Travel-related chikungunya cases in Canada, 2014

Abstract

Since the spring of 2014, there has been a large increase in travel-related chikungunya cases diagnosed in Canada. As of December 9, 2014, 320 confirmed and 159 probable cases have been diagnosed in Canada, with the majority of provinces identifying at least one imported case. This surge in Canadian infections has been associated with the incursion of chikungunya virus into the Caribbean and the expansion of the virus in the Americas. Ongoing outbreaks in the Asia-Pacific region have also contributed to imported cases among Canadian travellers. Heightened awareness of chikungunya among clinicians is key to diagnosis. This highlights the need to ask for a travel history from anyone who presents with fever or recent onset of polyarthralgia, and to consider testing by provincial laboratories and the National Microbiology Laboratory for chikungunya virus and other diseases as indicated. Also essential is continued communication with travellers regarding the use of preventative measures to decrease the risk of exposure to mosquitoes when travelling to endemic areas.

Could exotic mosquito-borne diseases emerge in Canada with climate change?

“…The recent incursion of CHIKV and ZIKV into the western hemisphere and subsequent epidemic in the Caribbean and the Americas demonstrate the potential for exotic MBDs to spread extensively and rapidly across large vulnerable populations (33,34). As a result of the presence of MBDs worldwide, including in countries frequented by Canadian travellers, hundreds of residents returned to Canada with travel-acquired CHIKV and ZIKV between 2013 and 2017 (7,8, 10,35). Other common MBDs of concern for returned travellers include yellow fever, Japanese encephalitis and lymphatic filariasis.…”

“…For exotic MBDs that are zoonoses and require an animal reservoir that is currently present in Canada OVERVIEW (e.g. Japanese encephalitis), climate change could have further impact on the reservoir such as maintaining and supporting the expansion of natural habitats and prolonging the availability of food sources, thus increasing population size (51,52). Extreme weather events, such as droughts and heat events, can bring host reservoirs searching for water sources and mosquito breeding grounds together (53)(54)(55).…”

Prevalence of chronic comorbidities in chikungunya: A systematic review and meta-analysis

“…In 2016 alone, there were over 500,000 cumulative CHIKV cases (Pan American Health Organization, 2017). In Canada, 479 confirmed and probable cases were diagnosed in 2014 (Drebot et al, 2015), of which, 128 cases were imported (Pan American Health Organization, 2017).…”

Is there a risk of chikungunya transmission in Canada?

“…A rapid increase in laboratory diagnoses of travel-acquired chikungunya infections in Canadians has been seen recently (3). This would be expected, given the high numbers of Canadians who travel to affected regions for business and pleasure (3).…”

“…A rapid increase in laboratory diagnoses of travel-acquired chikungunya infections in Canadians has been seen recently (3). This would be expected, given the high numbers of Canadians who travel to affected regions for business and pleasure (3). In addition to the direct risk of infections being acquired during travel, what is the risk that travellers who have acquired infection abroad return and act as a source of local autochthonous chikungunya transmission in Canada?…”