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Chikungunya has Arrived in Costa Rica

December 15th, 2014

I am never fond of travel advisories because far too often, people overreact to things that are just not all that serious.  On the other hand, I delayed blogging about these two topics until I could get the full picture. Neither is, in my opinion, reason to change travel plans.  Both, however, should be read and absorbed so you can enjoy your time in Costa Rica.

The first is about the chikungunya virus now having arrived in Costa Rica.

The second is about the death of an 11-year-oldchild from a brain infection last July that prompted the Florida Health Department to issue an advisory alert after tests confirmed the infection was caused by an amoeba he contracted while vacationing in Costa Rica. If these subjects are of interest to you… read on!

The Costa Rica Ministerio de Salud has confirmed the arrival of the chikungunya virus in Costa Rica.

What is chikungunya? (to me, the older nastier big brother of Dengue Fever)

ae_aegypti_ae_albopictusChikungunya is an illness caused by a virus that spreads through mosquito bites. Chikungunya is primarily transmitted by the mosquito Aedes aegypti, the same critter responsible for the spread of dengue fever. Read about dengue here and here.

The most common symptoms of chikungunya are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Chikungunya disease rarely results in death, but the symptoms can be severe and disabling. Most people who get sick feel better within a week. In some people, the joint pain may last for months or years.

Who is at risk?

Travelers who go to the islands in the Caribbean are at risk of getting chikungunya. In addition, travelers to Africa, Asia, and islands in the Indian Ocean and Western Pacific are also at risk, as the virus is present in many of these areas.  It is also now here!

What can travelers do to prevent chikungunya?

This part revolves around prevention as there is no cure. It is about 100% common sense!

Use an appropriate insect repellent as directed.
Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:
DEETExternal Web Site Icon (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon)
Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US])
Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals)
IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)
Always follow product directions and reapply as directed:
If you are also using sunscreen, apply sunscreen first and insect repellent second.
Follow package directions when applying repellent on childrenExternal Web Site Icon. Avoid applying repellent to their hands, eyes, and mouth.
Use permethrin-treatedExternal Web Site Icon clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:
Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
If treating items yourself, follow the product instructions carefully.
Do not use permethrin directly on skin.
Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.  Maybe hard to do on a tropical day at the beach
Stay and sleep in screened or air conditioned rooms. Easy in Costa Rica unless you are camping in the rain forest.  If you are, use a bed net if the area where you are sleeping is exposed to the outdoors.

 Where are some cases in Costa Rica?

You would think this would be a simple thing, but few things are simple in Costa Rica, so I am going to just give the areas that so far have generated reports. The critical thing is to understand that mosquitoes fly around, so just about anywhere there are mosquitoes biting, there might be exposure. So… the answer is to protect yourself as outlined above.   I would never cancel a trip to Costa Rica because of bugs!

Some locations in Costa Rica where reports have been made:   Parrita, Costa de Pájaros, Chomes,  Tamarindo, Manzanillo, Puntarenas, and Abangares.

So what are the symptoms?

  • Most people infected with chikungunya virus will develop some symptoms.
  • Symptoms usually begin 3–7 days after being bitten by an infected mosquito.
  • The most common symptoms are fever and joint pain.
  • Other symptoms may include headache, muscle pain, joint swelling, or rash.
  • Chikungunya disease does not often result in death, but the symptoms can be severe and disabling.
  • Most patients feel better within a week. In some people, the joint pain may persist for months.
  • People at risk for more severe disease include newborns infected around the time of birth, older adults (≥65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease.
  • Once a person has been infected, he or she is likely to be protected from future infections.

Summary?

Come and visit and use bug spray.

Important update:  Added 25 December from Voice of America.

A debilitating mosquito-borne virus, called Chikungunya, has stricken more than 1 million people in the Western Hemisphere since spreading there a year ago.

The Pan-American Health Organization reports 155 reported deaths as of December 12, almost all in the Caribbean island nations of Guadeloupe and Martinique. There have been 1,900 cases reported in travelers returning to the United States.

Chikungunya is marked by severe joint pain, inflammation, headaches, rashes and fever. If the infection is severe enough, it can lead to death. Symptoms can persist for months in those who survive, causing debilitating arthritis.

The virus, which has symptoms similar to dengue fever, has long been a scourge in Asia and Africa. In fact the name, Chikungunya, comes from the African Makonde dialect, meaning “bending over in pain.”

There is currently no vaccine or treatment for the disease.

Chikungunya is carried by two mosquito species — Aedes aegypti and Aedes albopictus — that also transmit the dengue virus. Chikungunya, which is carried in the blood, is picked up by mosquitoes after they bite an infected person and spread when the insects then bite uninfected individuals.

Public health officials worry that the virus could persist in the Americas for months, as climate conditions in the tropical countries are ripe for the insect carriers to flourish.

They warn that Chikungunya cases could escalate in a number of South American countries, including Brazil, Peru and Paraguay, with the approach of the summer months.


Florida child dies after contracting amoeba from Costa Rican hot springs

My source for this topic was an article that appeared in The Tico Times in August 2014. Click here to view this article.  Rather than just repeat what they have written I suggest that you read it completely if you plan to visit Costa Rica and enjoy the many wonderful hot springs offered here. I am going to excerpt a few key items, but really, read the entire article yourself  -PLEASE.

Just an FYI.  For years, I have suggested that folks avoid swimming in the many fresh water rivers and lakes in Costa Rica.  I think water sports like skiing and wind surfing are another matter though.

The child reportedly  “died from a brain infection caused by Naegleria fowleri, an amoeba widely found in warm freshwater and soil”.

There are only 134 documented cases of deaths from Naegleria fowleri in the past 50 years in the U.S. Most from Florida.

Reduce your risk of Naegleria infection by using nose clips or keeping your head above water in warm freshwater.

Elizabeth Abrahams S. , a microbiologist with the University of Costa Rica’s (UCR) Parasitology Department, confirmed this is the first documented case of a Naegleria-related death involving Costa Rica

Children are most prone because their bodies absorb the amoeba more easily.

“There is no need to be alarmed, but we recommend owners of tourism businesses to remain vigilant at their facilities,” Abrahams said. “Placing warning signs is a preventive measure, but considering that amoebas are present all over the world, this could mean that every single hot springs resort in the world should warn visitors about this.”

Always remember you are in the tropics when you are in Costa Rica, and while there are risks inherent when traveling anywhere in foreign countries, you should simply weigh the benefits of travel to exotic places vs. staying safe at home.


One Response to “Chikungunya has Arrived in Costa Rica”

  1. Kim Kranich on December 16, 2014 8:52 am

    Thanks for posting this.

    I find your blog very informative and I appreciate it!

    I was specifically interested in this sentence from yesterday’s post:

    “For years, I have suggested that folks avoid swimming in the many fresh water rivers and lakes in Costa Rica. ”

    Can you please tell me more about this? Why don’t you advise swimming in the fresh lakes and rivers? That was one of the things we were hoping to do when we visit.

    Thank you.

    Kim

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