What the Chikunguynya Virus Means for Cuba

What the Chikunguynya Virus Means for Cuba
May 11, 2014
Graham Sowa

HAVANA TIMES — After months of hopping from one Caribbean island to the
next the Chikunguynya virus has arrived within 50km of Cuban shores.
With confirmed cases in neighboring Haiti this disease has implications
for the Cuban public health system, vector control campaign, and tourist
industry.

The Chikunguynya virus is spread by the Aedes aegypti mosquito. This is
the same vector that spreads the Dengue virus, endemic to Cuba, as well
as Yellow Fever, which has been eradicated from the island.

A day or so after being bitten the victim develops fever and joint pain
which can also include headache, rash, muscle pain and/or joint
swelling. While rarely fatal, the symptoms are significant enough to
ruin a 7 day Caribbean vacation or lose a week or more of work.
The clinical presentation and course of the disease are so similar to
Dengue it is only possible to distinguish the two by using expensive
laboratory tests such as viral isolation or polymerase chain reaction.

As a medical student in Havana´s epidemiological reference hospital,
Hospital Salvador Allende, I've seen my share of Dengue…plus some.

A few weeks ago we were introduced to Chikunguynya via a presentation at
the Cerro Pediatric Hospital where I am currently rotating. An
epidemiologist told us that we need to consider the virus on our
differential diagnosis for suspected Dengue cases. Up to now there have
been no confirmed cases of Chikunguynya originating from Cuba.

When Chikunguynya does show up the Ministry of Public Health is probably
preparing for more hospital admits for acute fever.

Current policy dictates that all patients with suspected Dengue cases
are admitted to the hospital until they complete serological studies on
the 7th day of the clinical illness. Because the presentation of
Chikunguynya is so similar to Dengue that hospitals, especially urban
ones, will have to contend with increased patient loads. Further
complicating the situation is that there is no immunity to the
Chikunguynya amongst the Cuban population, which means everyone has a
theoretical chance to become infected.

Of course Cuba´s anti-vector campaign against the Aedes aegypti will
continue to try to prevent disease spread and the related stress on the
public health system.

As a first hand participant in the anti-vectoral campaign I have mixed
feelings about how the campaign is run on the ground. It seems that
every year no matter how many times we go out into neighborhoods and do
public education, or knock on doors asking people if they have fever, or
get chased out of houses, businesses, or even clinic rooms by the
fumigation squad, Dengue still fills up our hospital.

I anticipate we will be expected to double our efforts once Chikunguynya
makes its presence known. However, short of major upgrades to Havana´s
infrastructure to do away with standing water and increased quality of
housing I don't think eradication of Aedes is likely. And as long is
Aedes is around so is Dengue, with Chikunguynya soon to be added.

Waiting for the arrival of Chikunguynya right along with the health
service is the tourist sector.

Cuba counts on at least 2 billion dollars a year from tourism to keep up
its barely positive economic growth. After the cholera scare last year
Cuban tourism has proven to be pretty resilient to new health concerns.
However any new disease, and subsequent travel alerts issued by other
countries or the World Health Organization, will have a negative impact
on the tourist industry.

At least Cuba won't be alone in the suffering, as the entire Carribean
region, and eventually all parts continental America were Aedes flies,
will become host to Chikunguynya. Hopefully the emergence of the disease
in the Western world will spur research towards a vaccine, or at the
very least invite more regional cooperation on public health.

Source: "What the Chikunguynya Virus Means for Cuba - Havana Times.org"
- http://www.havanatimes.org/?p=103561