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Volume 20, Number 8—August 2014
Peer Reviewed Report Available Online Only

Preparedness for Threat of Chikungunya in the Pacific

Adam RothComments to Author , Damian Hoy, Paul F. Horwood, Berry Ropa, Thane Hancock, Laurent Guillaumot, Keith Rickart, Pascal Frison, Boris Pavlin, and Yvan Souares
Author affiliations: Secretariat of the Pacific Community, Noumea, New Caledonia (A. Roth, D. Hoy, P. Frison, Y. Souares); Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea (P.F. Horwood); National Department of Health, Port Moresby, Papua New Guinea (B. Ropa); Yap State Department of Health Services, Federated States of Micronesia (T. Hancock); Institut Pasteur, Noumea (L. Guillaumot); Queensland Health, Brisbane, Queensland, Australia (K. Rickart); World Health Organization, Port Moresby (B. Pavlin)

Main Article

Table 2

PPHSN recommendations for enhanced surveillance to the PICT in response to the threat of chikungunya outbreaks in the region

Category Recommendations
Syndromic surveillance We recommend enhanced surveillance with the purpose of prompt detection of any possible case in each PICT to organize a rapid response and mitigate the spread and impact as much as possible. National health authorities should ensure that their syndromic surveillance sentinel sites report weekly, adhere to case definitions, and report the number of patients that fit the case definitions of prolonged fever (any fever lasting ≥3 d) and AFR. These should be used as proxies for suspected chikungunya. Data on the other syndromes should be collected as usual. For countries/territories that use the optional syndrome dengue-like illness as part of their syndromic surveillance system, sentinel sites should report weekly also on this syndrome as it fits with chikungunya clinical symptoms. In addition to the existing surveillance system, any extension of the sentinel network or tracking trends at national level to detect chikungunya cases can be explored and discussed, depending on the local situation.
Vector control services to gear up in preparation A review of supplies and equipment should be undertaken, orders placed if required, staff refreshed on community-based activities (larvicide) and spraying methods and protocols (adulticide).
Breeding sites elimination using awareness campaigns aimed at the general public The time and season is appropriate to remind public about their role and responsibilities, and that the health authorities are intensifying relevant surveillance and response mechanisms as well. The campaigns do not have to focus on the risk specifically related to chikungunya but aim at vector control for vector-borne diseases, such as dengue and chikungunya, with a particular focus on container-breeding mosquitoes. Previous studies have shown that community engagement in vector control activities will achieve the greatest impact on reduction of Aedes mosquito vector species. All high-impact media and social networks should be asked to contribute, including educational and religious authorities.
Laboratory confirmation If there is an unexpected rise in the number of reported cases of prolonged fever, AFR, or dengue-like illness, confirmation of the diagnosis by laboratory testing is recommended. Specimens should be tested for dengue and chikungunya.
Strongly suspected exposure (e.g., travel history to an outbreak area) or confirmed case This should launch an immediate response, including:
• recording of information on the case(s), including age, sex, place of residence, travel history,
 identification of geographic cluster and mobilization of affected communities;
• vector control activities at the community level, focused around the residence of suspected cases,
 should be undertaken to eliminate potential breeding sites, and reduce the number of 
 natural and artificial water-filled container habitats that support the breeding of mosquitoes;
• spraying with insecticide to kill adult mosquitoes in the areas where the case-patient(s) reside(s)
 and work(s). Procedures must be clearly laid out and planned for by vector control services;
• using mosquito repellents on affected and exposed people to reduce the transmission of the 
• keeping potentially viremic patients (within the first 5–7 d of the disease) under impregnated
 (ideally) mosquito nets if admitted to a health facility;
• starting rapid and effective risk communication to inform the public (e.g., provision of information
 on the situation, how to protect themselves);
• disseminating treatment guidelines to hospitals and clinics to reduce the risk of hemorrhagic 

*Further details are available in the Pacific Outbreak Manual on the PPHSN Web site ( PPHSN, Pacific Public Health Surveillance Network; PICT, Pacific Island Countries and Territories; AFR, acute fever and rash.

Main Article

Page created: July 01, 2014
Page updated: July 01, 2014
Page reviewed: July 01, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.