Ryan Gill MS4 Chikungunya an emerging disease Emerging infectious viral disease spread by mosquitos Until the 2000s was not known to exist in the Western hemisphere Establishment in the US likely inevitable ID: 774713
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GrenadaInternational Elective in the Caribbean
Ryan Gill, MS4
Slide2Slide3Slide4Chikungunya - an emerging disease
Emerging infectious viral disease spread by mosquitos
Until the 2000s, was not known to exist in the Western hemisphere
Establishment in the US likely inevitable
Slide5Chikungunya virus - what is it?
Virus with many mammalian reservoirs, including humansSpread by the bite of Aedes genus mosquitos
Slide6Chikungunya infection
Symptoms/signs
classic triad of pruritic maculopapular rash, fever, and arthralgias (debilitating)
flu-like symptoms, HA, GI distress
rarely, hepatitis, neurologic sequelae (encephalitis)
Infection is self-limiting within 4-10 days
Prognosis is excellent
~10% experience chronic arthralgias
Caglioti, C., Lalle, E., Castilletti, C., Carletti, F., Capobianchi, M. R., & Bordi, L. (2013). Chikungunya virus infection: an overview.
New Microbiol
,
36
(3), 211-27.
Slide7Chikungunya infection
Slide8Chikungunya - Epidemiology
Previously isolated to Eastern hemisphere: Africa, Asia, India, surrounding areas
Occasional epidemics
In early 2000s, outbreak on Reunion Island
R0 = ~3. Influenza R0 = ~3. Infectious!
Slide9Chikungunya - Epidemiology
2005 - epidemics across various Indian Ocean islands, Indian subcontinent, Southeast Asia
December 2013 - first autochthonous case of Chikungunya reported in St Martin
first reported case in the Western hemisphere
2014 - autochthonous cases on most Caribbean islands, mainland South America
Cauchemez, S., Ledrans, M., Poletto, C., Quenel, P., de Valk, H., Colizza, V., & Boëlle, P. Y. (2014). Local and regional spread of chikungunya fever in the Americas.
Euro Surveill
,
19
, 28.
Slide10Slide11Chikungunya - new epidemic strain
These epidemics are caused by a single previously undescribed strain of CHIKV
Single base pair substitution grants new vector specificity to
Aedes albopictus
Establishment in the US is inevitable
already reports of sporadic autochthonous cases
Tsetsarkin, K. A., Vanlandingham, D. L., McGee, C. E., & Higgs, S. (2007). A single mutation in chikungunya virus affects vector specificity and epidemic potential.
PLoS pathogens
,
3
(12), e201.
Slide12Slide13Cultural barriers
Primary prevention of CHIKV = mosquito control, mosquito bite prevention
Poor public acceptance of mosquito as vector
Common to perceive cause of disease as a supernatural phenomenon in parts of Caribbean
Slide14Clinical experience
St Augustine’s Medical Services (SAMS)Only private hospital on the islandProvides outpt, inpt, OBGYN, specialty servicesLab services, x-ray, CT, pharmacy
Slide15Clinical experience
Worked with hospital owner
Primarily worked in outpt clinic with rounding on inpts throughout day
Opportunities to work with specialists who hold clinic or surgeries at SAMS
Can attend rounds at St. George’s General Hospital
Slide16Profound clinical experience
Working with Dr. Diez, a Venezuelan cardiothoracic surgeon who holds clinic at SAMS
Spoke about the issues of scale in regards to the practice of medicine, island medicine
Advice for intern year
Cardiology without stress testing
Slide17Profound cultural experience
Met Nigel Mathlin, co-founder of GrenCHAP, only LGBT advocacy group on island
Spoke at length about status of LGBT individuals in Grenadian society
Island is socially conservative
Many LGBT individuals seek asylum in other countries
Slide18GrenCHAP
Attended unveiling of PSAs for Love Without Fear campaignSeveral government officials in attendanceWill be broadcasted on local TV channels, as internet advertisements, social media
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