‘Knuckle fever’ reaches Italy

From San Diego, at a meeting of the Infectious Diseases Society of America

An exotic virus that debilitates victims with fevers and joint pain has spread from Africa and India to Italy, where it has caused at least 284 cases of illness.

The chikungunya-virus outbreak began in 2004 on Lamu, an island off the east coast of Africa, says Robert Breiman, an epidemiologist at the Centers for Disease Control and Prevention station in Kisumu, Kenya. It soon spread to the nearby Comoro Islands, and “then the bottle really opened up” and the outbreak leaped to mainland Africa and to India.

Breiman and his team estimate that 75 percent of the residents of Lamu contracted the virus. Once the virus is established in an area, “it’s almost impossible to escape,” Breiman says. On the Comoro Islands, 215,000 people became infected. French authorities reported 266,000 cases on Reunion Island, off Madagascar. There, health officials attributed 255 deaths to chikungunya, although the virus’ lethality is debated. People almost never die from it, says Breiman, “although they wish they had.”

The crippling symptoms often clear up in a few weeks, but can sometimes linger for months.

First identified in the 1950s, chikungunya means “stooped over in pain” in an African dialect. The illness used to be called knuckle fever, a reference to the swollen joints it can cause.

Mosquito control is the best way to limit outbreaks, says Breiman, but “traditionally, that has been very hard to implement.”

Although epidemiologists have not established exactly how the disease spread so widely, Breiman says that it’s likely that people infected in one area traveled to another, and then were bitten by local mosquitoes that continued the chain.

Breiman says “the question now is will it continue to spread to other places that have” the right type of mosquito. “And I would think that is likely.”

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