A risk assessment was issued last week by the European Centre for Disease Prevention and Control on the ongoing outbreak in Italy of chikungunya – a mosquito-borne viral disease.

The Health Promotion and Disease Prevention Directorate, in a statement has said that the health authorities in Malta are in direct communication with the European Centre for Disease Prevention and Control and the Health Security of the Commission to follow the situation.

Two related clusters of autochthonous transmission of chikungunya virus have been detected in Italy in the city of Anzio and in Rome, two areas located 60 km apart in the Lazio region. No cases have been reported in Malta, the Directorate said.

It advised that people returning from affected areas and developing sudden onset of high fever, severe joint pain, muscle pain, and rash within 2 weeks of returning should consult their family doctor and contact the Infectious Disease Unit on 21324086.

Travellers returning from affected areas are also advised to continue implementing the recommended measures to prevent getting bitten by mosquitoes for 10 days after their arrival in Malta.

The Directorate added that although there are no travel restrictions, people who plan to travel to affected areas are advised to take personal protective measures against mosquito bites by:

• Wearing long sleeves, long trousers, and hats.

• Using mosquito repellent that has DEET as an ingredient in concentrations between 40-50%. It is safe to use during pregnancy and while breastfeeding but only in concentrations less than 50%. This insecticide cannot be used on infants less than 3 months. Repellents need to be applied at regular intervals and in accordance with the product label.

• Sleeping or resting in screened or air-conditioned rooms otherwise use of insecticide-treated mosquito netting when sleeping is recommended.

• Individual protective measures to prevent mosquito bites should be applied all day long, especially during mid-morning and late afternoon to dusk, which are the periods of highest mosquito activity.

• Eliminating any possible mosquito breeding sites, such as standing collections of water while staying in an affected region.

The Directorate advised that travellers that have immune disorders or severe chronic illnesses should consult their doctor before travelling to affected areas.

The public is also encouraged to eliminate mosquito breeding sites in the community by removing standing collections of water such as left-over water in flower pots, wading pools, drain pipes, and watering cans.

Further information can be found here and here. A helpline for more information available on 21324086.

Chikungunya is a mosquito-borne viral disease transmitted by the bite of infected Aedes mosquitoes, primarily Aedes aegypti and Aedes albopictus.

The Aedes mosquito has white stripes on its black body and legs and is also known as Asian Tiger mosquito.

The Aedes albopictus species is established in many parts of the EU, primarily around the Mediterranean and also in Malta. No cases have been reported in Malta.

In 2007, chikungunya transmission was reported for the first time in Europe, when Italy experienced an outbreak affecting 217 cases in the Emilia Romagna region. Another localised outbreak of chikungunya is currently ongoing in Var department in South-eastern France since early August 2017.

The Directorate said that as the current outbreak in Italy is in the highly touristic greater metropolitan area of Rome and in the summer season when the mosquito is mostly active there is a risk for international spread via returning infected travellers to countries with established populations of Aedes albopictus.

Symptoms of chikungunya include sudden onset of high fever, severe joint pain, muscle pain, and rash. Symptoms typically appear on average 4 to 7 days after being bitten by an infected mosquito.

Most patients recover fully, but in some cases, joint pain may persist for several months. Chikungunya may also cause serious disease particularly in the elderly and immunocompromised. No specific treatment or vaccines are currently available.

Photograph: Aedes albopictus mosquito (Asian Tiger)

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