Chikungunya epidemic affects BVI

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Ckikungunya has been classified as an epidemic by the Environmental Health Department and it was announced that the community will need to partner with the various public agencies to curtail the spread of the virus which reportedly affects Tortola, Virgin Gorda, Jost Van Dyke and Anegada.

The Chikungunya virus is carried mainly by the Aedes Aegypti mosquito and is classified as a dengue-like sickness. Symptoms include a sudden high fever, severe pain in the wrists, ankles or knuckles, muscle pain, headache, nausea, and rash. Joint pain and stiffness are more common with Chikungunya than with dengue fever which is a widely known mosquito-carried infection. The symptoms appear between four to seven days after the bite of an infected mosquito and the majority of clinical signs and symptoms last three to ten days. Currently, there is no known vaccine or treatment for this condition.

25 cases have been recently confirmed in the United States Virgin Islands. Last June the Pan American Health Organization (PAHO) reported that most of the new cases were from the Latin regions of the Caribbean, with Guadeloupe, Martinique, and the French part of St. Martin all reporting new suspected and confirmed cases. The number of chikungunya cases in the region has risen to 135,427 suspected or confirmed cases.

In a statement to the House of Assembly on 11 September, Minister for Health and Social Development, Hon. Ronnie Skelton announced that the Ministry of Health, the Environmental Health Division, and the BVI Health Services Authority are working closely together to control and respond to the current outbreak. “After the earlier outbreak in Jost Van Dyke which largely subsided, there has been increased reporting of cases over the last few weeks, particularly on Virgin Gorda. Local transmission of the virus is documented on all islands except Anegada. Unfortunately, Madam Speaker, due to the high case load around the region, samples are no longer being sent to the Caribbean Public Health Agency (CARPHA) for confirmation,” the Minister stated.

However, on 16 September Chief Environmental Officer, Carnel Smith classified the current territorial Chikungunya situation as an epidemic and said that actions need to be taken to stop the spread of the virus. The announcement was made on the Speak out BVI radio program where Mr. Smith, and Dr. Paula Trotman-Hastings of the BVI Health Services Authority (BVIHSA) were guests.

In that radio broadcast, Mr. Smith said: “I think it is in epidemic proportion and if we don’t control it, it could get worse. We have the vector, which is the Aedes Aegypti mosquito in our Territory. If we are not careful it might very well become endemic and therefore you can always have a little spike in Chikungunya, and dengue if we don’t control the mosquitoes. I think the public needs to be warned, the public needs to take heed. The public needs to do what they are being asked to do because it’s in their best interest, so I don’t think we want to cut corners here or play politics.”

Dr. Trotman-Hastings announced that the situation is not a simple one: “It’s really a large picture that we have been dealing with now. We have seen lots of people that we have been testing over the last few months, and especially since the last rains a few weeks ago we started to see large number of people coming in with symptoms of high fever, feeling very unwell.”

How the Virus Came to the BVI

The Caribbean became more attentive  on Chikungunya  after it was reported in Saint Martin last year. It was later discovered here in the BVI, and since then there continues to be reported cases of the virus. In his radio broadcast, Mr. Smith gave an explanation on how the virus allegedly arrived in the Territory.

The Chief Environmental Health Officer said: “…(The) case of Chikungunya on Anegada might have resulted from a visitor from Virgin Gorda, who went down to Anegada. We are also aware that the number of cases that started to cascade in Virgin Gorda came as a result of an individual who visited the Dominican Republic, and they came back infected. Now, how do we know that that person was infected; it’s because we know the incubation period of the disease, and we know that when that individual got sick, it was too short a period to have caught it on Virgin Gorda. They came back in the viremic stage of the disease, and as a result (we) got a whole number of cases coming back from that. We also know that in December how it started in Jost Van Dyke — it came in from St Maarten. So, we are saying that we are a tourism country and we exchange visitors, we go places, people travel here, and it is very easy because people can come in looking very healthy and within two days…”

He noted that in July, during the regional basketball tournament that was held in the Territory, an individual came into the BVI from one of the countries allegedly infected. “He came in on  Sunday night, and by Monday night going into Tuesday morning he had high fever and he was very viremic. He went to the hospital and he was diagnosed with Chikungunya, and we know where he came from, in the area where he lived they had chikungunya. After that happened we had to take some actions in order to protect our population.”

While commenting on the issue of Chikungunya arriving via the ports, Dr. Trotman-Hastings stated: “We can’t discriminate against people visiting from places now, because we have cases of people coming back into the Virgin Islands from Florida who must have picked it up in Florida, which is the only logical explanation for the time they are exhibiting the symptoms. When you stop and think about it, if we have a lot of people moving from the BVI, St Thomas, St John to Miami why can’t you then have little pockets where it spreads and then come back in; so we just need to be prepared, protect ourselves and control the mosquitoes before the mosquitoes manage to control us.”

The number of deaths in the Caribbean from the disease  was 14 in June. Almost two thirds of the new cases involve suspected infections from the Dominican Republic and Haiti. The number of illnesses in the Dominican Republic climbed by 14,337, to 52,976 last June, while the number in neighboring Haiti climbed by 5,490, to 11,802. The European Centre for Disease Prevention and Control (ECDC), which has been tracking the outbreak in the Caribbean since it began in the French side of St. Martin in December, reported similar numbers. In June, the ECDC said there have been more than 100,000 suspected cases in the region and at least 14 deaths. It said an increasing number of cases have been reported from most of the affected areas.

The Fogging Approach

Fogging is regularly practiced by the Department, but it was announced that this approach might not be a very practical one. It was explained that it is  expensive to fog and that some chemicals used for fogging cost over $100, and in some cases over $200 per gallon: “If you multiply that by 30 gallons you know how much money you’re spending on the chemical, and that’s just the purchase price that does not include the importation of it, the equipment and then you might have to have other additives to it in order to give it the smoke. Also over a period of time your exposure to that, can cause you harm as well. You would want to do something to control mosquitoes, so you don’t want to have too much fogging. Besides that, the money spent fogging can go into some other use for us…It’s not a preventative measure, the prevention is stopping the breeding; so we need to take stock; and realize where we are going wrong, and where we need to take the correct step for our own good and own benefit,” Mr. Smith said.

Travel Advisories

The British Virgin Islands is listed on the US Center for Disease Control’s (CDC) list of countries in the Caribbean with Chikungunya. The CDC has also issued a travel advisory to that effect. However, Dr. Trotman-Hastings announced that there is no cause for alarm. She said: “If we share the information first…I think if we are upfront and we are clearly taking steps to address this overall situation there will be no reason for anybody to target us and say — oh look don’t go there. If we pretend as if it is not happening, that’s where we are going to run into problems; because we are not going to be taking the appropriate steps to control the mosquitoes to prevent them from spreading and that’s where people will come and get ill.”

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