Health Advisory: Chikungunya Virus in Paraguay and Risk to Travelers
March 3, 2023
Action Requested
- Consider chikungunya virus infection in travelers returning from Paraguay and surrounding countries with acute onset of fever and polyarthralgia.
- Contact the health department to facilitate diagnostic testing. The Snohomish County Communicable Disease Program can be reached at 425-339-3503.
- Rule out dengue virus infection in travelers with suspect chikungunya virus infection as these viruses often cocirculate and have similar clinical presentations during acute illness. Early clinical management of dengue can improve patient outcome.
- Consider other etiologies in the differential for patients testing negative for chikungunya and dengue infection (e.g., Zika, leptospirosis, malaria, infections caused by various bacterial or viral pathogens [e.g., rickettsia, group A streptococcus, rubella, measles, parvovirus, enteroviruses, adenovirus, Mayaro virus], post-infection arthritis, and rheumatologic conditions).
- Manage travelers with suspect chikungunya with acetaminophen as the preferred first-line treatment for fever and joint pain in travelers returning from Paraguay and surrounding areas. Aspirin and other NSAIDS should not be used until dengue can be ruled out to reduce the risk of hemorrhage.
- Be aware that people at risk for more severe disease include neonates exposed intrapartum, older adults (e.g., age >65 years), and people with underlying medical conditions (e.g., hypertension, diabetes, or cardiovascular disease).
- Provide travelers to Paraguay and surrounding areas information on the risk of chikungunya and dengue and how to prevent these mosquito-borne infections.
- Inform returning travelers suspected to have chikungunya of the need to protect themselves from mosquito exposure during the first week of illness to prevent further transmission in communities where the vector is present (Range of Ae. aegypti and Ae. albopictus in the United States).
- Report suspected chikungunya cases to state or local health department to facilitate diagnosis and mitigate risk of local transmission. To report to the Snohomish County Health Department, please visit our Disease Reporting page and contact our Communicable Disease team at 425-339-3503 for additional guidance.
Background
An increasing number of chikungunya cases has been reported in Paraguay, with more than 70,000 suspected cases since the outbreak began in October 2022, according to a recent CDC HAN alert. Most cases have been reported in the capital district of Asunción and the neighboring Central department. Further spread of the outbreak in Paraguay and to surrounding countries is possible.
Chikungunya virus is a mosquito-borne alphavirus transmitted by infected mosquitoes, and humans are the primary reservoir during epidemics. Beginning in late 2022, Paraguay reported an increasing number of chikungunya case and further increases in case counts are expected, including from other areas in Paraguay and surrounding countries (e.g., Brazil, Argentina, and Bolivia).
Most people infected with chikungunya virus become symptomatic. The incubation period is typically 3–7 days (range 1–12 days). The most common clinical findings are acute onset of fever and polyarthralgia. Joint pains are usually bilateral, symmetric, and often severe and debilitating. Other symptoms can include headache, myalgia, arthritis, conjunctivitis, nausea, vomiting, or maculopapular rash. Clinical laboratory findings can include lymphopenia, thrombocytopenia, and elevated creatinine. Rare complications include uveitis, retinitis, myocarditis, hepatitis, nephritis, bullous skin lesions, hemorrhage, meningoencephalitis, myelitis, Guillain-Barré syndrome, and cranial nerve palsies.
People at risk for more severe disease include neonates exposed intrapartum, older adults (e.g. age > 65 years), and people with underlying medical conditions (e.g., hypertension, diabetes, or cardiovascular disease).
View the full Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) Health Advisory for more information, including about laboratory diagnosis and treatment of symptoms.
Additional Resources