The Cayman Islands may be just beginning to familiarize itself with the mosquito-borne chikungunya virus, but to Dr. Sandeep Mahendra, it’s nothing new.
Dr. Mahendra, consultant physician at Health City Cayman Islands, has dealt with the virus and many patients suffering its ill effects while working at Dr. Devi Shetty’s hospital in India.
“It’s not a killer disease like malaria or dengue. We have seen thousands in India … during the epidemic season, but the mortality is very, very low,” Dr. Mahendra said.
Cayman’s first chikungunya case was confirmed on June 30 and two new suspected cases are currently being investigated.
Dr. Mahendra said that despite mortality rates being low, the virus can affect a person’s lifestyle, and can be crippling to children, patients over 60, and people with compromised immune systems.
“The long-term morbidity of crippling arthritis is very high, that’s why it’s going to affect the lifestyle of a person,” he said.
“Some patients who have severe compromised immunity, children, elderly people, pregnant women, people with malignancies and HIV, these are the people who have serious complications in the incidence of a [mosquito] bite,” he said.
Dr. Mahendra, who specializes in internal and critical care medicine, warned that the virus can be fatal in three instances – if it causes viral myocarditis, which is a disease of the heart muscle, inflammation of the brain, or hemorrhagic disease, which causes a patient to lose blood platelets.
But he said it was only likely to be fatal with patients who had compromised immune systems and that people with a good immune system could fight the virus off in a week to 10 days, and would be unlikely to have long-term health problems.
How it spreads
Both dengue and chikungunya are transmitted by Aedes aegypti mosquitoes and cannot be passed directly from human to human. The Aedes aegypti mosquito can be recognized by white markings on legs and the thorax.
According to Dr. Mahendra, who previously worked at the Narayana Hospital in Bangalore, India, the virus belongs to a subgroup of Flavivirus family, which includes the West Nile virus, dengue virus, tick-born virus, yellow fever virus and others.
He said it is spread through the salivary gland of a mosquito.
“Once a mosquito bites a human being – there is a chikungunya cycle which happens where the mosquito will start replicating the virus in its salivary gland, and the cycle takes around three to four days to complete while the virus rests, so when it goes to bite a human being, it will inject the virus through the salivary glands,” he said.
Dr. Mahendra also warned that the infectivity rate of the virus is high.
“A single infected mosquito has the infectivity rate of about 60 percent,” said Dr. Mahendra. “So that’s the reason why you need to use preventative methods to kill the mosquitoes as soon as possible,” he said.
“Travelers who come on cruise ships to Cayman Islands may even be a potential candidates who spread this virus because there are so many other islands that have declared the virus an epidemic,” he added.
Dr. Mahendra said there were two options to stop the virus from spreading, the first was to kill the mosquito nesting sites and the second was to protect from bites.
“Use proper clothing techniques to cover all exposed areas during the daytime, because if a mosquito bites a traveler who’s been infected with chikungunya and the same mosquito bites any human being on the island that could be one of the major modes to spread this virus,” said Dr. Mahendra.
He said people should apply mosquito repellent starting from the morning and not just at night.
“Remember that once you apply the repellent in the morning time, usually it will cover you for two to three hours, then later you need to reapply,” said Dr. Mahendra.
“People think it’s only the night time that mosquitoes bite and [there’s a chance to] get infected, but it is mostly in the daytime,” he added.
He also warned that special precautions should be taken for young children.
“Children and infants are best isolated from mosquito biting areas. Prevent mosquito bites by using mosquito nets in homes and also whenever children go out in strollers,” he said.
There is currently no cure or vaccine for chikungunya. If a patient is diagnosed, Dr. Mahendra said treatment options were similar to that of the common flu.
“Once infected, patients should get proper hydration by drinking lots of liquids, avoid dehydration, go to their primary care physician, and get treated by analgesics and anti-inflammatory drugs, similar to treating the common flu.”
Chikungunya symptoms are fever, joint pains, muscle pain, headache, nausea, fatigue and rash.
This disease was first reported in the Caribbean region in December 2013 and since then 25 Caribbean countries have reported 4,970 confirmed chikungunya cases.