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Chikungunya Outbreak in Italy - Question and Answers

24 Sep 2007

Chikungunya is a mosquito borne virus that has spread through East Africa, the Indian Ocean region and South-East Asia. In 2006, following a large outbreak in the Indian Ocean, a group of European public health experts convened by ECDC concluded that there was a potential risk of chikungunya outbreaks happening in Europe, given the presence of mosquitoes capable of carrying the virus in several European countries. At the end of August, Italy notified its EU partners of an outbreak of chikungunya in the district of Ravenna in North-Eastern Italy, which seems to have started after a traveller who had caught chikungunya in India was bitten by local Aedes albopictus mosquitoes (the so called Tiger mosquito).

What is the significance of this first ever outbreak of chikungunya on the European continent?

In 2006 an ECDC expert meeting concluded that transmission of chikungunya by the mosquitoes in Europe was a potential risk. However, there were some uncertainties then about the ability of Aedes albopictus mosquitoes to effectively transmit chikungunya in a European environment. The outbreak in Ravenna district gives us confirmation that mosquito borne outbreaks of chikungunya can happen in Europe. This is of concern, in that the Aedes albopictus mosquito – the vector for the Ravenna outbreak – is present in many parts of Europe.

Is there a risk of chikungunya becoming endemic in parts of Europe, as it has in parts of Africa and Asia?

This is a risk that we need to take seriously. The experience in the French Overseas Department of Réunion, and in affected countries such as India, is that if you have a large outbreak of chikungunya then it becomes very difficult to eradicate the virus from the mosquito population, especially in urban areas. This is why the Italian authorities are taking such active steps to contain the outbreak in Ravenna district.

Where else in Europe could outbreaks of chikungunya happen?

Outbreaks of Chikungunya can occur in areas of Europe where Aedes albopictus mosquitoes or Aedes aegypti mosquitoes are present. Currently, Aedes albopictus presence is documented in most part of Italy, and limited coastal areas of Southern France, Spain, the Netherlands and some areas around the Adriatic Sea, including parts of Greece. The presence of Aedes aegypti mosquitoes has been detected in Madeira Island (one of the Portuguese autonomous regions) two years ago.

In the future, additional areas could be affected by Aedes albopictus mosquitoes as the climatic conditions are favourable for the establishment of the mosquito in most costal areas of the Adriatic, costal areas of the Mediterranean in Greece, France and Italy and large areas of the Atlantic coasts of France, Spain, Portugal, the UK and Ireland.

How dangerous is chikungunya?

Chikungunya is unpleasant, but it is rarely life threatening. Most individuals who catch chikungunya will be ill mainly with fever and joint pain and recover without consequences. Some people develop more chronic forms with persistent joint pains, which may be incapacitating for several weeks, even months. It is only among vulnerable groups such as the elderly and people with chronic medical conditions that chikungunya presents a serious risk.

What is being done to contain the chikungunya outbreak in Ravenna district?

The Italian authorities are actively looking for cases of chikungunya and killing the mosquitoes in the areas around the houses of people infected with the disease. They have undertaken health education in the affected villages to ensure people know how to protect themselves against mosquitoes and eliminate breeding sites for mosquitoes. These efforts seem to be having an impact.

What is the role of the EU in responding to the outbreak in Italy?

The Italian public health authorities are leading the response to the outbreak in Ravenna district. However, they have notified their EU partners about the outbreak as there is a small possibility that citizens from other EU countries who have visited Ravenna district could have been infected with chikungunya.

As mentioned before, the outbreak in Ravenna district is a significant event as it confirms that chikungunya can be spread by mosquitoes in Europe. ECDC, the European Commission and other EU Member States are therefore keen to monitor developments in Ravenna district.

One of the reasons that ECDC was created was to enable Europe’s health expertise and experience to be pooled and utilised to address health threats of common interest. Member States have a common interest in ensuring chikungunya does not become established in any part of European. ECDC is therefore working to put its expertise, and that of disease experts across the EU, at the disposal of Italy. For example, the French authorities have had the experience of handling a major chikungunya outbreak in Réunion in 2005 – 2006. Lessons learned in Réunion could prove important in addressing the outbreak in Ravenna district.

Background on ECDC

The European Centre for Disease Prevention and Control (ECDC) is an EU agency tasked with identifying assessing and communicating threats to human health posed by infectious diseases. It supports the work of public health authorities in the EU and EEA/EFTA Member States.

For further information

Ben Duncan, ECDC Spokesman, tel: +46.708.597833, Email: press@ecdc.europa.eu

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