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The painfilled aftermath of chikungunya

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Chikungunya continues to spread in the Caribbean, and in Central and South America. By far, the worst of the outbreak of the mosquito borne illness has been on the island of Hispaniola, in Haiti and the Dominican Republic. Americans living and working in those countries have contracted the disease and are now reporting continuing symptoms or a relapse of symptoms. Dr. Jen Halverson spoke with the Examiner on Twitter July 2 about her experience.

Halverson first experienced the symptoms of chikungunya on May 13. Her illness was confirmed by blood tests, antibody and PCR, done on May 19. It has been seven weeks since she first became ill.

Dr. Halverson caught chikungunya while volunteering in Haiti. She returned to the United States on May 18. In mid-June she was the subject of several news stories in the Minnesota media describing her illness and recovery.

It has not been much of a recovery. She wakes up limping every day. In the last several days, Halverson states, her fingers, wrists and one shoulder have been painful for the first time in weeks.

The doctor is not alone with suffering painful aftereffects from chikungunya. On Twitter, a number of Americans in Haiti and the Dominican Republic are talking about continuing symptoms or a relapse of symptoms weeks after recovering from the initial illness.

One man became ill with chikungunya on May 30. The following day, he tweeted "Have the Chikungunya virus & have never been this sick with fever & joint pains." On June 1, he wrote "Have had malaria 18 times , twice this year, but this virus make malaria seem like the sniffles." Today, in response to a question from the Examiner, he said "No relapse, but symptoms every day: lots joint pains and fever at night."

A human rights activist in Haiti contracted chikungunya on May 16 and had recovered enough to return to work by May 22. Seven weeks later, she is having continuing joint pain and swelling.

One young woman, who asked that she be called GOALS after her employer in Haiti, tweeted her illness. Her first chikungunya symptoms began May 19. On June 2, she was able to tweet: "I hate to say it outloud, but it looks like my extreme tiredness from chikungunya is finally gone... I feel GREAT today! Watch out world!" July 2, she reported a relapse of symptoms "just had fever/pain again yesterday/Monday. Came out of nowhere."

The Institut Pasteur says this about the long-term effects of chikungunya:

The clinical symptoms of chikungunya usually disappear relatively quickly – patients tend to recover from the fever and rashes associated with the disease within a few days, but joint problems can persist for several weeks. Infection by the chikungunya virus does not seem to have been the direct cause of the small number of fatalities recorded during epidemics.

Joint pain can persist in subacute or chronic form for several months or even years, particularly in older patients. In a retrospective South African study, 10% of patients were still affected 3 to 5 years after acute infection by the chikungunya virus.

A study of a small number of patients who had been ill with chikungunya and recovered was published in 2013. Among their conclusions were:

We found that 60% of patients experienced arthralgia 36 months after the onset of acute disease. Arthralgia affected most often multiple sites and were usually incapacitating. In addition to arthralgia, many patients suffered from myalgia and cutaneous lesions and several cognitive dysfunctions. We also showed that age over 35 years and the presence of arthralgia 4 months after the onset of disease are risk factors for long-term arthralgia. Patients with long-term arthralgia did not display biological markers typically found in autoimmune or rheumatoid diseases.

A larger study, also published in 2013, found that just 25 percent of patients who had rheumatic musculoskeletal pain during their chikungunya illness were symptom free two years after the end of their acute infection. Lingering pain was reported by 43 percent of the patients and relapsing episodes of pain by 32 percent. The study identified several predictors for continuing pain symptoms, including a patient age of 45 or older and severe pain during the acute illness.

In the tweets about continuing pain, there are comments about the difficulty of packing a suitcase, opening a bottle of Coke or being able to roll up the window in a pickup truck. Dr. Halverson notes that for the people of Haiti, post-chikV arthritis presents a much different and far more serious problem.

I think about a whole nation of people (many of whom do manual labor for a living) dealing with chronic arthritis. And I think about people carrying 5 gallon buckets of water on their head while dealing with post-chikV joint pain.

We have it pretty good here in the U.S. but for the average Haitian, this post-chikV arthritis could be quite debilitating. & by having it good, I mean access to pain meds, little to no manual labor, etc. Situation for average Haitian is very diff.

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