, given the coincidence of cases where a person has died after a fever due to Chikungunya.Some mention to know of cases where the disease has repeated itself, situation which has been described in literature (7).
Little is known in Colombia of this new arbovirus and its genomes must be analyzed to observe if there are mutations and associate them more in depth with the clinical presentation that is presenting itself in patients.There is a need to establish whether the co-infection with other arbovirus exacerbates the symptoms or not.It would be important to consider a vaccine with autochthonous strains.