View source for 2013–2014 chikungunya outbreak

{{Short description|Disease outbreak in the Americas}}
{{use mdy dates|date=May 2014}}
{{Infobox event
| title           = 2013–2014 Chikungunya Outbreak
| image           = 
| image_size      = 
| caption         = 
| date            = {{start date|2013|12}}
| place           = {{Collapsible list
| expand          = 
| framestyle      = 
| titlestyle      = 
| title           = Caribbean
| liststyle       = 
| hlist           = 
| bullets         = 
| <!-- 1          = -->     {{flag|Anguilla}}
| <!-- 2          = -->    {{flag|Antigua and Barbuda}}
| <!-- 3          = -->     {{flag|Aruba}}
| <!-- etc        = -->    {{flag|Bahamas}}
| <!-- etc        = -->    {{flag|Barbados}}
| <!-- etc        = -->    {{flag|British Virgin Islands}}
| <!-- etc        = -->    {{flag|Cayman Islands}}
| <!-- etc        = -->    {{flag|Curaçao}}
| <!-- etc        = -->    {{flag|Dominica}}
| <!-- etc        = -->    {{flag|Dominican Republic}}
| <!-- etc        = -->    {{flag|French Guiana}}
| <!-- etc        = -->    {{flag|Grenada}}
| <!-- etc        = -->    {{flag|Guadeloupe}}
| <!-- etc        = -->    {{flag|Guyana}}
| <!-- etc        = -->    {{flag|Haiti}}
| <!-- etc        = -->    {{flag|Jamaica}}
| <!-- etc        = -->    {{flag|Martinique}}
| <!-- etc        = -->    {{flag|Montserrat}}
| <!-- etc        = -->    {{flag|Puerto Rico}}
| <!-- etc        = -->    {{flag|Saint Barthélemy}}
| <!-- etc        = -->    {{flag|Saint Kitts and Nevis}}
| <!-- etc        = -->    {{flag|Saint Lucia}}
| <!-- etc        = -->    {{flag|Saint Martin}}
| <!-- etc        = -->    {{flag|Saint Vincent and the Grenadines}}
| <!-- etc        = -->    {{flag|Sint Maarten}}
| <!-- etc        = -->    {{flag|Surinam}}
| <!-- etc        = -->    {{flag|Trinidad and Tobago}}
| <!-- etc        = -->    {{flag|Turks and Caicos Islands}}
| <!-- etc        = -->    {{flag|United States Virgin Islands}}
}}
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'''North America''' <br>{{flag|Mexico}} <br>{{flag|United States}} <small>([[Florida]])</small><br />
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'''Central America'''
<br>{{flag|Belize}} <br>{{flag|Costa Rica}} <br>{{flag|El Salvador}} <br>{{flag|Guatemala}} <br>{{flag|Honduras|1949}} <br>{{flag|Nicaragua}} <br>{{flag|Panama}}
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'''South America''' <br>{{flag|Brazil}} <br>{{flag|Colombia}} <br>{{flag|Ecuador}} <br>{{flag|Paraguay}} <br>{{flag|Venezuela}}
| reported deaths = 183
|notes            = Reference: [[Pan American Health Organization|PAHO]] (February 6, 2015)<ref>{{cite web|url=http://www.paho.org/hq/index.php?option=com_topics&view=article&id=343&Itemid=40931&lang=es |title=Número de casos informados de artritis epidémica chikungunya en las Américas - SE 5 (February 6, 2015) |publisher=Pan American Health Organization|access-date=February 11, 2015}}</ref>
}}

The '''2013–2014 chikungunya outbreak''' represented the first recorded [[Chikungunya outbreaks|outbreak of the disease]] outside of tropical Africa and Asia.  In December 2013, the first locally transmitted case of [[chikungunya]] in the Americas was detected in [[Saint Martin (island)|Saint Martin]]. Shortly after the first case the disease began to spread rapidly throughout the Caribbean region.  By the end of the year, it had spread to [[Martinique]] and [[Guadeloupe]], with suspected cases in [[Saint Barthélemy]].  By the end of January 2014, cases had been confirmed in Saint Barthélemy, as well as the [[British Virgin Islands]], [[Dominica]], and [[French Guiana]].  On the basis of 4,000 confirmed cases and over 30,000 suspected cases, the [[Caribbean Public Health Agency]] (CARPHA) declared a Caribbean-wide epidemic of the virus in early May.  By the end of May, four cases of chikungunya had been confirmed in Florida.  By July 2014 there were an estimated 355,000 cases in the Caribbean.<ref>{{cite web|url=http://www.cidrap.umn.edu/news-perspective/2014/07/chikungunya-outbreak-exceeds-355000-cases|title=Chikungunya outbreak exceeds 355,000 cases|publisher=[[Center for Infectious Disease Research and Policy]] ([[University of Minnesota]])|date=14 July 2014}}</ref>  By August 2014, 25 Caribbean countries had confirmed at least one case.<ref>{{cite web|url=http://wwwnc.cdc.gov/travel/notices/watch/chikungunya-caribbean|title=Chikungunya in the Caribbean|publisher=Centre for Disease Control and Prevention|access-date=8 October 2014}}</ref> The epidemic was over by 2015.

==Background==
{{main|Chikungunya}}
Chikungunya is an [[arbovirus]] common to tropical regions of Africa and Asia. It is spread to humans by ''[[Aedes]]'' mosquitoes (primarily ''[[Aedes aegypti]]'') that breed in stagnant water.<ref name=AP />  The virus was first isolated in 1953, and likely first arose during the 1700s.<ref name=APfirst /><ref name=Cherian2009>{{cite journal |vauthors=Cherian SS, Walimbe AM, Jadhav SM |title=Evolutionary rates and timescale comparison of Chikungunya viruses inferred from the whole genome/E1 gene with special reference to the 2005–07 outbreak in the Indian subcontinent |journal=Infect. Genet. Evol. |volume=9 |issue=1 |pages=16–23 |date=January 2009 |pmid=18940268 |doi=10.1016/j.meegid.2008.09.004|display-authors=etal}}</ref>

Chikungunya is characterized by a sudden high fever and intense joint pain, between four and seven days after infection.<ref name=AP /><ref name=Antigua />   It can also cause headaches, muscle pain, fatigue, and rashes.<ref>{{cite news|title=Chikungunya spreading to other countries in the Caribbean|url=http://www.upi.com/Health_News/2014/05/02/Chikungunya-spreading-to-other-countries-in-the-Caribbean/4561399051386/|date=May 2, 2014|agency=UPI|access-date=May 2, 2014}}</ref> Most infected patients recover within 10 days, and deaths are rare.  However, in some cases joint pain can linger for months or years. There is no [[vaccine]] or treatment for chikungunya and preventing its spread is difficult.<ref name=AP />  Outbreaks are primarily dealt with through preventive measures, such as wearing long-sleeved clothing, and [[Vector (epidemiology)|vector]] population control.<ref name=CIDRAP />

==First cases==
In early December 2013, health officials confirmed two cases of locally transmitted chikungunya on the French half of [[Saint Martin (island)|Saint Martin]].  It was announced to the public on December 17, by which time 10 cases had been confirmed and many more suspected cases were undergoing lab tests.  Vice President [[Guillaume Arnell]] declared that his country had an "obligation" to prevent the disease from spreading.  "It started here so we have to contain it here", he said.<ref name=APfirst>{{cite news|title=Mosquito virus spreads to Caribbean |work=Caribbean Business |agency=AP |date=December 17, 2014 |url=http://www.caribbeanbusinesspr.com/news/mosquito-virus-spreads-to-caribbean-92039.html |access-date=May 3, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20131221214825/http://www.caribbeanbusinesspr.com/news/mosquito-virus-spreads-to-caribbean-92039.html |archive-date=December 21, 2013 |df=mdy }}</ref>  Swift action was taken, and a [[Pan American Health Organization]] representative said she was satisfied by the response.<ref name=APfirst />  Even so, there were 66 confirmed cases by the end of the month, including at least one case on the Dutch half of the island, and more than 180 suspected cases.  The virus had also spread to [[Martinique]] (3 cases) and [[Guadeloupe]] (1 case) by the end of the year. In [[Saint Barthélemy]], there were 21 suspected cases.<ref name=CIDRAP>{{cite news|title=Caribbean chikungunya outbreak grows, poses threat to US|publisher=CIDRAP|author=Lisa Schnirring|date=December 30, 2013|url=http://www.cidrap.umn.edu/news-perspective/2013/12/caribbean-chikungunya-outbreak-grows-poses-threat-us|access-date=May 2, 2014}}</ref>

Previously, chikungunya had not been found in the Americas.<ref name=AP />  Although it had never previously been found, it was considered an emerging threat and preparations for its spread were underway by 2012.  In July 2013, a Caribbean-wide virtual meeting was held to educate high-ranking medical personnel on how to detect the virus.<ref name=Jamaica>{{cite news|title=Chikungunya now an epidemic in the Caribbean|date=May 1, 2014|work=Jamaica Observer|url=http://www.jamaicaobserver.com/latestnews/Chikungunya-now-an-epidemic-in-the-Caribbean|access-date=May 2, 2014|archive-url=https://web.archive.org/web/20140503071055/http://www.jamaicaobserver.com/latestnews/Chikungunya-now-an-epidemic-in-the-Caribbean|archive-date=May 3, 2014|url-status=dead|df=mdy-all}}</ref>  It is unclear how the virus first spread to the Americas' mosquito population.<ref name=APfirst />

==Spread of the chikungunya virus==
By January 21, 2014, cases had been St. Barthelemy and the [[British Virgin Islands]].  [[Dominica]] and [[French Guiana]] both had one reported case due to travel in the affected islands.<ref>{{cite news |url= http://www.cbc.ca/news/health/mosquito-borne-chikungunya-virus-infects-people-on-5-caribbean-islands-1.2504922 |title= Mosquito-borne chikungunya virus infects people on 5 Caribbean islands |publisher= [[Canadian Broadcasting Corporation]] |date=January 21, 2014 |access-date= May 2, 2014}}</ref>  At the start of April, chikungunya was confirmed in the [[Dominican Republic]].<ref>{{cite news|url= http://www.diariolibre.com/noticias/2014/04/04/i555291_pruebas-laboratorio-confirman-virus-chikungunya-nigua.html |title= Pruebas de laboratorio confirman virus de Chikungunya en Nigua |work= Diario Libr|access-date=May 3, 2014|date=April 4, 2014|language=Spanish }}</ref>  On 24 April, [[Saint Vincent and the Grenadines]] announced the island had three confirmed cases of chikungunya and an outbreak was officially declared. Two days later, [[Antigua and Barbuda]] announced its first confirmed case, on the island of Antigua.  Four other cases were suspected.<ref name=Antigua>{{cite news|url= http://www.caribbean360.com/news/antigua-latest-caribbean-island-to-be-hit-by-chikungunya-disease|title= Antigua latest Caribbean island to be hit by chikungunya disease|work= Caribbean 360|date= April 26, 2014|access-date= May 3, 2014|archive-date= October 24, 2017|archive-url= https://web.archive.org/web/20171024152536/http://www.caribbean360.com/news/antigua-latest-caribbean-island-to-be-hit-by-chikungunya-disease|url-status= dead}}</ref>

At the end of April, there were more than 4,100 probable cases of chikungunya across fourteen different Caribbean countries.<ref name=epidemic />  In addition to thirteen island nations, the virus had been confirmed in French Guiana. Martinique, Guadeloupe, and St. Martin had the most reported cases.<ref name=AP>{{cite news|title=Recently Arrived Chikungunya Virus Gains Foothold In Caribbean|date=May 2, 2014|agency=AP|work=Huffington Post|url=http://www.huffingtonpost.com/2014/05/02/chikungunya-virus-caribbean_n_5256278.html|access-date=May 2, 2014}}</ref>

During the week of April 27, 2014, health officials from multiple agencies met in the Dominican Republic to discuss the outbreak.<ref name=AP />  On May 1, the [[Caribbean Public Health Agency]] (CARPHA) declared a Caribbean-wide [[epidemic]] of the virus.<ref name=Jamaica /><ref name=epidemic>{{cite news|title=Caribbean-wide Chikungunya epidemic declared |date=May 2, 2014 |publisher=Cayman 27 |author=Mona Tatum |author2=Kevin Watler |url=http://www.cayman27.com.ky/2014/05/02/caribbean-wide-chikungunya-epidemic-declared |access-date=May 2, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140503074914/http://www.cayman27.com.ky/2014/05/02/caribbean-wide-chikungunya-epidemic-declared |archive-date=May 3, 2014 |df=mdy }}</ref>  The United States–based [[Centers for Disease Control and Prevention]] said it was "working with state health departments to increase awareness about chikungunya and to facilitate diagnostic testing" in preparation for possible introduction into [[South Florida]].<ref name=AP />

As of May 19, 2014, the Dominican Republic had over 32,000 reported cases of chikungunya, representing 68% of the total cases registered to date.<ref name=DominicanRep.>{{cite news|last=Mejía|first=Odalis|title=Suben a 32,519 los casos chikungunya; 8,000 en semana|url=http://hoy.com.do/suben-a-32519-los-casos-chikungunya-8000-en-semana/|access-date=24 May 2014|newspaper=Hoy|date=20 May 2014|archive-url=https://web.archive.org/web/20140525000418/http://hoy.com.do/suben-a-32519-los-casos-chikungunya-8000-en-semana/|archive-date=May 25, 2014 |language=Spanish|quote=El Ministerio de Salud Pública informó que ascienden a 32,519 los casos de fiebre por chikungunya notificados en todo el país, de los cuales 8,059 se han producido en una sola semana. De estos últimos el 68% se detectó en San Cristóbal.}}</ref>  By the end of May, four cases had been confirmed in Florida.<ref>{{cite news |date=May 22, 2014 |title=Fourth Case Of Mosquito Borne Chikungunya Fever Confirmed In Florida |url=http://miami.cbslocal.com/2014/05/22/fourth-case-of-mosquito-borne-chikungunya-fever-confirmed-in-florida/ |newspaper=CBS Miami |location=[[Miami]] |access-date=November 24, 2014 }}</ref> Over 50,000 people were suspected to have contracted the virus in total.<ref name=CUM>{{cite web|title=Salud revela que hay 32,519 casos de chikungunya|url=http://clinicaunionmedica.com/noticia/ver_noticia/277|publisher=Clínica Unión Médica|access-date=29 May 2014|location=Santiago de los Caballeros|language=Spanish|date=26 May 2014|quote=Con 32,519 casos, República Dominicana acumula el 68% del registro de chikungunya en 16 países del Caribe, región donde se han contabilizado 51,139 casos y 14 muertes.|archive-url=https://web.archive.org/web/20140531153221/http://clinicaunionmedica.com/noticia/ver_noticia/277|archive-date=May 31, 2014|url-status=dead}}</ref>

As of late September 2014, Health Minister Nancy Pérez of [[Venezuela]] stated that only 400 Venezuelans were infected with chikungunya<ref name=ELPAIS2014>{{cite news|title=Venezuela's Maduro denounces "psychological war" waged by opposition|url=http://elpais.com/elpais/2014/09/19/inenglish/1411136258_789165.html|access-date=24 September 2014|agency=El Pais|date=19 September 2014}}</ref> while the [[Central University of Venezuela]] stated that there could be between 65,000 and 117,000 Venezuelans infected.<ref name=ScienceCHIK>{{cite news|last1=Wade|first1=Lizzie|title=In Venezuela, doctor flees after being accused of terrorism amid fever outbreak|url=https://www.science.org/content/article/venezuela-doctor-flees-after-being-accused-terrorism-amid-fever-outbreak|access-date=28 September 2014|agency=Science|date=23 September 2014}}</ref> The Venezuelan government has announced a three-stage plan to counter the outbreak, with Health Minister Pérez stating that the key function is to eliminate areas of mosquito breeding.<ref>{{cite news|title=Venezuelan gov't launches plan against dengue, chikungunya|url=http://www.eluniversal.com/nacional-y-politica/140929/venezuelan-govt-launches-plan-against-dengue-chikungunya|access-date=3 October 2014|agency=El Universal|date=29 September 2014}}</ref>

By November 2014 most of the Caribbean Islands were affected and the Pan-American Health Organization reported about 800,000 suspected cases alone in the Caribbean.<ref>{{cite web |url=http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&Itemid=270&gid=28239&lang=en |title=Number of Reported Cases of Chikungunya Fever in the Americas, by Country or Territory 2013/2014 (to week noted) |author=<!--Staff writer(s); no by-line.--> |date=November 14, 2014 | format= PDF (348 KB)|website=paho.org |publisher=[[Pan American Health Organization]] |access-date=November 24, 2014}}</ref>

==References==
{{reflist|30em}}

{{Epidemics}}

{{DEFAULTSORT:2013-2014 Chikungunya Outbreak}}
[[Category:2013 disease outbreaks]]
[[Category:2014 disease outbreaks]]
[[Category:2013 in the Caribbean]]
[[Category:2014 in the Caribbean]]
[[Category:Health disasters in North America]]
[[Category:Chikungunya]]
[[Category:Health disasters in the Caribbean]]