Undercurrents: Chikungunya About Gone for Now, but Not Forgotten

A regular Source feature, Undercurrents explores issues, ideas and events as they develop beneath the surface in the Virgin Islands community.

Six months after Gloria Salas-Lindquist came down with chikungunya, she’s still feeling its effects.

“It’s always worse in the morning,” said the Addelita Cancryn Junior High School teacher and cross country assistant coach. “It’s like major arthritis. I feel like I’m 90 years old.”

Most people who get the mosquito-borne virus are sick for about a week, experiencing fever, joint pain, and possibly headache, muscle pain, swelling and rash. But many have long-term effects that can last for months and up to a year.

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Attacked in August, Salas-Lindquist said she didn’t even try going to her regular aerobics class until after Christmas. She is finally starting to recover, but progress seems more a matter of willpower than health. She’s back at exercise, but can only manage 3-pound weights, not the 5-pounds she used to handle.

“It sucks the energy out of you,” she said. And it can be depressing. “It’s emotionally draining.”

In a separate interview, fellow sufferer Erva Denham described a similar experience, right down to the comparison with a 90-year-old.

“It feels like a combination of arthritis with muscle cramps,” Denham said. “Dengue hurts a lot too, but this one has actual cramping and swelling with it … Some mornings I wake up and I can’t even bend my fingers.”

It’s been three months since she came down with the symptoms, and Denham said she’s just beginning to feel better. Still, after a morning of errand-running, the fatigue characteristic of chikungunya wipes her out for the rest of the day.

“It won’t kill you, but you’ll wish you were dead,” Denham quipped. “Now my worse curse is ‘May you get chikungunya and may the pain last forever.’”

Another St. Thomas woman, who did not want her name used, said she got the virus in October and her husband got it in November. For both, its effects lingered through January.

“We had a hard time walking. It was comical to watch, but it was very painful,” she said. Besides the arthritis-like symptoms and the fatigue, she reported swollen glands, a swollen earlobe, feet so painful it was difficult to stand, and days she could barely use her hands. The pair shared many symptoms, but others were individualized.

Until they finally subsided about three weeks ago, some of the symptoms were intermittent. “You’d be fine, then you got sick. You’d be fine, then you got sick,” she said.

These are just the sort of stories Dr. Esther M. Ellis, the territorial epidemiologist for the Virgin Islands, is hoping to hear from chikungunya patients who had blood tests and are in the Health Department’s system.

The department has started contacting known chikungunya patients, conducting an epidemiology investigation to gather information related to treatment and vulnerability to the disease and to track its long-term effects or sequelae, Ellis revealed last week. A sequela is an abnormal condition resulting from a previous disease.

Virus ‘gone to come back’

Ellis had good news too, although it was qualified. On St. Thomas and St. John, “the outbreak’s over,” she said, and “on St. Croix, it’s almost over.” In recent weeks, there have been just one or two reported cases per week on St. Croix, and none on St. Thomas.

According to a report Ellis released late last week, in 2014, doctors and health care providers reported 1,865 cases of the disease in the territory; another 231 cases were actually confirmed by blood tests. In the first four weeks of 2015, five cases have been confirmed and another 39 reported.

The actual number of cases are probably somewhat higher for both years, since some people may not have sought medical attention and so didn’t get into the count.

The first confirmed case of chikungunya appeared in the British Virgin Islands in January 2014 and in the U.S. Virgin Islands in May 2014. In the USVI it spread first in the St. Thomas-St. John district and later appeared on St. Croix. Infections began slowing toward the end of 2014.

Because of the way the disease is spread, Ellis said the territory should be pretty well free of it for a few years. Humans are host to the chikungunya virus. When an Aedes aegypti mosquito bites a person who has the active virus in his or her blood, then the mosquito can pass on the virus to the next human it bites.

But anyone who has had the disease becomes immune to the virus after the disease passes. So right now, a large portion of the V.I. population is immune; they are eliminated from the cycle.

In effect, the chikungunya virus in the Virgin Islands is a victim of its own success. The virus appears to have died out in this area, Ellis said.

But that’s only temporary. As Ellis pointed out, even if the virus is gone from the area, with modern travel it can easily be reintroduced. And between babies being born and people moving to the territory, there will soon be plenty of humans who aren’t immune and can play the part of the perfect host.

The common period between outbreaks in regions throughout the world is roughly three years, she said.

Health officials hope to be better prepared next time. That’s why they are trying to learn more about the virus and its effects through the survey.

They already have some data concerning the age and gender of patients. Of the 2,096 combined confirmed and reported cases in 2014, 1,168 involved females and 808 involved males; gender was not reported in the remaining 120 cases. It isn’t clear that the virus shows a gender preference, however; the numbers may be the result of more women than men seeking treatment.

The 2014 numbers don’t seem to indicate a marked difference in age preference for the disease. Of the 2,096 patients, 424, or 20 percent, were under age 20; 479 (23 percent) were between ages 20-38; 555 (26 percent) were aged 40-59; and 501 (24 percent) were over 60. Age was not reported for the remaining 137 cases, representing 7 percent of the total.

Don’t call us, we’ll call you

With the survey, health officials are looking for demographic information like gender and age, but they also are asking such questions as whether patients experienced joint pain before getting chikungunya, whether they missed work or school because of it, and if the pain is more prevalent one time of day than another.

“All these things will help us,” Ellis said. “The goal of this investigation is to provide a better understanding of the epidemiology of the ongoing chikungunya virus outbreak in the U.S. Virgin Islands and to determine risk factors for both acute infection and for the presence of long-term sequelae.”

Only individuals already in Department of Health records will be surveyed, she said. That’s because health officials need subjects who tested positive at the time the virus was active. But that’s a sufficient number to determine meaningful statistics. Ellis is hoping people who receive a call from the department will take the few minutes to answer the survey.

Chikungunya history is recent

Researchers are still learning about the disease. Although there are some who think it can be traced back further through historical references, according to information online, the official discovery of chikungunya came in 1952 in an area of Africa between Mozambique and Tansania known as the Makonde Plateau.

Its name derives either from the Makonde word meaning “that which bends up” or from the Swahili term meaning “the illness of the bended walker,” according to online sources. Both translations conjure up the image of a person experiencing severe joint pain.

To date, there is no vaccine for the disease and no cure.

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