Key points
- There is no specific treatment for chikungunya virus disease (chikungunya); clinical management is supportive.
- Patients suspected to have chikungunya should be managed for dengue until dengue has been ruled out.
- Counsel travelers at risk for chikungunya to prevent mosquito bites and get vaccinated before travelling, if vaccination is recommended.
Treatment
No specific antiviral treatment is available for chikungunya; however, several therapeutic options are being investigated. Treatment for symptoms can include rest, fluids, and use of analgesics and antipyretics. Nonsteroidal anti-inflammatory drugs can be used to help with acute fever and pain. However, in dengue-endemic areas or in travelers to these areas, acetaminophen is the preferred first-line treatment for fever and joint pain until dengue can be ruled out, to reduce the risk of hemorrhage from dengue.
Keep in mind
Patients suspected to have chikungunya should be managed for dengue until dengue has been ruled out.
- Proper clinical management of dengue reduces the risk of medical complications and death.
- Aspirin and other NSAIDs can increase the risk of hemorrhage in patients with dengue.
For patients with persistent joint pain related to chikungunya, use of nonsteroidal anti-inflammatory drugs, corticosteroids including topical preparations, and physical therapy might help lessen the symptoms.
Prevention
Counsel travelers at risk for chikungunya about taking steps to prevent mosquito bites and getting vaccinated before traveling, if vaccination is recommended for them.
Travelers at increased risk for more severe disease, including travelers with underlying medical conditions and women late in their pregnancy (as their fetuses are at increased risk), might consider avoiding travel to areas with ongoing outbreaks. If travel is unavoidable, emphasize taking steps to prevent mosquito bites and getting vaccinated before traveling, if vaccination is recommended for them.
Prevent mosquito bites
During travel
- Use Environmental Protection Agency (EPA)-registered insect repellent.
- Wear long, loose-fitting shirts and pants.
- Treat clothing and gear with 0.5% permethrin.
- Choose lodging with air conditioning or screens on windows and doors; use a mosquito net if sleeping outdoors.
After travel
People suspected or confirmed to have chikungunya virus infection should prevent further mosquito exposure during the first week of illness to reduce the risk of local transmission.
Vaccination
Chikungunya can be prevented through vaccination. Two chikungunya vaccines are available in the United States: a live-attenuated vaccine (IXCHIQ) and a virus-like particle vaccine (VIMKUNYA). Vaccination should be considered for some travelers at higher risk of exposure to chikungunya virus and for some laboratory workers.