Q COSTA RICA — Chikungunya resurfaced in Costa Rica in 2016 after nearly a decade without transmission, resulting in 438 cases treated at the Caja Costarricense de Seguro Social (CCSS).
This situation is concerning because the virus has shifted from imported cases to community transmission and could spread further during the rainy season.
According to El Observador, CCSS records include 338 emergency room visits and 100 outpatient visits for illnesses associated with the virus. The Ministry of Health, however, reports 48 PCR-confirmed cases up to epidemiological week 28, covering the period of July 12 to 18, published on August 6.
The difference between the two figures can be explained by the fact that a medical consultation for suspected chikungunya does not always result in a confirmed case, and because the same person may visit the same health center more than once, or different ones.
The first cases appeared in January and were linked to people who contracted the virus outside the country. Later, the presence of the transmitting mosquito allowed the contagion to take hold within communities.
The Director of Health Surveillance, Jennyfer González, explained that the outbreaks began with cases linked to importation, but local transmission was later established because the vector was already present. She also noted that all the cases classified as imported that the Ministry of Health had identified were related to travel to Nicaragua.
The change was rapid: between mid-June and early July, the country went from accumulating 11 cases to detecting significant clusters of local transmission.
One of these clusters was identified in Guanacaste. The first infections emerged in Playa Langosta, and later, health investigations found cases in Huacas, Tamarindo, Sardinal, Belén, and Flamingo. Another cluster appeared in Alajuela. Of the 16 cases that province recorded in July, 13 were linked to an outbreak in El Coyol.
González stated that the circulation of chikungunya had likely begun before authorities officially detected the first outbreaks. “These are people who don’t seek medical attention; we don’t receive notification, the system isn’t alerted, and we don’t find out. We only find out retrospectively when we begin the investigations,” the official said.
What is Chikungunya?
Chikungunya is a mosquito-borne viral disease characterized by the sudden onset of a high fever and severe, often debilitating joint pain. The infection is transmitted to humans through the bites of infected female Aedes aegypti and Aedes albopictus mosquitoes, which are also known vectors for dengue and Zika viruses.
The name “chikungunya” originates from the Makonde language of southern Africa and translates to “that which bends up” or “bent over in pain,” directly referencing the stooped posture assumed by patients suffering from its excruciating joint symptoms.
Key Symptoms
Symptoms typically present 4 to 8 days after an individual is bitten by an infected mosquito. While the clinical presentation is highly similar to Dengue and Zika, the joint pain associated with chikungunya is uniquely intense.
- Sudden High Fever: An abrupt spike in body temperature is usually the initial indicator.Severe
- Joint Pain: Primarily targets the extremities like wrists, ankles, fingers, and knees.Joint
- Swelling: Accompanied by visible inflammation and localized tenderness.
- Physical Weakness: Intense muscle pain, fatigue, and general physical exhaustion.
- Skin Rash: A maculopapular rash frequently appears across the torso and limbs.
- Other Signs: Headaches, nausea, and mild bleeding from the nose or gums may occur.
Treatment and Medical Management
There is no specific antiviral medicine available to cure a chikungunya infection. Medical care focuses primarily on relieving patient symptoms:
- Over-the-Counter Analgesics: Medications containing acetaminophen or paracetamol are recommended to manage fever and pain.
- Avoid Aspirin and NSAIDs: Do not use aspirin, ibuprofen, or naproxen until a doctor has explicitly ruled out dengue fever. If the patient actually has dengue, NSAIDs can critically escalate the risk of severe internal bleeding.
- Hydration and Rest: Drinking plenty of fluids and getting complete bed rest are vital for recovery.
- Chronic Management: While acute symptoms typically resolve within a week, the associated joint pain can become chronic, lingering for months or even years in older adults.
Prevention and Vaccine Status
The most effective way to minimize risk is through vigilant vector control and avoiding bites.
- Bite Prevention: Apply EPA-registered insect repellents containing DEET, wear long-sleeved clothing, and utilize window screens or insecticide-treated bed nets.
- Eliminate Standing Water: Routinely empty containers, flower pots, and tires where mosquitoes breed.
- Vaccines: Regulatory bodies in multiple countries have approved two preventative chikungunya vaccines for at-risk populations. However, these vaccines are not yet in widespread global distribution. If you are planning to travel to an endemic area, consult a healthcare provider regarding availability and recommendations.
With notes from the World Health Organization, the Centers for Disease Control, and Wikipedia.