Primary prevention

Avoidance of mosquito bites

  • Infection is prevented by avoidance of mosquito bites.

  • Potential measures include: reducing time of outdoor exposure (mosquitoes can transmit infection throughout the day, not just at dusk or dawn); wearing long sleeves; consistent use of repellents containing DEET (30% to 50%), picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol; use of permethrin on clothing; decreasing conditions in or around the household that may favour the breeding of larvae (such as removing containers that hold water); use of mosquito nets and air conditioning; and redoubling efforts while travelling in endemic areas.[25][34][40]

  • The Public Health Department of California has extensive guidelines for mosquito surveillance, detection, and eradication that could be used by local health departments.[41]​​

Vaccine

  • A single-dose, live-attenuated vaccine is approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the prevention of disease caused by chikungunya virus in adults ≥18 years of age who are at increased risk of exposure to chikungunya virus.

  • The vaccine was approved in the US under an accelerated approval process based on anti-chikungunya virus neutralising antibody titres. The same data were used for European approval. Continued approval may be contingent upon verification of clinical efficacy in confirmatory studies.[42]

    • A phase 3 randomised pivotal clinical trial using the vaccine enrolled 4128 participants. Specific neutralising antibodies against chikungunya virus showed a 471-fold increase compared with baseline at day 29, and remained up to 107-fold increase as compared with the baseline at day 180. The vaccine was safe and well tolerated and no safety concerns were raised.[43]​ The trial lacked clinical endpoints; however, a surrogate marker of protection is considered acceptable for approval under the FDA’s accelerated approval process.

  • The US Advisory Committee on Immunization Practices recommends the vaccine for people ≥18 years travelling to a country or territory where there is a chikungunya outbreak, and laboratory workers with potential for exposure to the virus. The vaccine may also be considered in the following people travelling to a country or territory without an outbreak, but with evidence of chikungunya virus transmission among humans within the last 5 years:[44]

    • People aged >65 years, particularly those with underlying medical conditions who are likely to have at least moderate exposure to mosquitoes

    • People staying for a cumulative period of ≥6 months.

  • The vaccine is contraindicated in immunocompromised people.

  • The decision to use the vaccine during pregnancy should take the person’s risk of wild-type chikungunya virus infection, gestational age, and risks to the fetus or neonate from vertical transmission of wild-type chikungunya virus into consideration. Neonates should be monitored closely for 7 days after birth if they are born within 14 days of the mother receiving vaccination. It is unknown whether the vaccine virus can be vertically transmitted and cause fetal or neonatal adverse events.

  • Severe or prolonged chikungunya-like adverse effects that may prevent daily activities or require medical intervention are possible after vaccination. Post-marketing studies are required to assess the serious risk of severe chikungunya-like adverse reactions following administration.

Vaccines in development

  • Other vaccines are in late preclinical or clinical development.

  • Leading candidates include a virus-like particle vaccine (which has FDA fast-track designation and European Medicines Agency priority medicine designation), and BBV87 (an inactivated whole virion vaccine).[45]

  • A chimeric vaccine using measles virus encoding chikungunya structural proteins (MV-CHIK), has also shown safety and tolerability in randomised phase 2 trials and produced immunogenicity in the majority of recipients after a single injection.[46]

Secondary prevention

Community education is important to identify the burden of the problem and to set actions to prevent proliferation of mosquitoes and avoid exposure.[63]

Especially in non-endemic areas, infected individuals should stay away from biting mosquitoes while they are ill, to prevent new local outbreaks.

Travellers need to be educated about their risk and the basic precautions they should take. They also need to identify symptoms and seek care if required.[32] CDC: Yellow Book: Health information for international travel Opens in new window​​

Sanitary authorities need to be aware of the risk of transmission via blood transfusion and assess the need for donor screening in epidemic situations.[26]

It is a notifiable disease in some countries.

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