Category Archives: Outbreaks

Avian Influenza A(H7N9) Perspectives in JIDC: Immune Status, The Elderly and Pandemics. by Stephen Huang

On 31 March 31 2013, the Chinese National Health and Family Planning Commission officially announced the emergence of novel avian influenza A(H7N9) virus infection in humans.  This virus has now caused disease in 108 people (as of 23 April 23), including severe cases and mortality.  Although the virus has not been shown to transmit from human-to-human, avian influenza A(H7N9) virus poses a pandemic threat in the human population due to the lack of pre-existing immunity and its high fatality rate, should human-to-human transmission occur.


Figure 2 from Guan et al., 2013: Typical wet market in China showing staked cages of chickens, ducks and pigeons

In this issue of JIDC, Yi and colleagues of the International Institute of Infection and Immunity, Shantou University Medical College, Shantou, Guangdong, China, published a manuscript reporting a possible route via the mixed poultry-mammals  environment in the Chinese live markets as the source of avian influenza A(H7N9) virus human infections.


Figure 3 from Guan et al., 2013: Typical wet market in China showing close proximity of multiple species including rabbits

Furthermore, based on the predominant number of severe cases in the elderly, the paper also puts forth the elderly population as at high risk for avian influenza A(H7N9) virus H7N9 human disease.


Figure 5 from Guan et al., 2013: Number of nrH7N9 human cases per age group in
China as of April 15

The manuscript describes the lack of knowledge in designing effective H7N9 vaccines and immune surveillance, as well as lack of understanding in the disease’s pathogenesis, especially in the high-risk group.  This issue requires immediate attention for assessing a possible new pandemic outbreak.  The article can be found under this link:

Stephen Huang


Filed under China, Countries, Environmental Issues, Infectious Disease, Influenza, Outbreaks

Outbreaks: Chikungunya outbreak in the Republic of Congo

JIDC Outbreaks

JIDC is introducing a new section of our Blog, Outbreaks.  Outbreaks will report on current infectious outbreaks worldwide and will include a summary of scientific information and /or epidemiology concerning the pathogen.  If you have an outbreak to report or a summary you would like to see posted, please contact me at

Outbreak:  Chikungunya Outbreak in the Republic of Congo

Chikungunya fever is a crippling disease caused by an arthropod-borne virus (arbovirus) transmitted to humans through mosquitoes.  Although Chikungunya virus is not often associated with mortality, the effects of virus outbreaks are often devastating, causing significant economic loss.  The recent outbreak of Chikungunya fever in the Republic of Congo has reported thousands of people affected. 


Outbreak of Chikungunya in the Republic of Congo

It was reported by IRIN, the UN’s humanitarian news and analysis service, on June 15th, 2011 that a large outbreak of possible Chikungunya fever (CHIKF) is affecting the Republic of Congo ([1]. In Brazzaville, the Republic of Congo’s largest city, an estimated 1,000 cases of CHIKF is suspected since the beginning of June.  CHIKF in humans is caused by infection of the chikungunya virus (CHIKV) which is transmitted by mosquitoes to people (arbovirus)[2].  Testing of patients who presented with CHIKF symptoms in the Republic of Congo have resulted positive for the CHIKV. 

IRIN reported “More than 900 people are showing symptoms of chikungunya, which is transmitted by mosquito,” Director-General of Health Alexis Elira Dokekias told a news conference on 14 June. 

By the end of June (June 28, 2011) an IRIN representative reported there were approximately 8,000 CHIKF affected people with no associated deaths. 

Although historically CHIKV is found in tropical regions of the globe, outbreaks have been reported in temperate regions suggesting the expanding tropism of the virus.


JIDC has published 3 articles on CHIKV that can be found Open Access on the JIDC website:

  1.  A Review of Chikungunya by Cavrini F. et al., JIDC 2009 entitled Chikungunya:  an emerging and spreading arthropod-borne viral disease [2].
  2. Antiviral therapy for Chikungunya by Ravichandran R. and Manian M. JIDC 2008 entitled Ribavirin therapy for Chikungunya arthritis [3].
  3. A Case Report of Chikungunya in India by Kumari R. et al., JIDC 2010 entitled The first Chikungunya case from Sonipat district near the national capital city of Delhi, India[4].


CHIKF not only a disease of the tropics

Historically CHIKV was only found in tropical regions.  In 2007, an outbreak of CHIKV occurred in Emilia Romagna region of Northern Italy.  The Italian outbreak of CHIKV spread through communities surrounding the city of Ravenna during August to October 2007 and also involved the major Italian city of Bologna [5,6].  In Italy, 254 people were determined to be infected with CHIKV which was transmitted by Ae. albopictus mosquito. The mosquito has been found in the Emilia Romagna region since 1990 [7–9].  The virus was brought to the Emilia Romagna region by a traveller returning from a CHIKV affected country.  The virus was of the Central/East African virus genotype [7,8].  Genomic sequencing showed that the amino acids sequence included a substitution mutation in the E1 envelope protein (E1-A226V) [10] which is important for viral entry into host cells.  This mutation was acquired during the large 2005-2006 Indian Ocean CHIKV outbreak and enabled the virus to infect the Ae. albopictus mosquito where previously it only infected the Ae. aegyptii [11].  Importantly, from this outbreak, it was shown that temperate regions are also susceptible to the CHIKV infections and not only tropical regions.  

CHIKV Outbreak in Emilia Romagna region of Northern Italy. Cavrini F. et al., JIDC 2009


History of CHIKV

Interestingly, CHIKV has been shown to infect and be transmitted by 2 species of mosquitoes:  Ae. aegyptii and Ae. albopictus mosquitoes.  Chikungunya was identified in East Africa in the early 1950s and since then has caused epidemics in continental Africa, the Indian Ocean region, and countries of Southeast Asia such as India where there has been an estimated 1.39 million cases (since 2006) [4,12–15] .  The only reported outbreak outside of these areas was in Italy in the Emilia Romagna region in 2007.  Small non-epidemic imported cases have been reported in other regions such as North America, France and Japan which were caused by travellers returning from affected areas [16–18]. 

The epidemic which occurred on La Reunion Island, Indian Ocean in 2005-2006 was a devastating CHIKV outbreak where over one-third of the population was affected [19].  During this outbreak, the CHIKV acquired a genetic mutation permiting the Ae. albopictus mosquito to carry the CHIKV.  Previously CHIKV only circulated in Ae. aegyptii mosquitoes [19,20].  CHIKV is now of global health concern since expansion of mosquito vectors has created potential for the Chikungunya virus to spread to temperate areas as Ae. albopitcus inhabits regions in North America and Europe [21,22].     

CHIKV Clinical Manifestations

The defining symptom of CHIKF is severe joint pain and as the severe joint pain increases the patient often takes a bent posture.  Chikungunya, a word originating from the Tanzanian and Mozambique region meaning that which bends up, describes this distorted posture[20].  Other symptoms of CHIKF include sudden appearance of high fever, rash, headache, nausea, vomiting, myalgia and arthalgia or severe joint pain.  Symptoms start 4 to 7 days following infection which defines the acute phase of CHIKF.  Importantly, the acute phase lasts approximately 2 weeks, joint pain can persist for months or years following initial infection [6,7,23]. 

CHIKV Immune Response and Treatments

Currently, the immune response for CHIKV infection remains largely uninvestigated and there is no specific treatment available.  Reported in 2010, Ravichandran R. and Manian M. investigated the use of the antiviral agent ribavirin in patients suffering from severe joint pain attributed to CHIKV infection [3].  The ribavirin treated patients had a faster resolution of joint pain and joint inflammation compared to a control patient group.     

Cytokines have also been investigated as possible therapeutic drug targets and or biomarkers for CHIKF [24,25].  Importantly, Cytokines are immune mediators that direct immune responses during infection.  Ng and colleagues found that IL-1b, IL-6 and RANTES were correlated with severe acute phase CHIKF during the Singapore 2007 CHIKV outbreak [25].  Recently it was reported the acute phase of CHIKV infection is characterized by a strong innate immune response leading to CD8 T cell adaptive immunity[26]. It is clear that the immune response toward CHIKV needs to be further investigation and the cytokine signatures validated as possible biomarkers and/or drug targets for CHIKF.

Chikungunya Virus Phylogenetics

Chikungunya virus (CHIKV) is a single-stranded positive-sense RNA virus where there are three genotypes transmitted by mosquitoes.  The virus is of the Alphavirus genus in the Togaviridae family [21,23]. 

 Thanks to the IRIN!


Do you have questions?  Or would you like to report and outbreak in your area?  Please contact JIDC and let us know!


Reference List


        1.    2011 June) IRIN.

        2.    Cavrini F, Gaibani P, Pierro AM, Rossini G, Landini MP, Sambri V (2009) Chikungunya: an emerging and spreading arthropod-borne viral disease. J Infect Dev Ctries 3: 744-752.

        3.    Ravichandran R, Manian M (2008) Ribavirin therapy for Chikungunya arthritis. J Infect Dev Ctries 2: 140-142.

        4.    Kumari R, Nand P, Mittal V, Lal S, Saxena VK (2010) The first Chikungunya case from Sonipat district near the national capital city of Delhi, India. J Infect Dev Ctries 4: 262-263.

        5.    Seyler T, Rizzo C, Finarelli AC, Po C, Alessio P, Sambri V, Ciofi Degli Atti ML, Salmaso S (2008) Autochthonous chikungunya virus transmission may have occurred in Bologna, Italy, during the summer 2007 outbreak. Euro Surveill 13.

        6.    Liumbruno GM, Calteri D, Petropulacos K, Mattivi A, Po C, Macini P, Tomasini I, Zucchelli P, Silvestri AR, Sambri V, Pupella S, Catalano L, Piccinini V, Calizzani G, Grazzini G (2008) The Chikungunya epidemic in Italy and its repercussion on the blood system. Blood Transfus 6: 199-210.

        7.    Sambri V, Cavrini F, Rossini G, Pierro A, Landini MP (2008) The 2007 epidemic outbreak of Chikungunya virus infection in the Romagna region of Italy: a new perspective for the possible diffusion of tropical diseases in temperate areas? New Microbiol 31: 303-304.

        8.    Bonilauri P, Bellini R, Calzolari M, Angelini R, Venturi L, Fallacara F, Cordioli P, Angelini P, Venturelli C, Merialdi G, Dottori M (2008) Chikungunya virus in Aedes albopictus, Italy. Emerg Infect Dis 14: 852-854.

        9.    Charrel RN, de L, X (2008) Chikungunya virus in north-eastern Italy: a consequence of seasonal synchronicity. Euro Surveill 13.

      10.    Bordi L, Carletti F, Castilletti C, Chiappini R, Sambri V, Cavrini F, Ippolito G, Di CA, Capobianchi MR (2008) Presence of the A226V mutation in autochthonous and imported Italian chikungunya virus strains. Clin Infect Dis 47: 428-429. 10.1086/589925 [doi].

      11.    Tsetsarkin KA, Vanlandingham DL, McGee CE, Higgs S (2007) A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog 3: e201. 07-PLPA-RA-0664 [pii];10.1371/journal.ppat.0030201 [doi].

      12.    Demanou M, Antonio-Nkondjio C, Ngapana E, Rousset D, Paupy C, Manuguerra JC, Zeller H (2010) Chikungunya outbreak in a rural area of Western Cameroon in 2006: A retrospective serological and entomological survey. BMC Res Notes 3: 128. 1756-0500-3-128 [pii];10.1186/1756-0500-3-128 [doi].

      13.    Niyas KP, Abraham R, Unnikrishnan RN, Mathew T, Nair S, Manakkadan A, Issac A, Sreekumar E (2010) Molecular characterization of Chikungunya virus isolates from clinical samples and adult Aedes albopictus mosquitoes emerged from larvae from Kerala, South India. Virol J 7: 189. 1743-422X-7-189 [pii];10.1186/1743-422X-7-189 [doi].

      14.    Santhosh SR, Dash PK, Parida M, Khan M, Rao PV (2009) Appearance of E1: A226V mutant Chikungunya virus in Coastal Karnataka, India during 2008 outbreak. Virol J 6: 172. 1743-422X-6-172 [pii];10.1186/1743-422X-6-172 [doi].

      15.    2011) NVBDCP (2007).  Chikungunya fever situation in the country during 2006.

      16.    Parola P, de L, X, Jourdan J, Rovery C, Vaillant V, Minodier P, Brouqui P, Flahault A, Raoult D, Charrel RN (2006) Novel chikungunya virus variant in travelers returning from Indian Ocean islands. Emerg Infect Dis 12: 1493-1499.

      17.    Gibney KB, Fischer M, Prince HE, Kramer LD, St GK, Kosoy OL, Laven JJ, Staples JE (2011) Chikungunya fever in the United States: a fifteen year review of cases. Clin Infect Dis 52: e121-e126. ciq214 [pii];10.1093/cid/ciq214 [doi].

      18.    Mizuno Y, Kato Y, Takeshita N, Ujiie M, Kobayashi T, Kanagawa S, Kudo K, Lim CK, Takasaki T (2010) Clinical and radiological features of imported chikungunya fever in Japan: a study of six cases at the National Center for Global Health and Medicine. J Infect Chemother . 10.1007/s10156-010-0124-y [doi].

      19.    Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, Vaney MC, Lavenir R, Pardigon N, Reynes JM, Pettinelli F, Biscornet L, Diancourt L, Michel S, Duquerroy S, Guigon G, Frenkiel MP, Brehin AC, Cubito N, Despres P, Kunst F, Rey FA, Zeller H, Brisse S (2006) Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med 3: e263. 06-PLME-RA-0242R1 [pii];10.1371/journal.pmed.0030263 [doi].

      20.    Thiboutot MM, Kannan S, Kawalekar OU, Shedlock DJ, Khan AS, Sarangan G, Srikanth P, Weiner DB, Muthumani K (2010) Chikungunya: a potentially emerging epidemic? PLoS Negl Trop Dis 4: e623. 10.1371/journal.pntd.0000623 [doi].

      21.    Sudeep AB, Parashar D (2008) Chikungunya: an overview. J Biosci 33: 443-449.

      22.    De L, X, Leroy E, Charrel RN, Ttsetsarkin K, Higgs S, Gould EA (2008) Chikungunya virus adapts to tiger mosquito via evolutionary convergence: a sign of things to come? Virol J 5: 33. 1743-422X-5-33 [pii];10.1186/1743-422X-5-33 [doi].

      23.    Cavrini F, Gaibani P, Pierro AM, Rossini G, Landini MP, Sambri V (2009) Chikungunya: an emerging and spreading arthropod-borne viral disease. J Infect Dev Ctries 3: 744-752.

      24.    Chirathaworn C, Rianthavorn P, Wuttirattanakowit N, Poovorawan Y (2010) Serum IL-18 and IL-18BP levels in patients with Chikungunya virus infection. Viral Immunol 23: 113-117. 10.1089/vim.2009.0077 [doi].

      25.    Ng LF, Chow A, Sun YJ, Kwek DJ, Lim PL, Dimatatac F, Ng LC, Ooi EE, Choo KH, Her Z, Kourilsky P, Leo YS (2009) IL-1beta, IL-6, and RANTES as biomarkers of Chikungunya severity. PLoS One 4: e4261. 10.1371/journal.pone.0004261 [doi].

      26.    Wauquier N, Becquart P, Nkoghe D, Padilla C, Ndjoyi-Mbiguino A, Leroy EM (2011) The acute phase of chikungunya virus infection in humans is associated with strong innate immunity and T CD8 cell activation. J Infect Dis 204: 115-123. jiq006 [pii];10.1093/infdis/jiq006 [doi].

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Filed under Chikungunya, Chikungunya, Infectious Disease, JIDC News, Outbreaks, Uncategorized