CDC in V.I. to help respond to chikungunya


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A St. Thomas doctor says she believes she is treating another case of locally-acquired chikungunya, although the lab tests are not yet back to confirm the diagnosis.

Meanwhile, a team from the U.S. Centers for Disease Control and Prevention that came to the territory last week after the first locally-acquired chikungunya case here was confirmed is working on helping the V.I. Health Department beef up its surveillance, investigation and diagnostic capacity, while also providing education to health care workers about the clinical management of the mosquito-borne virus.

On Friday, the CDC team presented information on chikungunya to top executives at Luis Hospital on St. Croix. This week, the team is scheduled to make presentations to physicians and clinicians at both Schneider Hospital on St. Thomas and Luis Hospital on St. Croix.

Chikungunya has swept rapidly through the Caribbean since the first locally-acquired case in the Americas was diagnosed in St. Martin in December.

Earlier this month, officials confirmed the first locally-acquired case of chikungunya in the territory in a person who became ill on St. Thomas. There have also been two imported cases of chikungunya - where the person acquired the virus in another locale and then returned to the territory before getting sick - reported, both of them on St. Thomas.

Esther Ellis, who is transitioning from being employed as an epidemic intelligence service officer with the CDC to becoming the territorial epidemilogist for the V.I. Health Department, said Sunday night that officials have now confirmed a total of three locally-acquired cases of chikungunya in the territory, all on St. Thomas.

The fact that there are locally-acquired cases in the territory means that the virus is present in the local mosquito population, and the Health Department is urging residents to take precautions to avoid being bitten. Likewise, Health has also urged anyone who thinks they may have chikungunya to see a doctor.

Chikungunya, like dengue fever, is a reportable disease in the territory.

One of the goals of the CDC in its trip here is to help strengthen surveillance and diagnostic testing capacity to identify additional cases, and the agency is doing the laboratory work to confirm suspected chikungunya cases at no cost to the patient.

Dr. Elizabeth Flower-LaPlace, a physician on St. Thomas, said that she believes she is treating a patient with chikungunya, a 68-year-old woman who lives in Bonne Resolution on St. Thomas.

Flower said she has notified the Health Department of the suspected case, spoke to the CDC about it, and sent off blood for lab work to confirm the diagnosis. However, she said, it takes approximately nine days or so for the results to come back.

"This is the first one I've seen," Flower said of the suspected case.

Although chikungunya has symptoms that are similar to dengue, Flower said the patient with the suspected case of chikungunya presented with slightly different symptoms than she is accustomed to seeing with dengue fever.

Chikungunya is a virus - transmitted to people by the bite of an infected mosquito - that can cause an illness characterized by fever and joint pain, the most common symptoms, according to the CDC. Other symptoms may include headache, muscle pain, joint swelling, or rash.

Specifically, Flower said that this patient's joint pain was much more pronounced than she typically sees with dengue fever, and the rash was different.

Noting that the testing for chikungunya is expensive and some insurance companies won't pay for it, Flower said the free testing by the CDC is important.

Ellis said that officials want to know how widespread the virus is in the territory.

The CDC is working to get local health care providers trained and prepared to treat patients with chikungunya, she said. There is no vaccine for chikungunya, and no specific anti-viral treatment. Care is supportive, to ease symptoms.

The CDC has a variety of goals while its team is here in the territory, which include assisting with investigations of lab-confirmed chikungunya cases; helping strengthen surveillance and diagnostic testing capacity to identify additional cases; establishing routine data analysis and reports to track the outbreak and direct response efforts; educating health care providers and the general public to lessen the spread of the virus; assessing the existing needs in clinical capacity; collecting mosquito specimens to determine which species are here and playing a role in transmitting chikungunya, to calculate infection rates and to assess for insecticide resistance; and developing recommendations for mosquito control and other prevention efforts.

Health Commissioner Darice Plaskett said that they have already updated the reportable disease form the department uses, to be specific to dengue and chikungunya, to make it more user-friendly.

The most recent update available on Sunday on the Caribbean regional outbreak from the Pan American Health Organization is almost a month old and showed 61,864 suspected cases, 4,356 confirmed cases, and 13 deaths from chikungunya. In recent days, the first cases in Cuba were reported.

The strain of chikungunya that has been spreading through the Caribbean is being carried by the same species of mosquito, the Aedes, that typically carries dengue fever, so the steps to avoid being bitten are the same.

Symptoms of chikungunya usually begin 3-7 days after being bitten by an infected mosquito. Most chikungunya patients feel better within a week or so, according to the CDC.

However, some people with chikungunya may develop prolonged joint pain that can last for months, according to the CDC. Such prolonged joint pain is not typical for dengue.

- Contact Joy Blackburn at 714-9145 or email jblackburn@dailynews.vi.

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