Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 20, Number 8—August 2014
Letter

Chikungunya in the Caribbean—Threat for Europe

On This Page
Figures
Article Metrics
13
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: The first evidence of chikungunya virus in the Western Hemisphere was its detection in December 2013 in the French West Indies (1). One month later, the virus spread to other Caribbean islands.

Two cases of chikungunya in siblings (an 8-year old girl and a 10-year old boy) were recently identified at Toulouse University Hospital in southwestern France. Two days after these children had returned to France from the island of Martinique (French West Indies), acute fever associated with an arthromyalgic syndrome developed in these children. The children had maculopapular, nonpruriginous rashes on their arms and legs and endobuccal petechiae. The boy had bilateral knee effusions, and the girl had a measles-like rash that became more extended. Both children also had many mosquito bites that they scratched. They were discharged on the day of their admission. These 2 cases reported in metropolitan France after the patients visited Martinique indicate rapid spread of chikungunya virus.

Figure

Thumbnail of Phylogenetic tree constructed by using the neighbor-joining method and based on a partial (205 nt) sequence of the envelope protein 1 gene of chikungunya virus that was imported to France from Martinique. Phylogenetic analysis includes reference sequences of chikungunya viruses from East/Central/South African (ECSA), West African (WA), and Asian (A) lineages. Sequences are indicated as GenBank accession number and country. The imported chikungunya strain isolated in this study is in

Figure. Phylogenetic tree constructed by using the neighbor-joining method and based on a partial (205 nt) sequence of the envelope protein 1 gene of chikungunya virus that was imported to metropolitan France...

We identified the virus by sequencing a 205-nt fragment within the envelope protein E1 gene of chikungunya virus (2) and performing phylogenetic analyses on the basis of reference sequences. This virus was a strain from Asia (Figure), whereas virus detected in 2 children in southeastern France in September 2010 had been imported from Rajasthan, India, and was an East/Central/South Africa strain (3). All of these strains did not show the single amino acid substitution in the envelope protein gene (E1-A226V) that favors adaptation for dissemination by Aedes albopictus mosquitoes (4) and would affect the potential magnitude of this outbreak.

Ae. aegypti mosquitoes are common in the Western Hemisphere, where they are the major vector of urban dengue and yellow fever, and will facilitate spread of chikungunya in this region. Ae. albopictus (Asian tiger mosquito) is also an efficient vector of chikungunya virus and is found in many areas, including southern Europe. This mosquito species was responsible for the extensive chikungunya outbreak on La Réunion Island in the Indian Ocean (5) and was involved in the first chikungunya outbreak in Italy in 2007 (6). In these 2 outbreaks, human and mosquito virus strains contained mutation A226V in the envelope protein gene.

Ae. albopictus mosquitoes became established in a large area (91,150 km2) of southern France in 2013, where ≈13 million persons live. This mosquito, which is highly efficient in transmitting chikungunya virus (7), has been present in the study area for 2 years. For these reasons, a chikungunya/dengue national control program for continental France was established in 2006. The program involves rapid virologic diagnosis of imported or suspected autochthonous cases and vector control measures. This program operates during May–November, the period when Ae. albopictus mosquitoes circulate, and is based on entomologic surveillance data. The area covered by the program in 2013 was >10 times larger than that covered in 2006.

The presence of an effective vector, its progressive spread, and the outbreak of chikungunya in the Western Hemisphere increase concerns of a chikungunya outbreak in Europe (8). The greatest challenge is to find a way of interrupting the transmission chain of the virus as soon as possible. This challenge requires an effective policy of informing travelers at risk, early screening based on rapid virologic diagnosis, and effective vector control. Such control measures need an educated population to ensure emptying standing water from flowerpots, gutters, buckets, pool covers, pet water dishes, and discarded tires. They also need global antivector measures (eradication of eggs, larvae, and adults of Aedes spp. mosquitoes).

These measures must be extremely efficient because an outbreak of chikungunya in the Western Hemisphere could spread rapidly. All countries in southern Europe are concerned by this public health challenge, and the battle against chikungunya requires rapid establishment of a supranational organization that should be able in real time to collect and return epidemiologic, virologic, and entomologic data. Although the usual movements of tourists around southern Europe during the summer will increase the number of persons at risk in this area, an even greater threat is the international movement of >600,000 persons expected to attend the next Soccer World Cup in Brazil in 2014 (9).

Top

Jean-Michel MansuyComments to Author , Erick Grouteau, Catherine Mengelle, Isabelle Claudet, and Jacques Izopet
Author affiliations: Toulouse University Hospital, Toulouse, France (J.-M. Mansuy, E. Grouteau, C. Mengelle, I. Claudet, J. Izopet); Institut National de la Santé et de la Recherche Médicale, Toulouse (J. Izopet); Université Toulouse III Paul-Sabatier, Toulouse, (J. Izopet)

Top

References

  1. Leparc-Goffart  I, Nougairede  A, Cassadou  S, Prat  C, de Lamballerie  X. Chikungunya in the Americas. Lancet. 2014;383:514 . DOIPubMedGoogle Scholar
  2. Pastorino  B, Bessaud  M, Grandadam  M, Murri  S, Tolou  HJ, Peyrefitte  CN. Development of a TaqMan RT-PCR assay without RNA extraction step for the detection and quantification of African chikungunya viruses. J Virol Methods. 2005;124:6571. DOIPubMedGoogle Scholar
  3. Grandadam  M, Caro  V, Plumet  S, Thiberge  JM, Souares  Y, Failloux  AB, Chikungunya virus, southeastern France. Emerg Infect Dis. 2011;17:9103. DOIPubMedGoogle Scholar
  4. Tsetsarkin  KA, Vanlandingham  DL, McGee  CE, Higgs  S. A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog. 2007;3:e201. DOIPubMedGoogle Scholar
  5. Vazeille  M, Moutailler  S, Coudrier  D, Rousseaux  C, Khun  H, Huerre  M, Two chikungunya isolates from the outbreak of La Reunion (Indian Ocean) exhibit different patterns of infection in the mosquito, Aedes albopictus. PLoS ONE. 2007;2:e1168. DOIPubMedGoogle Scholar
  6. Rezza  G, Nicoletti  L, Angelini  R, Romi  R, Finarelli  AC, Panning  M, Infection with chikungunya virus in Italy: an outbreak in a temperate region. Lancet. 2007;370:18406. DOIPubMedGoogle Scholar
  7. Vega-Rua  A, Zouache  K, Caro  V, Diancourt  L, Delaunay  P, Grandadam  M, High efficiency of temperate Aedes albopictus to transmit chikungunya and dengue viruses in the Southeast of France. PLoS ONE. 2013;8:e59716. DOIPubMedGoogle Scholar
  8. Fischer  D, Thomas  SM, Suk  JE, Sudre  B, Hess  A, Tjaden  NB, Climate change effects on chikungunya transmission in Europe: geospatial analysis of vector’s climatic suitability and virus' temperature requirements. Int J Health Geogr. 2013;12:51. DOIPubMedGoogle Scholar
  9. Brazilian Government Website. World Cup Portal [cited 2014 May 6]. http://www.copa2014govbr/en.

Top

Figure

Top

Cite This Article

DOI: 10.3201/eid2008.140650

Related Links

Top

Table of Contents – Volume 20, Number 8—August 2014

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Jean-Michel Mansuy, Virology Laboratory, University Hospital Purpan, 330 Ave de Grande Bretagne, TSA 40031, Toulouse 31059, France

Send To

10000 character(s) remaining.

Top

Page created: July 21, 2014
Page updated: July 21, 2014
Page reviewed: July 21, 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.
file_external