January 27, 2015 Vol. 8, No.
1
IN THIS ISSUE:
Chikungunya Fever Update
Ebola Update
Key Points:
Travel-related cases of chikungunya in
Canada have surged due to transmission in
the Caribbean, Central and South America,
Ocean Pacific Islands, Mexico and Florida
Consider chikungunya in the differential for
the returning traveler with fever and joint
pain
The World Health Organization has
announced the end of the Ebola outbreak in
Mali
Chikungunya Fever Update
Chikungunya fever is caused by chikungunya
virus transmitted by day-biting mosquitoes
Aedes aegypti and Aedes albopictus, which
can also transmit dengue.
The virus is endemic in Africa, Asia and the
Indian subcontinent.
Since December 2013, local transmission of
the virus in the Caribbean and subsequent
expansion in the Americas has been reported.
In October 2014, local transmission was also
reported in the south of France (Montpellier).
Increase in travel-related Chikungunya cases
Since 2014, there has been a surge in travel-
related chikungunya cases in Canada. As of
December 9, 2014, 320 confirmed and 159
probable cases have been diagnosed.
No local transmission of chikungunya has
occurred or is expected in Canada, since the
primary mosquito vectors are absent.
Clinical presentation
Symptoms appear usually 3-7 days (range 2-12
days) after the bite of an infected mosquito.
The majority of people infected become
symptomatic.
Page 1 of 2
FROM:
Eileen de Villa, MD MBA MHSc CCFP FRCPC
Acting Medical Officer of Health
Abrupt onset of fever and polyarthralgia are
the primary clinical signs. Other symptoms
include myalgia, headache, nausea/vomiting,
rash, and fatigue.
Most patients fully recover without long-term
consequences.
The elderly, children, pregnant women, and
people will chronic conditions such as
diabetes are more vulnerable to serious
complications.
Diagnosis
Chikungunya fever may co-exist with other
infectious diseases like dengue fever, which
shares some clinical signs and can result in
misdiagnosis.
Chikungunya typically causes pain that is
much more intense and localized in joints and
tendons than dengue.
Chikungunya serologic testing requirements:
Collect blood in a red cap tube
Ensure the laboratory requisition indicates:
o Chikungunya testing
o symptoms, onset date and travel
history including location (required)
Prevention and Treatment
No vaccine for chikungunya exists.
Counsel your patients to use a DEET
containing mosquito repellent
Treatment is supportive
References
1. Public Health Agency of Canada (PHAC). Chikungunya in the
Caribbean and South America: Travel health notice. Last modified:
January 19, 2015. http://www.phac-aspc.gc.ca/tmp-pmv/notices-
avis/notices-avis-eng.php?id=120
2. Government of Canada. Chikungunya. Last modified: October 2,
2014. http://travel.gc.ca/travelling/health-
safety/diseases/chikungunya
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Page 2 of 2
3. Pan American Health Organization (PAHO). Chikungunya. Last
modified: January 16, 2015.
http://www.paho.org/hq/index.php?option=com_content&view=article&id=8303&Itemid=40023&lang=en

4. PAHO. Information for Healthcare providers: Chikungunya fever.

January 2014
http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23974&Itemid=

5. Drebot MA, Holloway K, Zheng H, and NH Ogden. (2015). Travel-

related chikungunya cases in Canada, 2014. CCDR 41(1).
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/15vol41/dr-rm41-
01/assets/pdf/15vol41_01-eng.pdf

6. Drebot M, Director, Zoonotic Diseases and Special Pathogens,

National Microbiology Laboratory, PHAC, Winnipeg, Manitoba,
Personal Communication via e-mail, June 24, 2014.

7. Centers for Disease Control and Prevention. Chikungunya:

information for healthcare providers. Last modified: July 22, 2014.
http://www.cdc.gov/chikungunya/pdfs/CHIKV_Clinicians.pdf

Ebola Update

The World Health Organization has announced

an end to the Ebola outbreak in Mali
Case incidence continues to fall in Guinea,
Liberia and Sierra Leone
Over 21 000 cases and more than 8600 deaths
have been reported in these three countries to
date
Updated signage for primary care screening
has been posted on the Ministry of Health and
Long-Term Cares Ebola website:
www.ontario.ca/ebola

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