On December 12, 2013, the Caribbean Public Health Agency (CARPHA) received notification of ten confirmed cases of locally acquired chikungunya virus infection on the French side of the Caribbean island of Saint Martin, which is divided into two parts, Sint Maarten and Saint Martin, governed by the Netherlands and France respectively. Four additional cases have been identified as probable cases, and 20 other persons are suspected of having the disease. Laboratory test results are awaited and it is likely that the number of confirmed cases will increase.
Chikungunya is a viral disease, carried mainly by the Aedes aegypti mosquito and causes a dengue-like sickness. Symptoms include a sudden high fever, severe pain in the wrists, ankles or knuckles, muscle pain, headache, nausea, and rash. Joint pain and stiffness are more common with chikungunya than with dengue. The symptoms appear between four to seven days after the bite of an infected mosquito. The majority of clinical signs and symptoms last three to 10 days, but joint pain may persist longer. Severe cases requiring hospitalisation are rare.
There is no vaccine or treatment for chikungunya, which has infected millions of people in Africa and Asia since the disease was first recorded in 1952.
It is noteworthy that this is the first time locally-acquired cases of chikungunya have been detected in the Caribbean. In the Americas, imported cases had previously been reported from Brazil, Canada, French Guiana, Guadeloupe, Martinique and the United States of America.
The health authorities on both sides of the island are cooperating closely in response to the cases and have enhanced epidemiological surveillance, carried out measures to control mosquito breeding sites and are advising people on how to protect themselves. There is currently no evidence of cases on the Dutch side of the island, or in other parts of the Caribbean.
Dr C. James Hospedales, the Executive Director of CARPHA said “In addition to chikungunya on the French-side, both sides of the island are also currently experiencing a dengue epidemic. Given that the type of mosquito that transmits chikungunya is widely distributed in the Caribbean region and is also known to transmit dengue, the Region is at risk for spread of the virus. Dr. Hospedales explained that the measures used for controlling the spread of chikungunya are the same as those applied for the control of dengue as both diseases are transmitted by the same mosquito, Aedes aegypti. He said the best way to protect yourself from this disease is to avoid mosquito bites and to prevent mosquitoes breeding in and around your home environment.
CARPHA is therefore urging the public to inspect their homes and yards weekly, and eliminate potential mosquito breeding sites indoors and outdoors by keeping water drums and barrels tightly covered, and throwing out stagnant water from flower vases, old tyres, and other containers that might act as breeding sites. An action pictogram to aid managing your environment can be downloaded from the CARPHA website (http://carpha.org/wp-content/uploads/2013/12/CARPHA-YARD-POSTER-2.pdf) and used as a checklist. Members of the public can protect themselves from mosquito bites by wearing long-sleeved clothing or long pants, and using insect repellents liberally, and mosquito nets at night.
In order to ensure an effective public health response in the Region to this disease, CARPHA has been in communication with both sides of the island and is coordinating its activities with those of the Pan American World Health Organization/World Health Organization (PAHO/WHO) and other key stakeholders. CARPHA has also been working with Caribbean health authorities to ensure that they are able to identify cases early and mount a rapid but coordinated public health response that includes identification and clinical management of cases, vector control measures, surveillance, and effective public communication measures.
Port of Spain, Trinidad and Tobago, December 13, 2013.