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Briefing Statement 
 
Bureau: 
National Park Service 
Issue:  
Update—Chikungunya outbreak in the Caribbean and South America 
Park Sites: BUIS, CHRI, SAJU, SARI, VICR, VIIS 
Date:  
June 16, 2014 
 
Background: In December 2013, the first locally-acquired cases of chikungunya fever 
in the Americas occurred among residents of Saint Martin (French side). Since 
December, chikungunya virus (CHIKV)—a virus transmitted by mosquitoes—has 
spread to 18 other nations/territories in the Caribbean and South America where over 
170,000 suspected and confirmed cases have been reported (as of June 13). 
 
Puerto Rico and the U.S. Virgin Islands both confirmed their first locally-acquired cases 
of chikungunya fever in late May and early June, respectively. In the continental U.S., 
no locally-acquired cases have been reported, but several states have reported cases 
among travelers to the Caribbean. 
 
Symptoms of chikungunya fever include high fever, headache, and severe joint pain; 
the disease is rarely fatal. As a vaccine is not available, the best strategy is to prevent 
mosquito bites. Park managers should educate employees and visitors about 
chikungunya fever and support/implement appropriate prevention measures. 
 
Current Status: 
• For up-to-date information on CHIKV and the outbreak in the Americas: 
o U.S. Centers for Disease Control and Prevention (CDC) 

 http://www.cdc.gov/chikungunya/ 
o Pan American Health Organization (PAHO)  

 http://www.paho.org/hq/index.php?lang=en 
o Caribbean Public Health Agency (CARPHA) 

 http://carpha.org/ 
• Basic facts about chikungunya 
o Viral disease transmitted to people by infected mosquitoes (Aedes species), 
which bite mainly during the day and can also transmit dengue virus 
o Chikungunya virus (CHIKV) first described in 1952 in Tanzania 
o Besides the Americas outbreak, large outbreaks have occurred since 2006 in 
Kenya, India, Indonesia, Thailand, and other Asian and African countries 
• Signs and symptoms 
o Symptoms usually begin 3-7 days (range: 1-12 days) after being bitten by an 
infected mosquito 

 Up to 25% of people infected with CHIKV do not have any symptoms 
o The most common symptoms are high fever (≥102°F) and severe joint pain 

 Joint pain is usually symmetric and occurs often in hands and feet 

 In Makonde (African language), chikungunya means “that which 
bends”, referring to stooped appearance of patients in severe pain 
 
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o Other symptoms include headache, muscle pain, rash, joint swelling, 
conjunctivitis, and nausea/vomiting 
• Treatment 
o There is no specific treatment or vaccine for CHIKV 
o Medicines (avoid aspirin) can help relieve fever and joint pain 
o A person who has recovered from chikungunya is likely immune against 
repeat infections 
• Risk for complications 
o Most patients feel better within a week, although joint pain and other chronic 
symptoms (e.g. fatigue, depression) may persist for months to years 
o People at increased risk for severe disease include: 

 Newborns exposed during delivery 

 Older adults ≥65 years 

 People with chronic medical conditions, such as diabetes, high blood 
pressure, and heart disease 
o Deaths are rare and occur mostly in older adults 
• Prevention measures 
o Wear long-sleeved shirts and long pants 
o Use repellents containing 30% or less DEET or 19% picaridin on exposed 
skin (http://www.cdc.gov/westnile/faq/repellent.html) 
o Wear permethrin-treated clothing, especially socks and pants  

 DO NOT treat skin with permethrin 
o Use bed nets, window/door screens, and indoor ceiling fans 
o Empty standing water from outdoor containers (e.g. flowerpots, tires, tarps) 
o Avoid outdoor activity at dawn and dusk (peak biting time) 
o Anyone who thinks they might have chikungunya should see a healthcare 
provider and remain under a mosquito bed net for duration of fever to reduce 
potential for infecting other mosquitoes 
o People at increased risk for severe disease should consider not traveling to 
areas with ongoing chikungunya outbreaks 
• Implications and actions for NPS managers 
o Review prevention measures with employees, concessioners, and volunteers, 
and post alerts on websites and in visitor centers 

 http://www.cdc.gov/chikungunya/pdfs/CHIKV_FACT%20SHEET_CDC
_General%20Public_cleared.pdf 
o Encourage inclusion of mosquito prevention measures in job hazard analyses 
o Document locations of and eliminate (in accordance with NPS policies) 
manmade mosquito habitat around human-occupied areas  
o Prioritize and track maintenance work orders (e.g. installing/fixing screens) 
o Contact your park/regional IPM coordinator for additional information on 
managing mosquitoes in human-occupied areas 
o If/when cases are identified at your park, consult with IPM, Office of Public 
Health, and Risk Management 
 
Contact:  CDR David Wong, MD, Chief, Epidemiology Branch, NPS Office of Public 
Health, (202) 538-9969, david_wong@nps.gov