Once bitten: Chikungunya in the Caribbean

It was the Caribbean’s big public health crisis of 2014: a rapidly spreading outbreak of mosquito-borne chikungunya. Nazma Muller investigates how governments have responded, and suggests how visitors to the Caribbean can avoid the dreaded pains and rashes of CHIK-V

Once bittenThe feared chikungunya virus, in extreme closeup. molekuul.be/shutterstock.com

One Panadol, one Panadol! One Panadol, one Panadol! The catchy hook line is the latest “lick” in Jamaica, where up-and-coming dancehall artiste Wayne J has scored a hit with his “Chikungunya” song. “Mosquito one, Mosquito two / Mosquito jump inna hot callaloo / Mosquito bite me, Mosquito bite you / Mek me tell yuh what a mosquito can do . . .” [Click here to view the video]

It is just one of a rash of songs that has popped up since the itchy mosquito-borne disease first hit the Caribbean, in St Martin in December 2013. Over the last year, the virus — which induces a rash all over the body, headaches, fever, and crippling joint pain — has become so talked-about across the region, even The Doctor himself, Beenie Man, produced a humorous masterpiece alongside veteran mento musicians The Astronauts, which has an “infectious” tune and “biting” lyrics: “We face flu, polo, pink eye, chicken pox, we thank God fi nuh send Ebola / We face mumps, measles and cancer / The AIDS question still nuh have no answer / Ah biological war dem a start pon we / Dem send a mosquito weh a backbiter!” [Click here to view the video]

In response, The Astronauts sing: “Mi nuh fraida nuh human being, or how much gunman inna yu scheme / You could have a dozen M-16 / Mi only fraida chikungunya / Mi no care you a which bad man / Neither which garrison you come from / You coulda spar wid a million don / Mi only fraida chicken gunman!”

While Jamaicans are sometimes accused of making a song and dance about everything, it’s testimony to their enduring sense of humour that they can joke and dance (of course there’s a dance — in fact, there’s a slew of them, all involving “chicken” moves) about this headache of a disease that has been crippling the Caribbean, in more ways than one. In addition to the symptoms of intense joint pain, chikungunya’s trademark symptom is a spine-twisting, toe-curling arthritis that can linger on for months. (The name of the virus is thought to come from a word in the Makonde language of Tanzania which means “that which bends up.”)

All jokes aside, though, the songs and dances are an effective way of educating the public about the symptoms and causes of “the gunya,” as it’s been dubbed in Jamaica, where thousands have been infected. Torrential rains across the Caribbean have caused the rate of infection to be high, and public health systems across the region have been sorely tested to combat the “chicken gun men.”

 

Chikungunya was first reported in southern Tanzania in 1952, according to the World Health Organisation. The chikungunya virus is carried by two types of mosquitoes, the yellow fever mosquito (Aedes aegypti) and the Asian tiger mosquito. So far, the virus strain circulating in the Americas is primarily spread by the former.

So for public health authorities, the first line of attack was to destroy all breeding sites for the mosquitoes, which bite during the day and need only a few drops of stagnant water in which to lay their eggs. Late last year, Caricom leaders met and agreed on a plan to tackle “CHIK-V”, which saw the WHO and the Pan-American Health Organisation Organisation facilitating bulk purchase of essential public health supplies, such as bed nets, insecticides, and repellent; and widespread campaigns to educate citizens and stakeholders in the tourism industry, with the media and local government bodies playing key roles in delivering the message about the need for all citizens to be part of the fight. The regional heads of government also acknowledged the need to strengthen their vector-control response capacities.

Public health agencies across the region have been on all-out education campaigns to sensitise their populations about the need to get rid of mosquito-breeding sites. In Trinidad and Tobago, the Minister of Health took the unprecedented step of writing a letter about the virus that was posted to households across the country. The Chikungunya Bus Tour — which featured a bus painted with the words “Don’t get bite! You can help tackle CHIK-V and Dengue!” — distributed fliers, mosquito nets, and “zappers” across the country.

In Jamaica, the parish council in Trelawny — perhaps best known as the birthplace of Usain Bolt — issued tough warnings to litterbugs about the hazards posed by discarded tyres, cups, and containers, all perfect breeding grounds for mosquitoes, and threatened to fine persistent offenders. Jamaica’s Chief Medical Officer urged every single Jamaican to search for and destroy mosquito breeding sites in and around their homes, workplaces, and communities by getting rid of old tyres and containers in which water can settle, punching holes in tins before disposing of them, and covering large drums, barrels, and tanks holding water.

“While the Government must lead the process, citizens have a major role to play in the reduction of the spread of this disease,” Jamaica’s health minister said. “It is therefore important for all of us to ensure that we are not harbouring this mosquito in our homes. Personal responsibility is going to be of utmost importance in the reduction of the spread of this disease.” He appealed to Jamaicans to take ten minutes each week to look around their environs and ensure there is no uncovered container with water that could breed mosquitoes. “Check your flower-pot saucers, your dish drainboards, your refrigerator troughs, plants, pet feeding bowls. Scrub them clean,” the minister urged.

Meanwhile, the Caribbean Public Health Agency has issued guidelines for cruise ships, hotels, and guesthouses, and for visitors to the region. Cruise lines are asked to provide passengers and crew with prepared materials on CHIK-V so they are aware of the signs and symptoms, how it is transmitted, and how it can be prevented — and urged to sell insect repellent on board cruise ships.

Hotel and guesthouse managers have been asked to keep premises free of standing water, install mosquito screening on windows and doors, supply guests with bed nets in areas where the sleeping quarters are exposed to the outdoors, and place insect repellents in every room — or have them available for purchase on the property.

The “good” news? Once you’ve had “the gunya,” you never get it again. Infected persons appear to have lifelong immunity to the particular strain of the virus (though some symptons can linger for months, in extreme cases even years.) So walk with your citronella oil or your DEET, and everything should be all right.

The best way to protect against chikungunya is to avoid being bitten by an infected mosquito:

• Use insect repellents on exposed skin. Insect repellents that contain DEET, Picaridin (also known as icaridin), oil of lemon eucalyptus (OLE), or IR3535 are the most effective and safe when used according to the label. If also using sunscreen, apply sunscreen first, then the repellent.

• Where possible, wear light-coloured long-sleeved shirts and long trousers, socks, and shoes.

• When indoors, use air conditioning and keep the doors and windows closed, unless they are screened, to keep out mosquitoes. If this is not possible, sleep under a mosquito net.