Mortality and global health estimates

Measuring how many people die each year and why they have died is one of the most important means along with
gauging how various diseases and injuries are affecting the living of assessing the effectiveness of a countrys
health system. Having those numbers helps health authorities determine whether they are focusing on the right kinds
of public health actions that will reduce the number of preventable deaths and disease.

Mortality and global health estimates

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Life expectancy

70 years

is the average life expectancy at birth of the global population in 2011.

Life expectancy at birth

Deaths

74%

of child deaths occur in Africa and South-East Asia.

Under-five mortality
Disability-adjusted life years (DALYs)

45%

of DALYs in low- and middle-income countries are caused by noncommunicable diseases.

25 July 2011
Chikungunya virus activity Global update
This update reports on current and recent chikungunya (CHIKV) outbreaks; it is not a comprehensive listing. Further
information on confirmed and suspected CHIKV outbreaks can be accessed via the NaTHNaC Outbreak Surveillance
Database.
A map of areas of risk for CHIKV is available from the World Health Organization.

Africa and the Middle East

Republic of Congo
The Republic of Congo has reported a CHIKV outbreak that has caused illness in thousands of people [1]. This is the
first time that the Republic of Congo has reported CHIKV [2]. Since the end of May 2011, the capital city of
Brazzaville, and Pointe Noire have been affected, and as of 1 July 2011, CHIKV has spread to the neighbouring Pool
region [1]. As of 23 June 2011, the total number of reported cases in the country has reached 7,474 [2].
Yemen
Since the end of 2010, an outbreak of CHIKV has been reported in the western coastal province of Hodeidah with
1,000 cases and 75 deaths. This is the first time CHIKV has been identified in Yemen [3].

Islands of the Indian Ocean

Historically outbreaks of CHIKV have occurred in several islands of the Indian Ocean including the Comoros,
Madagascar, Mayotte, Mauritius, Reunion and the Seychelles. In 2010, only Reunion reported cases of CHIKV [4].
In 2011, confirmed cases of CHIKV have been reported from Seychelles (one confirmed case) and Madagascar (five
confirmed and 102 suspected cases) [5].

Asia and Western Pacific

New Caledonia
Following two imported cases from Indonesia in 2011, the diagnosis of the first indigenous case of CHIKV was
confirmed on 3 March 2011 [6-7]. As of 7 July 2011, 33 cases of CHIKV have been reported. Of these, 29 cases were
from Noumea, one case from Sarramea and three cases from Dumba [6-7].
Malaysia
As of 25 June 2011, a total of 17 cases have been reported, representing a decrease of 98% compared with the
same period in 2010, when 684 cases were reported [8].
Singapore
As of 26 June 2011, two confirmed cases of CHIKV have been reported (one imported), compared with 26 cases in
2010 (20 imported) [9-10].
Thailand
As of week 28 in 2011, a total of 90 cases have been reported in 15 provinces of Thailand. To date, the most affected
provinces are Southern Province, followed by Central Province, North Province and North-East Province [11].
India
As of 26 March 2011, seven states have reported 1,180 suspected cases of CHIKV. The state of West Bengal has
reported most of the cases (504), followed by Tamil Nadu (328) and Maharashtra (154). The remaining cases were
reported from Karnataka, Goa and Kerala. [12].

Europe
France
As of 15 July 2011, one case of CHIKV has been confirmed in Provence-Alpes-Cte d'Azur, an area of enhanced
surveillance for the disease. The case occurred in a person from Brazzaville, Republic of Congo, who arrived in
France and reported symptoms on 3 May 2011 [13].
In 2010, two indigenous cases of CHIKV and four imported cases of CHIKV occurred in the Var department [14].

Advice for travellers

CHIKV is a viral infection of humans and non-human primates transmitted by Aedes spp. mosquitoes. It is endemic in
parts of sub-Saharan Africa, the islands of the Indian Ocean, and South and South East Asia. In symptomatic illness
there is the sudden onset of fever, headache, myalgia and arthralgia. After 2 to 3 days a generalised maculopapular
rash can develop. Most cases recover in 3 to 5 days, however, 5-10 percent of cases can have chronic joint pain,
arthritis and fatigue. Treatment is supportive.
There is no vaccine to prevent CHIKV. Travellers to endemic areas can reduce their risk of infection by
practising insect bite avoidance measures. Aedes spp. mosquitoes responsible for transmitting CHIKV, are most
active during daylight hours. Particular vigilance with bite avoidance should be taken around dawn and dusk.

References
1. Relief Web. The International Federation of Red Cross and Red Crescent Societies, Republic of Congo:
Chikungunya outbreak in Brazzaville, Pointe Noire and Pool, 29 June 2011. [Accessed 25 July 2011]. Available
at:http://reliefweb.int/sites/reliefweb.int/files/resources/Full_
Report_1514.pdf

http://www.nathnac.org/pro/clinical_updates/chik_global_250711.htm

Chikungunya
Chikungunya is a viral disease (genus Alphavirus) which is transmitted to humans by infected mosquitoes
including Aedes aegypti and Aedes albopictus. The name chikungunya originates from a verb in the Kimakonde
language, meaning 'to become contorted'. This refers to the 'stooped' appearance of those suffering with joint pain.
Symptoms

Symptoms appear between 4 and 7 days after the patient has been bitten by the infected mosquito and these include:
High fever (40C/ 104F)
Joint pain (lower back, ankle, knees, wrists or phalanges)
Joint swelling
Rash
Headache
Muscle pain
Nausea
Fatigue
Chikungunya is rarely fatal. Symptoms are generally self-limiting and last for 23 days. The virus remains in the
human system for 5-7 days and mosquitoes feeding on an infected person during this period can also become
infected. Chikungunya shares some clinical signs with dengue and can be misdiagnosed in areas where dengue is
common.
Chikungunya can be detected using serological tests. Recovery from an infection will confer life-long immunity.
Geographical range

Chikungunya has been identified in nearly 40 countries. Map of countries at risk available here
Countries having documented, endemic, or epidemic chikungunya are:
Asia: Human chikungunya virus infection has been documented in Cambodia, East Timor, India, Indonesia, Laos,
Malaysia, Maldives, Myanmar, Pakistan, Philippines, Runion, Seychelles, Singapore, Taiwan, Thailand and
Vietnam.
Africa: Chikungunya occurs in Benin, Burundi, Cameroon, Central African Republic, Comoros, Congo (DRC),
Equatorial Guinea, Guinea, Kenya, Madagascar, Malawi, Mauritius, Mayotte, Nigeria, Senegal, South Africa,
Sudan, Tanzania, Uganda and Zimbabwe.
Europe and the Americas: Aside from minor incidence rates caused by imported cases from travelers, Italy is the
only European country which has had an outbreak. The Americas have not had any major outbreaks so far.
Recent outbreaks

Chikungunya was first identified in Tanzania in the early 1952 and has caused periodic outbreaks in Asia and Africa
since the 1960s.
Outbreaks are often separated by periods of more than 10 years. Between 2001 and 2011, a number of countries
reported on chikungunya outbreaks.
2005-2006: More than 272 000 people were infected during an outbreak of Chikungunya in the Indian Ocean islands
of Runion and Mauritius where Ae. albopictus was the presumed vector.
2006: Outbreak in India, more than 1 500 000 cases of chikungunya were reported with Ae. aegypti implicated as the
vector.
2007: Migration of infected people introduced the infection in a coastal village in Italy. This outbreak (197 cases)
confirmed that mosquito-borne outbreaks by Ae. albopictus are plausible in Europe.