Chikungunya

Chikungunya
Rash from chikungunya
Pronunciation	/ˌtʃɪkənˈɡʌnjə/ [1] CHIK-ən-GUN-yə
Specialty	Infectious disease
Symptoms	Fever, joint pain, headache, muscle pain, joint swelling, and rash. [2]
Complications	Long term joint pain [2]
Usual onset	2 to 14 days after exposure [3]
Duration	Usually less than a week [2]
Causes	Chikungunya virus spread by mosquitoes [3]
Diagnostic method	Blood test for viral RNA or antibodies [3]
Differential diagnosis	Dengue fever, Zika fever [3]
Prevention	Chikungunya vaccine, Mosquito control, avoidance of bites [4]
Treatment	Supportive care [3]
Prognosis	Risk of death ~ 1 in 1,000 [4]
Frequency	> 1 million (2014) [3]

Chikungunya is an infection caused by the chikungunya virus. ^[3] The most common symptoms are fever and joint pain, ^[2] typically occurring four to eight days after the bite of an infected mosquito; ^[3] however some people may be infected without showing any symptoms. ^[5] Other symptoms may include headache, muscle pain, joint swelling, and a rash. ^[2] Symptoms usually improve within a week; however, occasionally the joint pain may last for months or years. ^{[2] [6]} The very young, old, and those with other health problems are at risk of more severe disease. ^[2]

The virus is spread between people by two species of mosquito in the genus Aedes : Aedes albopictus and Aedes aegypti , ^[3] which mainly bite during the day, ^{[7] [8]} particularly around dawn and in the late afternoon. ^[9] The virus may circulate within a number of animals, including birds and rodents. ^[3] Diagnosis is done by testing the blood for either viral RNA or antibodies to the virus. ^[3] The symptoms can be mistaken for those of dengue fever and Zika fever, which are spread by the same mosquitoes. ^[3] It is believed most people become immune after a single infection. ^[2]

The best means of prevention are overall mosquito control and the avoidance of bites in areas where the disease is common. ^[4] This may be partly achieved by decreasing mosquitoes' access to water, as well as the use of insect repellent and mosquito nets. Chikungunya vaccines have been approved for use in the United States ^[10] and in the European Union. ^{[11] [12] [13]} No specific treatment for chikungunya is available; supportive care is recommended, with symptomatic treatment of fever and joint swelling. ^[4]

The chikungunya virus is widespread in tropical and subtropical regions where warm climates and abundant populations of its mosquito vectors (A. aegypti and A. albopictus) facilitate its transmission. ^[3] The disease was first identified in 1952 in Tanzania and named based on the Makonde words for "to become contorted". ^[3] While the disease is endemic in Africa and Asia, outbreaks have been reported in Europe and the Americas since the 2000s. ^[3] In 2014, more than a million suspected cases occurred globally. ^[3] Chikungunya has become a global health concern due to its rapid geographic expansion, recurrent outbreaks, the lack of effective antiviral treatments, and potential to cause severe symptoms and death. ^[14]

Signs and symptoms

Chikungunya can be asymptomatic, with estimates of between 17% and 40% of infections showing no symptoms. ^[5] For those experiencing symptoms, they typically begin with a sudden high fever above 39 °C (102 °F) around 3 to 7 days after the bite of an infected mosquito. ^{[15] [5]} The fever is often accompanied by severe muscle and joint pain, which affects multiple joints in the arms and legs and is often symmetric – i.e. if one elbow is affected, the other is as well. ^{[16] [5]} People with chikungunya also frequently experience headaches, back pain, nausea, and fatigue. ^[16] Around half of those affected develop a rash, with reddening and sometimes small bumps on the palms, foot soles, torso, and face. ^[16]

For some, the rash remains constrained to a small part of the body; for others, the rash can be extensive, covering more than 90% of the skin. ^[15] Some people experience gastrointestinal issues, with abdominal pain and vomiting. Others experience eye problems, namely sensitivity to light, conjunctivitis, and pain behind the eye. ^[16] This first set of symptoms – called the "acute phase" of chikungunya – lasts around a week, after which most symptoms resolve on their own. ^[16]

For those with severe symptoms, approximately 30% to 40% continue to have symptoms after the "acute phase" resolves. ^{[5] [16]} The lasting symptoms tend to be joint pains: arthritis, tenosynovitis, and/or bursitis. ^[16] If the affected person has pre-existing joint issues, these tend to worsen. ^[16] Overuse of a joint can result in painful swelling, stiffness, nerve damage, and neuropathic pain. ^[16] Typically the joint pain improves with time; however, the chronic stage can last anywhere from a few months to several years. ^[16]

Almost all symptomatic cases feature joint pain, generally in more than one joint. ^[17] Pain most commonly occurs in peripheral joints, such as the wrists, ankles, and joints of the hands and feet as well as some of the larger joints, typically the shoulders, elbows and knees. ^{[17] [18]} Joints are more likely to be affected if they have previously been damaged by disorders such as arthritis. ^[18] Pain may also occur in the muscles or ligaments. In more than half of cases, normal activity is limited by significant fatigue and pain. ^[17] Infrequently, inflammation of the eyes may occur in the form of iridocyclitis, or uveitis, and retinal lesions may occur. ^[19] Temporary damage to the liver may occur. ^[20]

People with chikungunya occasionally develop long term neurologic disorders, most frequently swelling or degeneration of the brain, inflammation or degeneration of the myelin sheaths around neurons, Guillain–Barré syndrome, acute disseminated encephalomyelitis, hypotonia (in newborns), and issues with visual processing. ^[16]

Newborns, the elderly, and those with diabetes, heart disease, liver and kidney diseases, and human immunodeficiency virus infection tend to have more severe cases of chikungunya. Fewer than 1 in 1,000 people with symptomatic chikungunya die of the disease; generally these are people with pre-existing health conditions. ^{[16] [5]}

Transmission

Chikungunya is generally transmitted from mosquitoes to humans. Chikungunya is spread through bites from Aedes mosquitoes, specifically A. aegypti (Egyptian mosquito) and A. albopictus (Tiger mosquito). ^[3] Because high amounts of virus are present in the blood during the first few days of infection, the virus can spread from an infected human to a mosquito, where it replicates without harming the mosquito. Subsequently, a bite from the infected mosquito will transmit the virus back to a human. ^[3] The incubation period ranges from one to twelve days and is most typically three to seven. ^[17]

Rarely, the disease can be transmitted from mother to child during pregnancy or at birth, in women who become infected a few days before delivery. ^[5]

Mechanism

Chikungunya virus is passed to humans when a bite from an infected mosquito breaks the skin and introduces the virus into the body. The virus initially replicates in cells near the location of the bite; from here it enters the lymphatic system and the bloodstream, enabling it to circulate to organs and tissues which become infected. Most frequently it reproduces in the lymphatic system and the spleen, as well as peripheral joints, muscles and tendons where symptoms frequently occur; it appears that the virus is able to penetrate and replicate in many different types of cells. ^[21] In severe cases it can infect the brain and liver. ^{[22] [21]}

During the acute phase of infection, large numbers of infectious virus particles are present in the bloodstream, making it very likely that an uninfected mosquito will pick up the virus if it bites the human host. ^{[22] [21]}

During the first few days of infection, the host's innate immune system is activated, producing type I interferons and inflammatory cytokines to fight the infection. This generates the fever and localised inflammation which is characteristic of the disease. ^{[21] [23]} It takes about a week before the host's adaptive immune system begins to develop antibodies which eventually clear the virus from the bloodstream. ^[24] However the virus can persist within specific tissues, especially the joints, causing long term inflammation and pain in chronic cases. ^[23]

The virus has mechanisms which help it to evade the immune response. Within an infected cell, the viral nonstructural protein 2 (nsP2) interferes with the JAK-STAT signalling pathway to hinder it from triggering an antiviral response. ^[25] The virus can induce apoptosis (programmed cell death) in host cells; virus laden debris from apoptosis is engulfed by macrophages which in turn become infected. ^[26] The virus also seems to be able to evade T lymphocytes which seek to target and destroy the virus particles. ^[27]

Diagnosis

Diagnosing chikungunya can be difficult because its symptoms, such as sudden fever and joint pain, closely resemble other mosquito-borne illnesses like dengue fever and malaria. ^[28] Chikungunya should be suspected if a patient with these symptoms either lives in an area where the virus is endemic, or if they have recently traveled to such an area. ^{[28] [29]}

During the first week of illness, when virus is present in the bloodstream, it is possible to detect viral RNA in a blood sample using techniques such as reverse transcription-polymerase chain reaction (RT-PCR) or viral culture. ^[29] After this time, the body develops antibodies and the virus is eliminated from the bloodstream. Antibodies in blood serum persist for between 3 and 12 months; they can be detected for up to a year after infection using enzyme-linked immunosorbent assay (ELISA) or indirect fluorescent antibody (IFA). ^{[28] [30]} All of these techniques are time consuming and costly, requiring sophisticated laboratory equipment which may not be available in resource poor settings. ^[31]

Differential diagnosis

The Aedes mosquitoes which carry chikungunya virus can also carry other viruses such as dengue, zika, and yellow fever. ^[32] Other infections which should be considered include malaria, leptospirosis, measles, mononucleosis and African tick bite fever, which are often endemic in the same areas and can have similar symptoms. It is possible for a patient to be infected by more than one virus simultaneously. ^[28]

Prevention

A. aegypti mosquito biting a person

Although an approved vaccine exists, the most effective means of prevention is to avoid or prevent mosquito bites. The main strategies for this are: controlling mosquito populations by limiting their habitat; and protection against contact with disease-carrying mosquitoes. ^[4]  On a large scale, mosquito control focuses on eliminating standing water where mosquitoes lay eggs and develop as larvae. ^[33] Individuals should use mosquito repellent, as well as barriers such as loose clothing that covers the arms and legs, mosquito nets and window and door screens. ^[34]

Once immunity against chikungunya has been acquired, whether as a result of infection or vaccination, it endures long term and may be lifelong. ^{[5] [35]}

Vaccination

This section is an excerpt from Chikungunya vaccine.[ edit ]

Chikungunya vaccines are vaccines intended to provide acquired immunity against the chikungunya virus. ^{[36] [37]} As of 2025 ^[update] , two vaccines have been licensed in some countries. These are Ixchiq, a live attenuated vaccine from Valneva, and Vimkunya manufactured by Bavarian Nordic which utilises virus-like particle technology. ^{[38] [39] [40] [41]}

The most commonly reported side effects of Ixchiq include tenderness at the injection site, as well as headache, fatigue, muscle pain, joint pain, fever, and nausea. ^[39] However the license for Ixchiq has been suspended or restricted in some countries due to the risk of severe side effects, particularly in older people. ^{[42] [43]}

Treatment

No specific treatment for chikungunya is available. ^[4] Supportive care is recommended, and symptomatic treatment of fever and joint swelling includes the use of paracetamol (acetaminophen), rest, and fluids. ^{[4] [5]} Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen should not be used in the acute phase until dengue fever has been ruled out, as these can increase the risk of bleeding in dengue. ^{[3] [28]}

Chronic symptoms, especially joint pain, may persist for months after the infection has passed. The pain and swelling may be treated with NSAIDs or in more severe cases with corticosteroid drugs or disease-modifying antirheumatic drugs such as hydroxychloroquine. ^{[28] [44]}

Prognosis

The mortality rate of chikungunya is slightly less than 1 in 1000. ^[45] Those over the age of 65, infants, and those with underlying chronic medical problems are most likely to have severe complications. ^[46] Newborn infants are especially vulnerable as they lack fully developed immune systems, and may pick up the infection through vertical transmission from their mother. ^[46] The likelihood of prolonged symptoms or chronic joint pain is increased with increased age and prior rheumatological disease. ^{[47] [48]}

Epidemiology

Main article: Epidemiology of chikungunya

Dark green denotes countries with current or previous local transmission of chikungunya virus, per US Centers for Disease Control and Prevention (CDC) as of September 2019.

A. albopictus distribution as of 2015

A. aegypti distribution as of 2015

Chikungunya virus is transmitted by the bite of an infected mosquito of the genus Aedes, specifically Aedes aegypti and Aedes albopictus. ^[49] A. aegypti, the so-called Egyptian mosquito, is well adapted to urban settings in the tropics but has poor tolerance for low temperatures and is less able to overwinter in temperate climates. A. albopictus, the Asian Tiger mosquito, has a wider temperature tolerance and can overwinter as eggs in temperate regions. Both mosquitoes have spread from their ancestral ranges into tropical, sub-tropical, and some temperate regions of the Americas, Africa, Australasia and Eurasia. ^{[50] [51]}

In Africa, chikungunya virus is maintained by a sylvatic cycle in which the virus cycles between small mammals (principally non-human primates), and mosquitos; humans can be infected by a mosquito bite but the virus does not rely on humans for survival. ^[52] Elsewhere, chikungunya is maintained in an urban cycle in densely populated areas. In this, an infected mosquito bites a human, transmitting the virus which replicates in the human host; a few days later, large numbers of infective virus particles are present in the host's bloodstream. When another mosquito bites the infected human, it picks up the virus, and this cycle continues. ^[53]

As of December 2024 ^[update] , 119 countries and territories, principally those in tropical and subtropical regions, have reported local transmission of chikungunya. ^[54] In some of these it is endemic (continually present). In some regions the disease tends to manifest as periodic epidemics which can be sudden and intense, as the virus spreads among a population with a low level of herd immunity. ^{[55] [56]} Because of the difficulty in reliably diagnosing chikungunya disease, especially in resource poor contexts, there are no reliable statistics on its incidence. However epidemiological modelling studies estimate between 14.4 million ^[57] and 35 million people ^[55] are infected annually. Up to 848,000 people experience chronic long-term pain; annual mortality is estimated at up to 3,700 deaths. ^[55]

History

The term chikungunya is derived from the Makonde root verb kungunyala, meaning to dry up or become contorted, descriptive of the posture of people with chronic symptoms. ^[58] The disease was first clearly described by Marion Robinson ^[59] and W.H.R. Lumsden ^[58] in a pair of 1955 papers, following an outbreak in 1952 on the Makonde Plateau, along the border between Mozambique and Tanganyika (the mainland part of modern-day Tanzania). ^[58] The virus itself was isolated in 1955. ^[60] At that time, it was endemic to sub-saharan Africa, relying on A. aegypti to maintain its sylvatic cycle. ^[61] Prior to this, the disease may have caused sporadic epidemics in other regions, which had been incorrectly ascribed to dengue. ^{[62] [63] [64]}

The first direct evidence of chikungunya spreading outside of Africa came from Bangkok, Thailand, in 1958, during an urban outbreak. It subsequently appeared in India and Cambodia in the early 1960s, associated with the spread of the A. aegypti mosquito to those regions. ^[65]

An outbreak on the coast of Kenya in 2004 rapidly spread to the islands of the Indian Ocean (such as La Réunion) in 2005, then to India and Southeast Asia where it caused explosive outbreaks affecting millions of people. ^[66] Infected air travelers carried the virus into areas where the population had not previously been exposed to the disease and had no immunity. ^[67]

An analysis of the genetic code of chikungunya virus suggests that the wider spread of the disease since 2004 may be due to a genetic change which altered the E1 segment of the virus' viral coat protein, a variant called E1-A226V. Prior to this mutation, spread of the virus was restricted by the relatively narrow geographical range of its principal vector, A. aegypti . The adaptive effect of this mutation is that the virus became able to use A albopictus as a vector, spreading within its wider geographical range. ^{[68] [69]} A. albopictus is an invasive species which since the 1960's has spread through parts of Europe, the Americas, the Caribbean, Africa, and the Middle East. ^[70]

Chikungunya was introduced to the Americas in 2013, first detected on the French island of Saint Martin, ^{[71] [72]} and over the next four years more than 2.6 million cases were recorded in this region. ^[73]

Research

Chikungunya is one of more than a dozen agents researched as a potential biological weapon. ^{[74] [75]}

This disease is part of the group of neglected tropical diseases. ^[76]

Chikungunya virus

Virology

Chikungunya virus
Chikungunya virus structure at atomic resolution. Bar = 100 Å [77]
Virus classification
(unranked):	Virus
Realm:	Riboviria
Kingdom:	Orthornavirae
Phylum:	Kitrinoviricota
Class:	Alsuviricetes
Order:	Martellivirales
Family:	Togaviridae
Genus:	Alphavirus
Species:	Alphavirus chikungunya

Chikungunya virus is a member of the genus Alphavirus , and family Togaviridae . Chikungunya virus features an icosahedral capsid surrounded by a lipid envelope, with a diameter ranging from 60 to 70 nm. ^[78] It was first isolated in 1953 in Tanzania and is an RNA virus with a positive-sense single-stranded genome of about 11.6kb. ^[79] It is a member of the Semliki Forest virus complex and is closely related to Ross River virus, O'nyong'nyong virus, and Semliki Forest virus. ^[80] Because it is transmitted by arthropods, namely mosquitoes, it can also be referred to as an arbovirus (arthropod-borne virus). In the United States, it is classified as a category B priority pathogen, ^[81] and work requires biosafety level III precautions. ^[82]

Three genotypes of this virus have been described, each with a distinct genotype and antigenic character: West African, East/Central/South African, and Asian genotypes. ^[83] The Asian lineage originated in 1952 and has subsequently split into two lineages – India (Indian Ocean Lineage) and South East Asian clades. This virus was first reported in the Americas in 2014. Phylogenetic investigations have shown two strains in Brazil – the Asian and East/Central/South African types – and that the Asian strain arrived in the Caribbean (most likely from Oceania) in about March 2013. ^[84] The rate of molecular evolution was estimated to have a mean rate of 5 × 10⁻⁴ substitutions per site per year (95% higher probability density 2.9–7.9 × 10⁻⁴). ^[84]

The chikungunya virus genome encodes both structural and non-structural proteins as typical of alphavirus genomic organization. ^[85] The structural proteins, including the capsid, E3, E2, 6K and E1, are responsible for encapsulating the viral genome and assembling new viral particles. These proteins are critical for viral entry into host cells. Meanwhile, the non-structural proteins, nsP1, nsP2, nsP3, and nsP4, play essential roles in viral replication, translation, and immune evasion. ^[85]

Viral replication

Transmission electron micrograph of chikungunya virus particles

The virus consists of four nonstructural proteins and three structural proteins. ^[33] The structural proteins are the capsid and two envelope glycoproteins: E1 and E2, which form heterodimeric spikes on the viron surface. E2 binds to cellular receptors in order to enter the host cell through receptor-mediated endocytosis. E1 contains a fusion peptide which, when exposed to the acidity of the endosome in eukaryotic cells, dissociates from E2 and initiates membrane fusion that allows the release of nucleocapsids into the host cytoplasm, promoting infection. ^[86] The mature virion contains 240 heterodimeric spikes of E2/E1, which after release, bud on the surface of the infected cell, where they are released by exocytosis to infect other cells. ^[79]

See also

• Viruses portal

• Coalition for Epidemic Preparedness Innovations

References

1. "chikungunya". Oxford Learner's Dictionary. Oxford University Press. Archived from the original on 4 November 2014. Retrieved 4 November 2014.
2. CDC (15 May 2024). "Symptoms, Diagnosis, & Treatment". Centers for Disease Control and Prevention. Retrieved 15 October 2025.
3. "Chikungunya Fact Sheet (2025)". World Health Organization. 14 April 2025. Retrieved 20 October 2025.
4. Caglioti C, Lalle E, Castilletti C, Carletti F, Capobianchi MR, Bordi L (July 2013). "Chikungunya virus infection: an overview". The New Microbiologica. 36 (3): 211–27. PMID   23912863.
5. "Chikungunya – Fact sheet". European Centre for Disease Prevention and Control (ECDC). 24 June 2024. Archived from the original on 19 December 2013.
6. van Aalst M, Nelen CM, Goorhuis A, Stijnis C, Grobusch MP (1 January 2017). "Long-term sequelae of chikungunya virus disease: A systematic review". Travel Medicine and Infectious Disease. 15: 8–22. doi:10.1016/j.tmaid.2017.01.004. ISSN   1477-8939. PMID   28163198.
7. Paixão ES, Teixeira MG, Rodrigues LC (2018). "Zika, chikungunya and dengue: the causes and threats of new and re-emerging arboviral diseases". BMJ Global Health. 3 (Suppl 1) e000530. Bibcode:2018BMJGH...300530P. doi:10.1136/bmjgh-2017-000530. ISSN   2059-7908. PMC   5759716 . PMID   29435366.
8. "Preventing Chikungunya". U.S. Centers for Disease Control and Prevention (CDC). 26 February 2016. Archived from the original on 15 September 2016. Retrieved 26 September 2016.
9. AFP (23 July 2025). "Outbreak of Chikungunya Virus Poses Global Risk, Warns WHO". ScienceAlert. Retrieved 24 July 2025.
10. "FDA Approval". U.S. Food and Drug Administration (FDA) (Press release). 9 November 2023. Archived from the original on 11 November 2023. Retrieved 11 November 2023.
11. "Ixchiq EPAR". European Medicines Agency . 30 May 2024. Archived from the original on 1 June 2024. Retrieved 1 June 2024.
12. "First vaccine to protect adults from Chikungunya". European Medicines Agency (Press release). 31 May 2024. Retrieved 1 June 2024.
13. "Vimkunya EPAR". European Medicines Agency . 30 January 2025. Retrieved 16 February 2025.>
14. Moizéis RN, Fernandes TA, Guedes PM, Pereira HW, Lanza DC, Azevedo JW, et al. (19 May 2018). "Chikungunya fever: a threat to global public health". Pathogens and Global Health. 112 (4): 182–94. doi:10.1080/20477724.2018.1478777. ISSN   2047-7724. PMC   6147074 . PMID   29806537.
15. Burt FJ, Chen W, Miner JJ, Lenschow DJ, Merits A, Schnettler E, et al. (1 April 2017). "Chikungunya virus: an update on the biology and pathogenesis of this emerging pathogen". The Lancet Infectious Diseases. 17 (4): e107 –e117. doi:10.1016/S1473-3099(16)30385-1. ISSN   1473-3099. PMID   28159534.
16. Vairo F, Haider N, Kock RA, Ntoumi F, Ippolito G, Zumla A (25 October 2019). "Chikungunya: Epidemiology, Pathogenesis, Clinical Features, Management, and Prevention (Full text download)". Infectious Disease Clinics of North America. 33 (4): 1003–1025. doi:10.1016/j.idc.2019.08.006. ISSN   0891-5520. PMID   31668189.
17. Thiberville SD, Moyen N, Dupuis-Maguiraga L, Nougairede A, Gould EA, Roques P, et al. (1 September 2013). "Chikungunya fever: Epidemiology, clinical syndrome, pathogenesis and therapy". Antiviral Research. 99 (3): 345–70. doi:10.1016/j.antiviral.2013.06.009. ISSN   0166-3542. PMC   7114207 . PMID   23811281.
18. Burt FJ, Rolph MS, Rulli NE, Mahalingam S, Heise MT (February 2012). "Chikungunya: a re-emerging virus". Lancet. 379 (9816): 662–71. doi:10.1016/S0140-6736(11)60281-X. PMID   22100854. S2CID   33440699.
19. Mahendradas P, Ranganna SK, Shetty R, Balu R, Narayana KM, Babu RB, et al. (February 2008). "Ocular manifestations associated with chikungunya". Ophthalmology. 115 (2): 287–91. doi:10.1016/j.ophtha.2007.03.085. PMID   17631967.
20. Simon F, Javelle E, Oliver M, Leparc-Goffart I, Marimoutou C (June 2011). "Chikungunya virus infection". Current Infectious Disease Reports. 13 (3): 218–28. doi:10.1007/s11908-011-0180-1. PMC   3085104 . PMID   21465340.
21. Silva LA, Dermody TS (1 March 2017). "Chikungunya virus: epidemiology, replication, disease mechanisms, and prospective intervention strategies". The Journal of Clinical Investigation. 127 (3): 737–749. doi:10.1172/JCI84417. ISSN   0021-9738. PMC   5330729 . PMID   28248203.
22. Vu DM, Jungkind D, Angelle Desiree LaBeaud (1 June 2017). "Chikungunya Virus". Clinics in Laboratory Medicine. Emerging Pathogens. 37 (2): 371–382. doi:10.1016/j.cll.2017.01.008. ISSN   0272-2712. PMC   5469677 . PMID   28457355.
23. Srivastava P, Kumar A, Hasan A, Mehta D, Kumar R, Sharma C, et al. (28 April 2020). "Disease Resolution in Chikungunya—What Decides the Outcome?". Frontiers in Immunology. 11 695. doi: 10.3389/fimmu.2020.00695 . ISSN   1664-3224. PMC   7198842 . PMID   32411133.
24. CDC (20 August 2025). "Clinical Testing and Diagnosis for Chikungunya Virus Disease". Chikungunya Virus. Retrieved 27 October 2025.
25. Fros JJ, Liu WJ, Prow NA, Geertsema C, Ligtenberg M, Vanlandingham DL, et al. (15 October 2010). "Chikungunya Virus Nonstructural Protein 2 Inhibits Type I/II Interferon-Stimulated JAK-STAT Signaling". Journal of Virology. 84 (20): 10877–10887. doi:10.1128/jvi.00949-10. PMC   2950581 . PMID   20686047.
26. Srivastava P, Kumar A, Hasan A, Mehta D, Kumar R, Sharma C, et al. (28 April 2020). "Disease Resolution in Chikungunya—What Decides the Outcome?". Frontiers in Immunology. 11 695. doi: 10.3389/fimmu.2020.00695 . ISSN   1664-3224. PMC   7198842 . PMID   32411133.
27. Davenport BJ, Bullock C, McCarthy MK, Hawman DW, Murphy KM, Kedl RM, et al. (16 April 2020). "Chikungunya Virus Evades Antiviral CD8+ T Cell Responses To Establish Persistent Infection in Joint-Associated Tissues". Journal of Virology. 94 (9): 10.1128/jvi.02036–19. doi:10.1128/jvi.02036-19. PMC   7163133 . PMID   32102875.
28. Ojeda Rodriguez JA, Haftel A, Walker II (2025), "Chikungunya Fever", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30480957 , retrieved 30 October 2025
29. CDC (15 May 2024). "About Chikungunya". Centers for Disease Control and Prevention. Retrieved 15 October 2025.
30. Vairo F, Haider N, Kock RA, Ntoumi F, Ippolito G, Zumla A (25 October 2019). "Chikungunya: Epidemiology, Pathogenesis, Clinical Features, Management, and Prevention (Full text download)". Infectious Disease Clinics of North America. 33 (4): 1003–1025. doi:10.1016/j.idc.2019.08.006. ISSN   0891-5520. PMID   31668189.
31. Silva Ld, Costa LH, Dos Santos IC, de Curcio JS, Barbosa AM, Anunciação CE, et al. (1 February 2024). "Advancing Chikungunya Diagnosis: A Cost-Effective and Rapid Visual employing Loop-mediated isothermal reaction". Diagnostic Microbiology and Infectious Disease. 108 (2) 116111. doi:10.1016/j.diagmicrobio.2023.116111. ISSN   0732-8893. PMID   38016385.
32. Abbasi E (1 March 2025). "Global expansion of Aedes mosquitoes and their role in the transboundary spread of emerging arboviral diseases: A comprehensive review". IJID One Health. 6 100058. doi:10.1016/j.ijidoh.2025.100058. ISSN   2949-9151.
33. Weaver SC, Lecuit M (March 2015). "Chikungunya virus and the global spread of a mosquito-borne disease". The New England Journal of Medicine. 372 (13): 1231–39. doi:10.1056/NEJMra1406035. PMID   25806915.
34. "Mosquito bite avoidance: advice for travellers". UK Health Security Agency. 24 January 2023. Retrieved 11 November 2025.
35. "What Is Chikungunya?". Cleveland Clinic. Archived from the original on 14 September 2025. Retrieved 11 November 2025.
36. "Ixchiq". U.S. Food and Drug Administration. 9 November 2023. Archived from the original on 9 November 2023. Retrieved 10 November 2023. This article incorporates text from this source, which is in the public domain.
37. "Vimkunya". U.S. Food and Drug Administration (FDA). 1 October 2024. Archived from the original on 4 March 2025. Retrieved 3 March 2025.
38. "NaTHNaC - Chikungunya". National Travel Health Network and Centre. 14 April 2025. Retrieved 12 November 2025.
39. "FDA Approves First Vaccine to Prevent Disease Caused by Chikungunya Virus". U.S. Food and Drug Administration (FDA) (Press release). 9 November 2023. Archived from the original on 9 November 2023. Retrieved 10 November 2023.
40. "Ixchiq EPAR". European Medicines Agency . 30 May 2024. Archived from the original on 1 June 2024. Retrieved 1 June 2024. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
41. "Vimkunya EPAR". European Medicines Agency . 30 January 2025. Archived from the original on 16 February 2025. Retrieved 16 February 2025. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
42. CDC (22 August 2025). "Chikungunya Vaccine Information for Healthcare Providers". Chikungunya Virus. Retrieved 12 November 2025. As of Friday, August 22, 2025, FDA suspended the U.S. license for IXCHIQ, the live-attenuated chikungunya vaccine.
43. "IXCHIQ Chikungunya vaccine: temporary suspension in people aged 65 years or older". GOV.UK. 18 June 2025. Retrieved 12 November 2025. The Commission on Human Medicines (CHM) has temporarily restricted use of the IXCHIQ Chikungunya vaccine in people aged 65 years and over following very rare fatal reactions reported globally.
44. Pathak H, Mohan MC, Ravindran V (1 September 2019). "Chikungunya arthritis". Clinical Medicine. 19 (5): 381–385. doi:10.7861/clinmed.2019-0035. ISSN   1470-2118. PMC   6771335 . PMID   31530685.
45. Mavalankar D, Shastri P, Bandyopadhyay T, Parmar J, Ramani KV (March 2008). "Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India". Emerging Infectious Diseases. 14 (3): 412–15. doi:10.3201/eid1403.070720. PMC   2570824 . PMID   18325255.
46. Morrison TE (October 2014). "Reemergence of chikungunya virus". Journal of Virology. 88 (20): 11644–47. doi:10.1128/JVI.01432-14. PMC   4178719 . PMID   25078691.
47. Schilte C, Staikowsky F, Staikovsky F, Couderc T, Madec Y, Carpentier F, et al. (2013). "Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study". PLOS Neglected Tropical Diseases. 7 (3) e2137. doi: 10.1371/journal.pntd.0002137 . PMC   3605278 . PMID   23556021.
48. Gérardin P, Fianu A, Michault A, Mussard C, Boussaïd K, Rollot O, et al. (January 2013). "Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study". Arthritis Research & Therapy. 15 (1) R9. doi: 10.1186/ar4137 . PMC   3672753 . PMID   23302155.
49. "Chikungunya fact sheet". www.who.int. Retrieved 25 November 2025.
50. "Aedes aegypti - Factsheet for experts". European Centre for Disease Prevention and Control. 9 June 2017. Retrieved 27 November 2025.
51. "Aedes albopictus - Factsheet for experts". European Centre for Disease Prevention and Control. 9 June 2017. Retrieved 27 November 2025.
52. Powers AM, Logue CH (September 2007). "Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus". The Journal of General Virology. 88 (Pt 9): 2363–77. doi: 10.1099/vir.0.82858-0 . PMID   17698645.
53. Shandhi SS, Malaker S, Shahriar M, Anjum R (1 November 2025). "Chikungunya virus: from genetic adaptation to pandemic risk and prevention". Therapeutic Advances in Infectious Disease. 12 20499361251371110. doi:10.1177/20499361251371110. ISSN   2049-9361. PMC   12398651 . PMID   40893869.
54. "Chikungunya epidemiology update - June 2025 (pdf download)". World Health Organization. 11 June 2025. Retrieved 16 November 2025.
55. Ribeiro dos Santos G, Jawed F, Mukandavire C, Deol A, Scarponi D, Mboera LE, et al. (July 2025). "Global burden of chikungunya virus infections and the potential benefit of vaccination campaigns". Nature Medicine. 31 (7): 2342–2349. doi:10.1038/s41591-025-03703-w. ISSN   1546-170X. PMC   12283390 . PMID   40495015.
56. Silva LA, Dermody TS (1 March 2017). "Chikungunya virus: epidemiology, replication, disease mechanisms, and prospective intervention strategies". The Journal of Clinical Investigation. 127 (3): 737–749. doi:10.1172/JCI84417. ISSN   0021-9738. PMC   5330729 . PMID   28248203.
57. Kang H, Lim A, Auzenbergs M, Clark A, Colón-González FJ, Salje H, et al. (October 2025). "Global, regional and national burden of chikungunya: force of infection mapping and spatial modelling study". BMJ Global Health. 10 (10) e018598. doi:10.1136/bmjgh-2024-018598. ISSN   2059-7908. PMC   12506043 . PMID   41033690.
58. Lumsden WH (January 1955). "An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952–53. II. General description and epidemiology". Transactions of the Royal Society of Tropical Medicine and Hygiene. 49 (1): 33–57. doi:10.1016/0035-9203(55)90081-X. PMID   14373835.
59. Robinson MC (January 1955). "An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952–53. I. Clinical features". Transactions of the Royal Society of Tropical Medicine and Hygiene. 49 (1): 28–32. doi:10.1016/0035-9203(55)90080-8. PMID   14373834.
60. Ross RW (June 1956). "The Newala epidemic: III. The virus: isolation, pathogenic properties and relationship to the epidemic". Epidemiology & Infection. 54 (2): 177–191. doi:10.1017/S0022172400044442. ISSN   0022-1724. PMC   2218030 . PMID   13346078.
61. Powers AM, Logue CH (September 2007). "Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus". The Journal of General Virology. 88 (Pt 9): 2363–77. doi: 10.1099/vir.0.82858-0 . PMID   17698645.
62. Rathore MH, Runyon J, Haque Tu (1 August 2017). "Emerging Infectious Diseases". Advances in Pediatrics. 64 (1): 27–71. doi:10.1016/j.yapd.2017.04.002. ISSN   0065-3101. PMID   28688593.
63. Carey DE (July 1971). "Chikungunya and dengue: a case of mistaken identity?". Journal of the History of Medicine and Allied Sciences. 26 (3): 243–62. doi:10.1093/jhmas/XXVI.3.243. PMID   4938938.
64. Morens DM, Fauci AS (4 September 2014). "Chikungunya at the Door — Déjà Vu All Over Again?". New England Journal of Medicine. 371 (10): 885–887. doi:10.1056/NEJMp1408509. ISSN   0028-4793. PMID   25029435.
65. Weaver SC, Forrester NL (1 August 2015). "Chikungunya: Evolutionary history and recent epidemic spread". Antiviral Research. 120: 32–39. doi:10.1016/j.antiviral.2015.04.016. ISSN   0166-3542. PMID   25979669.
66. Soumahoro MK, Boelle PY, Gaüzere BA, Atsou K, Pelat C, Lambert B, et al. (14 June 2011). "The Chikungunya Epidemic on La Réunion Island in 2005–2006: A Cost-of-Illness Study". PLOS Neglected Tropical Diseases. 5 (6) e1197. doi: 10.1371/journal.pntd.0001197 . ISSN   1935-2735. PMC   3114750 . PMID   21695162.
67. Weaver SC, Lecuit M (March 2015). "Chikungunya virus and the global spread of a mosquito-borne disease". The New England Journal of Medicine. 372 (13): 1231–39. doi:10.1056/NEJMra1406035. PMID   25806915.
68. Tsetsarkin KA, Vanlandingham DL, McGee CE, Higgs S (December 2007). "A single mutation in chikungunya virus affects vector specificity and epidemic potential". PLOS Pathogens. 3 (12) e201. doi: 10.1371/journal.ppat.0030201 . PMC   2134949 . PMID   18069894.
69. Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, Vaney MC, et al. (July 2006). "Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak". PLOS Medicine. 3 (7) e263. doi: 10.1371/journal.pmed.0030263 . PMC   1463904 . PMID   16700631.
70. "Global Invasive Species Database". The International Union for Conservation of Nature Species Survival Commission. Retrieved 19 October 2025.
71. Charles J (1 June 2014). "Mosquito-borne virus knocking on Fla.'s door". Newspapers.com. The Miami Herald. p. A17. Retrieved 22 February 2023.
72. Silva LA, Dermody TS (1 March 2017). "Chikungunya virus: epidemiology, replication, disease mechanisms, and prospective intervention strategies". The Journal of Clinical Investigation. 127 (3): 737–749. doi:10.1172/JCI84417. ISSN   0021-9738. PMC   5330729 . PMID   28248203.
73. Staples JE, Hills SL, Powers AM (26 August 2025). "CDC Yellow Book: Health Information for International Travel: Chikungunya". Yellow Book. Centers for Disease Control and Prevention. Retrieved 8 December 2025.
74. "Chemical and Biological Weapons: Possession and Programs Past and Present Archived 23 June 2014 at the Wayback Machine ", James Martin Center for Nonproliferation Studies, Middlebury College, 9 April 2002, accessed 18 June 2014.
75. "How Chikungunya got its name, and was a potential biological weapon". 23 September 2016.
76. "Neglected tropical diseases". WHO. Archived from the original on 22 February 2014. Retrieved 26 September 2016.
77. Padilla-Sanchez V (10 August 2025), Chikungunya Virus, doi:10.5281/zenodo.16790088 , retrieved 10 August 2025
78. Rougeron V, Sam IC, Caron M, Nkoghe D, Leroy E, Roques P (1 March 2015). "Chikungunya, a paradigm of neglected tropical disease that emerged to be a new health global risk" . Journal of Clinical Virology. 64: 144–52. doi:10.1016/j.jcv.2014.08.032. ISSN   1386-6532. PMID   25453326.
79. Weaver SC, Osorio JE, Livengood JA, Chen R, Stinchcomb DT (September 2012). "Chikungunya virus and prospects for a vaccine". Expert Review of Vaccines. 11 (9): 1087–101. doi:10.1586/erv.12.84. PMC   3562718 . PMID   23151166.
80. Powers AM, Brault AC, Shirako Y, Strauss EG, Kang W, Strauss JH, et al. (November 2001). "Evolutionary relationships and systematics of the alphaviruses". Journal of Virology. 75 (21): 10118–31. Bibcode:2001JVir...7510118P. doi:10.1128/JVI.75.21.10118-10131.2001. PMC   114586 . PMID   11581380.
81. "NIAID Category A, B, and C Priority Pathogens". Archived from the original on 5 January 2014. Retrieved 23 July 2020.
82. "Biosafety in Microbiological and Biomedical Laboratories (BMBL) Fifth Edition" (PDF). Archived (PDF) from the original on 14 October 2014. Retrieved 1 January 2014.
83. Powers AM, Brault AC, Tesh RB, Weaver SC (February 2000). "Re-emergence of Chikungunya and O'nyong-nyong viruses: evidence for distinct geographical lineages and distant evolutionary relationships". The Journal of General Virology. 81 (Pt 2): 471–79. doi: 10.1099/0022-1317-81-2-471 (inactive 11 July 2025). PMID   10644846.
84. Sahadeo NS, Allicock OM, De Salazar PM, Auguste AJ, Widen S, Olowokure B, et al. (2017). "Understanding the evolution and spread of chikungunya virus in the Americas using complete genome sequences". Virus Evol. 3 (1) vex010. doi: 10.1093/ve/vex010 . PMC   5413804 . PMID   28480053.
85. Wang M, Wang L, Leng P, Guo J, Zhou H (1 March 2024). "Drugs targeting structural and nonstructural proteins of the chikungunya virus: A review" . International Journal of Biological Macromolecules. 262 (Pt 2) 129949. doi:10.1016/j.ijbiomac.2024.129949. ISSN   0141-8130. PMID   38311132.
86. Voss JE, Vaney MC, Duquerroy S, Vonrhein C, Girard-Blanc C, Crublet E, et al. (December 2010). "Glycoprotein organization of Chikungunya virus particles revealed by X-ray crystallography". Nature. 468 (7324): 709–12. Bibcode:2010Natur.468..709V. doi:10.1038/nature09555. PMID   21124458. S2CID   4412764.

External links

• "Chikungunya virus disease". European Centre for Disease Prevention and Control. 11 June 2017.