Chikungunya Goes Italian

Relatives, Oscar Wilde said, are people who don’t know how to live or when to die. Furthermore, when they visit, they can bring not only tedium but also sometimes disease, as several inhabitants of the province of Ravenna in northeast Italy discovered. A visiting relation from India became feverish 2 days after arrival in June 2007; it later developed that he was suffering from chikungunya infection, a viral disease transmitted to humans by Aedes mosquitoes. Italian mosquitoes that bit the Indian man spread the disease: By the end of September, 5% of the inhabitants of the town and 2.5% in a nearby village were infected. Nearly all of the 205 cases involved fever, fatigue, and joint pain. Chikungunya means “walking bent over” in Swahili, referring to the severe arthralgias that can last for months after the other symptoms resolve, usually within a week. Accompanying features of the acute disease include headache, myalgias, and skin findings, which occur in about 50% of patients and consist of (1) a morbilliform eruption, primarily on the thorax, that can be pruritic; (2) facial edema; (3) in children, a bullous rash with pronounced sloughing; or (4) localized petechiae.

Global travel of another sort had made the epidemic possible. In 1990, eggs of A. albopictus, the chikungunya virus vector, arrived in Italy in tires imported from the U.S. The virus itself originated in Kenya, departing there in 2005 and arriving at several islands in the Indian Ocean off the coast of Africa, including Reunion, Mauritius, and the Seychelles, where outbreaks occurred. It reached India in 2006.