Chikungunya Outbreaks from 2000 to 2015: A Review

Chikungunya is a mosquito-borne disease caused by an alphavirus from the Togaviridae family. The Chikungunya virus (CHIKV) is transmitted by the Aedes mosquitoes. The usual clinical signs of chikungunya are non-specific flu-like symptoms, a distinctive rash and severe joint pains. The disease shares some clinical signs with dengue and can be misdiagnosed in areas where dengue is endemic. There is no vaccine nor a specific antiviral treatment for CHIKV. CHIKV was initially seen in the early 1950s at the boundary of Tanzania and Mozambique. For the past 5 decades, CHIKV was limited to sub-Saharan Africa in addition to Southeast Asia. The situation worsened when CHIKV re-emerged in Kenya in 2004 and reached several other countries in and around the Indian Ocean. The epidemic swiftly reached regions like India and Southeast Asia and transmission of CHIKV was reported for the first time in Europe in 2007 in Italy. The purpose of this review is to summarize CHIKV outbreaks that have been reported in the 15-year period from 2000 to 2015 to show that periodic outbreaks have occurred not only in Asia and Africa, but in Europe and the Americas. It is evident that CHIKV is not restricted to a single region but has become a global public health challenge. As many citizens from non-endemic countries visit areas endemic for CHIKV fever, medical professionals must learn to recognize such cases among travelers returning from such areas with non-specific symptoms such as fever, arthralgia and skin eruptions. In endemic areas for mosquito-borne diseases, clinicians must be educated about the recognition, diagnosis and timely reporting of chikungunya virus disease cases.