Key points
- There is no specific treatment for chikungunya virus disease; clinical management is supportive.
- Patients with suspected chikungunya virus disease should be managed as dengue until dengue has been ruled out.
- Counsel travelers at risk for chikungunya about vaccination and using personal protective measures to prevent mosquito bites.
Treatment
No specific antiviral treatment is available for chikungunya; however, a number of 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. In dengue-endemic areas, however, acetaminophen is the preferred first-line treatment for fever and joint pain until dengue can be ruled out, to reduce the risk of hemorrhage.
Patients with suspected chikungunya virus disease should be managed as 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 virus disease, use of nonsteroidal anti-inflammatory drugs, corticosteroids including topical preparations, and physical therapy might help lessen the symptoms.
Prevention
Chikungunya can be prevented through vaccination. One chikungunya vaccine (called IXCHIQ) is available in the United States.
Regardless of vaccination status, travelers should be advised to use personal protective measures to decrease exposure to infected mosquitoes. This includes using insect repellent, wearing long-sleeved shirts and pants, and treating clothing and gear with 0.5% permethrin. Travelers should choose a hotel or lodging with air conditioning or screens on windows and doors.
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 the need for taking protective measures against mosquito bites and consider vaccination if appropriate.
People suspected or confirmed to have chikungunya virus infection should be protected from further mosquito exposure during the first week of illness to reduce the risk of local transmission.