- Email: [email protected]
The Caribbean response to chikungunya
Comment
The Caribbean response to chikungunya
www.thelancet.com/infection Vol 14 November 2014
In December, 2013, after reports received by the PAHO/WHO of cases of chikungunya in Saint Martin, CARPHA provided (and continues to provide) technical support to CARPHA member states, many of whom have implemented enhanced surveillance, detection, and rapid response activities. Teleconferences have been held with CARPHA member states as the situation has evolved, and a virtual network of experts, including virologists, clinicians, entomologists, epidemiologists, and environmental health specialists, was quickly established to assess the situation after the early reports. Field teams composed of staff from CARPHA and PAHO/WHO were quickly mobilised to help affected countries on the ground, including the provision of recommendations for vector control. A network of laboratories in the Caribbean, including those of CARPHA, CDC, and Institut Pasteur in French Guiana, are using appropriate diagnostic tests to confirm the presence of the chikungunya virus in suspected patients. Moreover, this network has worked determinedly to ensure that the diagnostic capabilities are deployed promptly in the area. The provision of accurate information through several channels in a transparent and timely manner by CARPHA member states, CARPHA, and its partners, such as PAHO/WHO and CDC, has underpinned the response, including the publication of recommendations for travellers to prevent international spread. A coordinated and collaborative multinational and multiagency effort has been mounted in the Caribbean region in both countries affected by chikungunya and those so far unaffected to ensure the accurate identification and reporting of cases in a timely manner. Additionally, the Institut Pasteur has launched an extensive programme of studies in the region, including research that will help to achieve improved diagnosis, surveillance, and prevention, and predictive models to improve understanding of the spread of the virus. Further research is needed into these and other areas. The spread of chikungunya to the Americas and other currently unaffected areas might be inevitable because of the widespread distribution of the vector and completely susceptible populations. Sustained commitment to efforts already underway, along with future initiatives to address remaining challenges, will
CDC/Science Photo Library
As of Oct 6, 2014, the Caribbean Public Health Agency (CARPHA) has reported 7981 confirmed cases of chikungunya since December, 2013, when the first cases were reported from the French Caribbean island of Saint Martin.1 These are the first occurrences of autochthonously transmitted chikungunya to be identified in the region. As with several other viruses that have spread as a result of human behaviour and globalisation, local spread was probably originated in a traveller returning from an affected area overseas. In an editorial, The Lancet commented that “The region [Caribbean] currently lacks adequate surveillance and virological testing infrastructure, which could hinder efforts to contain the virus.”2 The Caribbean has a long history of well established regional networks and has successfully eliminated viruses causing polio and measles, with extensive ongoing epidemiological and laboratory surveillance to maintain these achievements.3–5 Additionally, the countries of the Caribbean, CARPHA, Pan American Health Organization/WHO (PAHO/WHO), US Centers for Disease Control and Prevention (CDC), Institut Pasteur in French Guiana, and others have initiated preparedness and response efforts in relation to the International Health Regulations 2005 (IHR 2005).6 The risk for the introduction of chikungunya into the Americas was anticipated. Because of the broad distribution of the Aedes aegypti vector, suitable climatic conditions, and the frequency of travel between the Caribbean and countries currently recognised as being endemic for chikungunya, PAHO/ WHO, with collaboration from the CDC Division of Vector-borne Diseases (DVBD), established a working group to assess the potential threat of this virus to the region, and proposed measures to mitigate the public health threat. The working group produced preparedness guidelines that are being used across the region.7 Subsequently, PAHO/WHO, with the support of the DVBD, ran a training workshop, Preparedness and Response Plan for Chikungunya Virus Introduction in the Caribbean Sub-Region, in 2012. The objective of this workshop was to increase the capacity of Caribbean countries for the timely identification of chikungunya through surveillance, case detection, investigation, and initiation of appropriate public health actions.
1039
Comment
help to ensure that the Caribbean is fully engaged and able to adequately address chikungunya outbreaks, slow the spread of the virus, and minimise the effect of the disease on trade and travel in line with the IHR (2005). *Babatunde Olowokure, Lorraine Francis , Karen Polson-Edwards, Roger Nasci, Philippe Quénel, Sylvain Aldighieri, Dominique Rousset, Cristina Gutierrez, Pilar Ramon-Pardo, Thais dos Santos, C James Hospedales Caribbean Public Health Agency (CARPHA), Port of Spain, Trinidad and Tobago (BO, LF, KP-E, CG, CJH); Division of VectorBorne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA (RN); Institut Pasteur de la Guyane, Cayenne, French Guiana (PQ, DR); Pan American Health Organization/ World Health Organisation, Washington, DC, USA (SA, PR-P); and Pan American Health Organization/WHO Office for Barbados and Eastern Caribbean Countries, Bridgetown, Barbados (TdS) [email protected]
We declare no competing interests. 1
2 3
4 5
6
7
Caribbean Public Health Agency. Chikungunya advice to travellers. http://carpha.org/What-We-Do/Public-Health-Activities/Chikungunya (accessed March 28, 2014). The Lancet. Chikungunya—coming to America. Lancet 2013; 383: 488. Tikasingh ES. The hunt for Caribbean viruses: a history of the Trinidad Regional Virus Laboratory. Port of Spain, Trinidad: Caribbean Epidemiology Centre, 2000. Smith H, Beyrer C, Benons L, Hospedales J. Caribbean: measles elimination. Lancet 1991; 338: 563–64. Castillo-Solorzano CC, Ruiz Matus CR, Flannery B, Marsigli C, Tambini G, Andrus JK. The Americas: paving the road toward global measles eradication. J Infect Dis 2011; 204 (suppl 1): S270–78. WHO. International Health Regulations (2005), 2nd edn. Geneva: World Health Organization, 2005. http://whqlibdoc.who.int/ publications/2008/9789241580410_eng.pdf?ua=1 (accessed March 20, 2014). PAHO. Preparedness and response for chikungunya virus introduction in the Caribbean sub-region. Washington, DC: Pan American Health Organization, 2013. http://www.paho.org/hq/index.php?option=com_ docman&task=doc_view&gid=23768&Itemid=1 (accessed March 17, 2014).
Corrections See Articles page 1096
Groome MJ, Page N, Cortese MM, et al. Effectiveness of monovalent human rotavirus vaccine against admission to hospital for acute rotavirus diarrhoea in South African children: a case-control study. Lancet Infect Dis 2014; 14: 1096–104—In this Article, Kathleen Kahn’s surname was misspelt as Khan. The MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) was also omitted from her affiliation details. These corrections have been made to the online version as of Oct 20, 2014, and the printed Article is correct. Ermis B, Gardas F, Ceviz N, Ors R, Karakelleoglu C. Haemophagocytic syndrome following pseudomonas septicaemia. Lancet Infect Dis 2003; 3: 287—In this Clinical Picture, the authors names should have read “Bahri Ermis, Faith Kardas, Naci Ceviz, Rahmi Ors, and Cahit Karakelleoglu”. Yaw KL, Robinson JO, Ho KM. A comparison of long-term outcomes after meticillin-resistant and meticillin-sensitive Staphylococcus aureus bacteraemia: an observational cohort study. Lancet Infect Dis 2014; 14: 967–75—In table 4 of this Article, the data describes the relationship between MRSA status and all-cause hospital readmission, not infection-related hospital readmission. The last sentence of the Findings paragraph in the Summary should read “(odds ratio 1·06, 95% CI 0·67–1·68; p=0·81).” Also, table 5 has been added to show the data for the relationship between MRSA status and infection-related hospital readmission, and the last paragraph of the results should be replaced with the following statements: “There was a higher risk of all-cause hospital readmissions after MSSA bacteraemia than MRSA bacteraemia, but this association was not statistically significant after adjusting for other covariates (table 4). The risk of infection-related hospital readmissions was similar between the two groups both before and after adjustment for other covariates (table 5).” These corrections have been made to the online version as of Oct 20, 2014.
1040
www.thelancet.com/infection Vol 14 November 2014
The Caribbean response to chikungunya
www.thelancet.com/infection Vol 14 November 2014
In December, 2013, after reports received by the PAHO/WHO of cases of chikungunya in Saint Martin, CARPHA provided (and continues to provide) technical support to CARPHA member states, many of whom have implemented enhanced surveillance, detection, and rapid response activities. Teleconferences have been held with CARPHA member states as the situation has evolved, and a virtual network of experts, including virologists, clinicians, entomologists, epidemiologists, and environmental health specialists, was quickly established to assess the situation after the early reports. Field teams composed of staff from CARPHA and PAHO/WHO were quickly mobilised to help affected countries on the ground, including the provision of recommendations for vector control. A network of laboratories in the Caribbean, including those of CARPHA, CDC, and Institut Pasteur in French Guiana, are using appropriate diagnostic tests to confirm the presence of the chikungunya virus in suspected patients. Moreover, this network has worked determinedly to ensure that the diagnostic capabilities are deployed promptly in the area. The provision of accurate information through several channels in a transparent and timely manner by CARPHA member states, CARPHA, and its partners, such as PAHO/WHO and CDC, has underpinned the response, including the publication of recommendations for travellers to prevent international spread. A coordinated and collaborative multinational and multiagency effort has been mounted in the Caribbean region in both countries affected by chikungunya and those so far unaffected to ensure the accurate identification and reporting of cases in a timely manner. Additionally, the Institut Pasteur has launched an extensive programme of studies in the region, including research that will help to achieve improved diagnosis, surveillance, and prevention, and predictive models to improve understanding of the spread of the virus. Further research is needed into these and other areas. The spread of chikungunya to the Americas and other currently unaffected areas might be inevitable because of the widespread distribution of the vector and completely susceptible populations. Sustained commitment to efforts already underway, along with future initiatives to address remaining challenges, will
CDC/Science Photo Library
As of Oct 6, 2014, the Caribbean Public Health Agency (CARPHA) has reported 7981 confirmed cases of chikungunya since December, 2013, when the first cases were reported from the French Caribbean island of Saint Martin.1 These are the first occurrences of autochthonously transmitted chikungunya to be identified in the region. As with several other viruses that have spread as a result of human behaviour and globalisation, local spread was probably originated in a traveller returning from an affected area overseas. In an editorial, The Lancet commented that “The region [Caribbean] currently lacks adequate surveillance and virological testing infrastructure, which could hinder efforts to contain the virus.”2 The Caribbean has a long history of well established regional networks and has successfully eliminated viruses causing polio and measles, with extensive ongoing epidemiological and laboratory surveillance to maintain these achievements.3–5 Additionally, the countries of the Caribbean, CARPHA, Pan American Health Organization/WHO (PAHO/WHO), US Centers for Disease Control and Prevention (CDC), Institut Pasteur in French Guiana, and others have initiated preparedness and response efforts in relation to the International Health Regulations 2005 (IHR 2005).6 The risk for the introduction of chikungunya into the Americas was anticipated. Because of the broad distribution of the Aedes aegypti vector, suitable climatic conditions, and the frequency of travel between the Caribbean and countries currently recognised as being endemic for chikungunya, PAHO/ WHO, with collaboration from the CDC Division of Vector-borne Diseases (DVBD), established a working group to assess the potential threat of this virus to the region, and proposed measures to mitigate the public health threat. The working group produced preparedness guidelines that are being used across the region.7 Subsequently, PAHO/WHO, with the support of the DVBD, ran a training workshop, Preparedness and Response Plan for Chikungunya Virus Introduction in the Caribbean Sub-Region, in 2012. The objective of this workshop was to increase the capacity of Caribbean countries for the timely identification of chikungunya through surveillance, case detection, investigation, and initiation of appropriate public health actions.
1039
Comment
help to ensure that the Caribbean is fully engaged and able to adequately address chikungunya outbreaks, slow the spread of the virus, and minimise the effect of the disease on trade and travel in line with the IHR (2005). *Babatunde Olowokure, Lorraine Francis , Karen Polson-Edwards, Roger Nasci, Philippe Quénel, Sylvain Aldighieri, Dominique Rousset, Cristina Gutierrez, Pilar Ramon-Pardo, Thais dos Santos, C James Hospedales Caribbean Public Health Agency (CARPHA), Port of Spain, Trinidad and Tobago (BO, LF, KP-E, CG, CJH); Division of VectorBorne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA (RN); Institut Pasteur de la Guyane, Cayenne, French Guiana (PQ, DR); Pan American Health Organization/ World Health Organisation, Washington, DC, USA (SA, PR-P); and Pan American Health Organization/WHO Office for Barbados and Eastern Caribbean Countries, Bridgetown, Barbados (TdS) [email protected]
We declare no competing interests. 1
2 3
4 5
6
7
Caribbean Public Health Agency. Chikungunya advice to travellers. http://carpha.org/What-We-Do/Public-Health-Activities/Chikungunya (accessed March 28, 2014). The Lancet. Chikungunya—coming to America. Lancet 2013; 383: 488. Tikasingh ES. The hunt for Caribbean viruses: a history of the Trinidad Regional Virus Laboratory. Port of Spain, Trinidad: Caribbean Epidemiology Centre, 2000. Smith H, Beyrer C, Benons L, Hospedales J. Caribbean: measles elimination. Lancet 1991; 338: 563–64. Castillo-Solorzano CC, Ruiz Matus CR, Flannery B, Marsigli C, Tambini G, Andrus JK. The Americas: paving the road toward global measles eradication. J Infect Dis 2011; 204 (suppl 1): S270–78. WHO. International Health Regulations (2005), 2nd edn. Geneva: World Health Organization, 2005. http://whqlibdoc.who.int/ publications/2008/9789241580410_eng.pdf?ua=1 (accessed March 20, 2014). PAHO. Preparedness and response for chikungunya virus introduction in the Caribbean sub-region. Washington, DC: Pan American Health Organization, 2013. http://www.paho.org/hq/index.php?option=com_ docman&task=doc_view&gid=23768&Itemid=1 (accessed March 17, 2014).
Corrections See Articles page 1096
Groome MJ, Page N, Cortese MM, et al. Effectiveness of monovalent human rotavirus vaccine against admission to hospital for acute rotavirus diarrhoea in South African children: a case-control study. Lancet Infect Dis 2014; 14: 1096–104—In this Article, Kathleen Kahn’s surname was misspelt as Khan. The MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) was also omitted from her affiliation details. These corrections have been made to the online version as of Oct 20, 2014, and the printed Article is correct. Ermis B, Gardas F, Ceviz N, Ors R, Karakelleoglu C. Haemophagocytic syndrome following pseudomonas septicaemia. Lancet Infect Dis 2003; 3: 287—In this Clinical Picture, the authors names should have read “Bahri Ermis, Faith Kardas, Naci Ceviz, Rahmi Ors, and Cahit Karakelleoglu”. Yaw KL, Robinson JO, Ho KM. A comparison of long-term outcomes after meticillin-resistant and meticillin-sensitive Staphylococcus aureus bacteraemia: an observational cohort study. Lancet Infect Dis 2014; 14: 967–75—In table 4 of this Article, the data describes the relationship between MRSA status and all-cause hospital readmission, not infection-related hospital readmission. The last sentence of the Findings paragraph in the Summary should read “(odds ratio 1·06, 95% CI 0·67–1·68; p=0·81).” Also, table 5 has been added to show the data for the relationship between MRSA status and infection-related hospital readmission, and the last paragraph of the results should be replaced with the following statements: “There was a higher risk of all-cause hospital readmissions after MSSA bacteraemia than MRSA bacteraemia, but this association was not statistically significant after adjusting for other covariates (table 4). The risk of infection-related hospital readmissions was similar between the two groups both before and after adjustment for other covariates (table 5).” These corrections have been made to the online version as of Oct 20, 2014.
1040
www.thelancet.com/infection Vol 14 November 2014