Chikungunya virus spreads to half of Pacific

Transcript

The mosquito borne chikungunya virus has now reached half of the Pacific and is likely to spread to non-affected countries in the region over the next five years. 

The Secretariat of the Pacific Community says the first outbreak of chikungunya was detected in New Caledonia in 2011 and since then 14 outbreaks have been reported by 11 of the 22 Pacific Island nations. 

The SPC's Deputy Director of Public Health Dr Yvan Souarès told Jenny Meyer about the illness and his appeal for urgent action.

Dr Yvan Souarès says five countries are currently experiencing outbreaks, with growing number of cases in the Marshall Islands and the Cook Islands and ongoing cases in Kiribati, Samoa and American Samoa.

He says previous outbreaks in French Polynesia, New Caledonia, Papua New Guinea, Tonga and Yap are reportedly over for now.

YVAN SOUARES: Chikungunya is a bit tricky, like dengue or zika virus for example. Because the mosquette that spreads the virus, ie, Aedes aegypti, this mosquito is almost present in all the region and every Pacific island at the moment. This mosquito has a tendency to bite during the day. As opposed to mosquitos spreading malaria, for example which are actually biting during the night. Therefore sleeping under a mosquito net is fine, in terms of chikungunya spread, it's always better. But it doesn't prevent most of the bites, which happen during the day. Hence mosquito nets would be a lot useful for patients that have already been infected and that are getting fevers and the virus, in high quantities, is circulating in their blood. Hence the mosquitos biting these people can infect themselves with the virus and twelve days later they will be able to contaminate other people.

JENNY MEYER: I wonder if you could just explain what the exact symptoms of chikungunya are, given that it's so similar to dengue fever and the lesser known virus zika?

YS: Chikungunya first presents usually with a fever, acute fever. The fever comes abruptly. And it's generally speaking a fever that above 38 or 38.5 Celsius, it's a high fever. And that comes together with a rash and almost all the time joint, bone pains. And especially and that's the differential with dengue most often, these joints that are effected are the small joints. The small joints of the hands, the feet, the neck and the back bone. This is the reason why chikungunya is actually very debilitating.

JM: What's the current state of the Pacific in terms of health organisations being able to respond effectively, to treat these patients and try and minimise the long term disabling effects of it?

YS: The best placed agencies are the governments themselves and that has to be stressed. Because if surveillance and  response to any disease in the Pacific is to one day become sustainable, it will come from the countries, not from external agencies. However for the moment some help might be needed from time to time. Pacific islands hardly have suitable vector control services. And SPC and my programme especially, has been calling for some regional initiatives in that sense, for now several years. Unfortunately on that one we haven't been heard yet.

JM: What would you like to see happen? When you say you haven't been heard yet, who needs to hear and what the core message?

YS: Absolutely all the stakeholders. Starting with the countries themselves, the island countries themselves. But also all the development partners. The emergency in the Pacific in terms of mosquito borne diseases, the most urgency is to be able to fight the mosquitos. And this is exactly where the services are extremely low and extremely poor. We don't have any vaccine, we don't have any specific treatment for chikungunya virus. Hence the only way remaining to fight the disease is to try to control the mosquitos. And that is precisely what the Pacific Islands are not equipped at all for doing.

JM: Is this a bit of a wake up call, this information that you have recently collated and put together on the current state of chikungunya in the Pacific? Is it a wake up call for action?

YS: I'm a little saddened by your question Madam, and not because of yourself in particular. If I would answer "Yes, this is a wake up call", I would deny the work that SPC in particular, and my team especially have been doing for the last four years.  We've been publishing papers, informing the media, in the past four years, repeatedly, about the wave of mosquito borne diseases that the Pacific Islands are facing. We've been calling for multiple sources of solidarity, help, aid, networking and the like. You may review our PR in that period of time. So if this is for some people, and major stakeholders; like media, external agencies, governments and the rest; if this is the 'wake up call' then fine. I mean it's better now than never. But calling it a 'wake up call' when half of the countries have been already hit and affected, I think is a little bit cynical.

JM: How many people do you estimate have actually been infected with chikungunya? And do you have a number of fatalities overall in the region?

YS: Well what I can tell you for example is that the estimates are that 50,000 to 60,000 people have been affected in French Polynesia. That about, over ten thousand cases have been affected in Tonga. That close to 10,000 to 20,000 cases have been affected between American Samoa and Samoa and Tokelau. In Papua New Guinea, where the first major outbreak started in the region, the latest estimates that we have, long before circulation had stopped was 15,000 cases. And Papua New Guinea may be estimated at the magnitude of French Polynesia in my view. So we are talking about a hundred thousands of people at the moment probably. There has been very few deaths in fact, in French Polynesia a handful, about 12 to 15 deaths.

JM: Where does the future lie for the Pacific region with this disease?

YS: What we can infer is that half the countries that have not been affected will be affected. And then in a number of years, in five to ten years, the virus will emerge again.

JM: So do you feel in some ways that this is milestone, like a canary in the coal mine, for the rest of the world, regarding chikungunya that people must be alert to this virus?

YS:  The situation with mosquito borne diseases is certainly worsening. This is the wake up call that my team and SPC and I have been trying to spread around the region for the past four years. And we are very happy that now everybody hears the 'alarm clock'.