A chikungunya clinic in the Dominican Republic, which has also seen outbreaks of chikungunya. (Luz Sosa/PAHO/WHO/Flickr | CC BY-ND)

We Need to Talk About Chikungunya

My friend from Rio de Janeiro got chikungunya virus in April. First she came down with a high fever. Soon after, she developed a red rash. She went to the doctor and was told she had zika. She was not pregnant nor planning to conceive; thus, she wasn’t too worried about the diagnosis. In next to no time, however, she started to experience severe muscle pain. Her joints began to swell. She felt like she couldn’t even get out of bed.

While the fever passed and the rash went away, the dull muscle aches and joint pain remained. Just a week or so ago at lunch (in July), she asked me to open the beer bottle we were sharing. “Chikungunya” was her one-word explanation.

The Aedis aegypti, which can spread chikungunya, as well as dengue and zika. (CDC Global/Flickr | CC BY)
The Aedis aegypti, which can spread chikungunya, as well as dengue and zika. (CDC Global/Flickr | CC BY)

Like zika, chikungunya is a mosquito-born disease, carried by the infamous Aedis aegypti mosquito that has wreaked havoc across Latin America in the last several years. In the lead-up to the Summer Olympics in Rio de Janeiro this August, much has been said about the threat zika poses to tourists and athletes. Now definitively linked to the development of microcephaly and other birth defects related to the central nervous system, zika is very dangerous to pregnant women in the first trimester.

In the face of the zika outbreak, public health officials, feminist organizers, and physicians across the Americas have argued that access to contraception and abortion needs to improve. In fact, zika has become a rallying cry for changes to public health services in the region — particularly in Brazil.

Zika is no doubt dangerous — and scary. In light of the region’s restrictive bans on abortion, high rates of sexual violence, and endemic poverty that can severely hamper women’s ability to access birth control, women are faced with a heavy burden in relation to their health-related rights.

One in a series of public health posters aimed at getting people to help eliminate mosquito breeding areas, produced by the Brazil Ministry of Health.
One in a series of public health posters aimed at getting people to help eliminate mosquito breeding areas, produced by the Brazil Ministry of Health.

But in the tumult over zika, other mosquito-born diseases have disappeared from media coverage. I’m here to talk about chikungunya and dengue, the other Aedis aegypti viruses that, while not causing birth defects, can be severely debilitating to one’s health — and life.

Dengue has been around Brazil since the colonization of the Americas. Historians believe that the first reports of dengue come from the Caribbean in the late-1600s. Now it is considered endemic to much of the region, including Brazil. Symptoms include a high fever, severe headaches, eye, joint, and muscle pain, and a rash. Early detection and treatment greatly lowers the risk of medical complications. While dengue is not normally fatal, if not treated it can be life-threatening.

From January to the end of May 2016, nearly 64,000 people have contracted dengue in the state of Rio de Janeiro. That is nearly 382 cases per 100,000 people.1 That’s more than the confirmed zika cases in the state: over 46,000 people in January-May 2016 (almost 278 cases per 100,000 people).2

(Luz Sosa/PAHO/WHO/Flickr | CC BY-ND)
(Luz Sosa/PAHO/WHO/Flickr | CC BY-ND)

Chikungunya is a more recent arrival to the Americas. In 2013, the first case of chikungunya virus caused by an Asian genotype was confirmed in the Caribbean. By late 2014, Brazil recorded its first confirmed transmission in the northeast. It has now spread throughout the country. Symptoms of chikungunya are similar to dengue — high fever, headaches, and muscle pain (myalgia). But those who contract chikungunya can experience debilitating joint pain (polyarthritis/symmetric arthralgia) for months after the fever. Maybe my friend was hamming it up when she asked me to open the beer, or maybe she was still feeling the lingering effects of chikungunya.

From January to the end of May 2016, 4,600 people have gotten chikungunya in the state of Rio, nearly 28 cases per 100,000 residents. Compare that to the 9 people who got it in 2015.3 While these numbers are not as high as confirmed cases of zika and dengue, the alarming increase from last year should cause anyone to stop and ponder the implications. The Brazilian northeast, which has the most registered cases of Aedis aegypti-carried diseases, has reported that 45 people have died from chikungunya so far this year.

A US public health campaign poster, likely from the early- to mid-20th century when programs in both the US and Latin America successfully reduced or eliminated mosquito populations. (US National Library of Medicine | Public domain)
A US public health campaign poster, likely from the early- to mid-20th century when programs in both the US and Latin America successfully reduced or eliminated mosquito populations. (US National Library of Medicine | Public domain)

The surge in Aedis aegypti-born diseases in the late-twentieth and early-twenty-first centuries is disheartening. In the early-twentieth century, the mosquito was known for its transmission of yellow fever and malaria. In response, national and international groups worked tirelessly to eradicate the pesky bug. For instance, the U.S. government spend $20 million in successful eradication efforts during the construction of the Panama Canal. Early eradication policies in Rio de Janeiro were also successful. From the 1920s to 1960s, Latin American governments and international health organizations (including the Rockefeller Foundation) successfully eliminated the mosquito from most of the region’s countries.

Yet in the late 1960s, the mosquito lost political importance, and public health programs stopped their control of the bug. Perhaps the effects of the Cold War in the region, particularly the onset of violent anti-communist dictatorships supported by the US, took precedence. Or perhaps public health efforts thought they had won the battle against the bug and thus centered their efforts elsewhere. Whatever the case, the mosquito began to reappear with ferocity. Aedis aegypti is an incredibly adaptive insect. The species was once populous in forested areas, where it bred and congregated around water that collected in tree holes. But it quickly adapted to the rapid and uncontrolled urbanization that swept across the region in the second half of the twentieth century. As the World Health Organization (WHO) writes, the mosquito “flourishes in impoverished crowded areas with no piped water and poorly collected garbage and trash.”

Public health efforts in the Dominican Republic focused on reducing the mosquito population, which tends to flourish in poorer and crowded areas. (Luz Sosa/PAHO/WHO/Flickr | CC BY-ND)
Public health efforts in the Dominican Republic focused on reducing the mosquito population, which tends to flourish in poorer and crowded areas. (Luz Sosa/PAHO/WHO/Flickr | CC BY-ND)

To combat the disease today, public health efforts need to work on mosquito control. Remember, chikungunya, dengue, and zika are all carried by the same mosquito! Now’s the time for renewed international and national efforts to control Aedis aegypti.

My friend’s twelve-year-old daughter told me that getting zika was “melhor” (better) than contracting chikungunya. Her mother quickly cut in — “menos mal” (less bad) she corrected. As tourists, athletes, and coaches head down to Rio de Janeiro, “less bad” just might not cut it. And let’s not forget the millions of residents who face the possibility of contracting all three viruses on a daily basis.

I don’t want to give the impression that there is no way to be in Rio de Janeiro without contracting a mosquito-born illness. I’ve been here for a month now, and I’ve barely been bitten. Remember, it’s winter in the southern hemisphere. In Brazil, July and August are the months in which the Aedis mosquito is least prevalent. My advice? Use repellent. And watch out for chikungunya.

Further Reading

Verna Aardema, Why Mosquitos Buzz in People’s Ears: A West African Tale (Penguin, 1992).

J.R. McNeill, Mosquito Empires: Ecology and War in the Greater Caribbean, 1620-1914 (Cambridge, 2010).

Notes

  1. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico 47, n. 27 (2016): 2. Return to text.
  2. Ibid., 8. Return to text.
  3. Ibid., 6. Return to text.

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