by Dr. Edward R. Rosick
image via nbcnews.com
The mass exodus of the wintertime population of the midwest is in full swing as I write this article. People are flocking to parts south to avoid the snow, cold and gloom that inevitably infects our part of the nation this time of year as well as to frolic and have fun in the sun and sands of Florida and the Caribbean islands. In days past, the only thing these lucky travelers would have to worry about was if they brought enough sunscreen or the headaches from drinking too much local rum. But unfortunately, there’s a new threat to both their fun and health, and it comes with a strange name: Chikungunya.
What is Chikungunya?
Chikungunya is a alphavirus that was first discovered in the 1950s after residents in Tanzania began reporting an acute disease consisting of high fevers and debilitating joint pain. It was discovered that Chikungunya was transmitted by the bite of infected mosquitos and could rapidly infect entire villages. The virus quickly spread throughout Africa and Asia during the ensuing decades, yet was largely absent in the Americas; for instance, from 2006-2013 an average of 28 people a year in the U.S. tested positive for Chikungunya, and all these were after the affected people traveled to areas of the world where the virus was present.
Recent Cases of Chikungunya
Unfortunately, all this has changed, and not for the better. The Centers for Disease Control (CDC) has recently stated that 2,344 cases of chikungunya were diagnosed in U.S. citizens in 2014, with the vast majority of those having been infected in the Caribbean islands.(1) Even more frightening is the face that since May of 2014, the U.S. territory of Puerto Rico has had approximately 27 thousand cases of the disease.(2) The chikungunya virus is now here, and there’s no reason to think that it’s going to be going away in the near future.
“Aren’t you blowing this out of proportion, Dr. Rosick?” some of you may be saying. “Fevers and joint pain–chikungunya sounds just like a case of the common flu.” While both influenza and chikungunya are viruses and both cause fevers and body aches, that’s where the comparisons end. While both diseases have the hallmark of high fevers, the joint pain experienced by most people infected with chikungunya is very severe and debilitating, causing those infected to literally ‘bend’ like twigs due to the intense pain. What’s even more frightening is that while the signs and symptoms of influenza usually resolve in a matter of days to weeks, the intense join pain of chikungunya can last for weeks to months to longer.
Persons at Risk
According to the CDC, persons at risk for severe disease after being infected with chikungunya include “…older adults (e.g.,>65 years), and persons with underlying medical conditions (e.g., hypertension, diabetes, or cardiovascular diseases). Some patients might have relapse of rheumatologic symptoms (e.g., polyarthralgia, polyarthritis, tensynovitis) in the months following the acute illness.”(3) So no, chikungunya is not the flu, and for the millions of Americans that travel to the Caribbean each winter, it certainly is a new and serious disease.
Of course, as a physician and scientist, one of the first words in my mind when reading about any symptoms caused by new diseases such as chikungunya is “why;” that is, why does chikungunya cause long-term debilitating joint pain and illness when other viruses, like influenza, last for only days or weeks. The answer to this question is still being examined, but it appears that chikungunya may cause unrelenting joint pain by the way it tricks the human immune system–especially the type mediated by a specialized cell known as T-cells–into essentially allowing the chikungunya virus to remain alive and active.(4) In addition, it’s been shown that the chikungunya virus also disrupted the natural inflammatory responses of the human body which also may lead to the chronic joint pain seen in people who have been infected.(5)
So does all this bad news mean I’m telling my patients to avoid traveling to anywhere south of the Mason-Dixon line and rather, learn to endure our brutal midwestern winters? The answer is absolutely not! With some planning and wise choices, traveling to parts south in the winter can still mean days of sun and fun rather then sickness and disease.
Staying Safe from Chikungunya
One of the first things I counsel my patients is to get on the CDC website and see where chikungunya is most prevalent in those countries where it has gained a foothold and if possible, avoid those areas. Second, traveling to any country where chikungunya or any other misquito-borne illness is prevent means investing in and using a high quality mosquito repellent all the while you’re in that country. Finally, taking probiotics–the good bacteria found in yogurt and kefir and now showing up in study after study as being vital in maintaining optimal health–can go a long way to keep you healthy and happy and may potentially help you avoid getting nasty diseases such as chikungunya.
A just published article in the journal Beneficial Microbes discussed a double blind, placebo-controlled clinical study showing that probiotics can definitely enhance the immune system in those aged 50-70 years of age.(6) Another recent article in the journal Probiotics and Health highlighted a study of a probiotic formulation on the immune system in mice (7). Researchers conclusively showed that mice given a supplement known as Del-Immune V that contains active parts of the probiotic Lactobacillus rhamnosus V had a statistically significant increase in blood levels of chemicals known as cytokines, which are known to be part of the immune system when compared to mice that were not given the probiotic formulation. Studies also show that probiotics can also modulate the inflammatory response (8), which potentially may help with the chronic inflammation seen in patients with chikungunya.
So when you’re getting ready to leave the snow and cold to parts south, remember to take your sunscreen, insect repellent, and probiotics supplements to give you the best chance of having fun and staying healthy.
1. Chikungunya virus in the United States. Centers for Disease Control and Prevention. http://www.cdc.gov/chikungunya/geo/united-states.html
2. Puerto Rico hit by 27,000 chikungunya cases since May. http://foxnews.com/latino/health/2015/02/06
3. Clinical evaluation and disease. Center for Disease Control and Prevention. http://cdc.gov/chikungunya/hc/clinicalevaluation.html
4. Poo YS, Rudd PA, Gardner J et al. Multiple immune factors are involved in controlling acute and chronic chikungunya virus infection. Neg Trop Disease 20014; 8(12): 1-15.
5. Hawman DW, Stoermer KA, Montgomery SA et al. Chronic joint disease caused by persistent chikungunya virus infection is controlled by adaptive immune response. Jour Virology 2013; 87(24): 13878-888.
6.Miyazawa K, Kawase M, Kubota A et al. Heat-killed Lactobacillus gasseri can enhance immunity in the elderly in a double blind, placebo-controlled clinical study. Benefi Micro 2015; 4: 1-9.
7. GSichel L, Timoshok NA, Pidgorskyy VS, Spivak NY. Study of interferonogenous activity of the new probiotic formulation Del-Immune V. Probiotics and Health 2013; 1(2): 1-6.
8. Vilahur G, Lopez-Bernal S, Camino S et al. Lactobacillus plantarum CECT 7315/7316 intake modulates the acute and chronic innate inflammatory response. Eur Jour Nutri 2014; Nov 19 Epub.