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. 2014 Jun 6:6:ecurrents.outbreaks.2134a0a7bf37fd8d388181539fea2da5.
doi: 10.1371/currents.outbreaks.2134a0a7bf37fd8d388181539fea2da5.

Assessing the origin of and potential for international spread of chikungunya virus from the Caribbean

Kamran Khan  1 , Isaac Bogoch  2 , John S Brownstein  3 , Jennifer Miniota  4 , Adrian Nicolucci  4 , Wei Hu  4 , Elaine O Nsoesie  5 , Martin Cetron  6 , Maria Isabella Creatore  4 , Matthew German  4 , Annelies Wilder-Smith  7
Affiliations

Assessing the origin of and potential for international spread of chikungunya virus from the Caribbean

Kamran Khan et al. PLoS Curr. .

Abstract

Background: For the first time, an outbreak of chikungunya has been reported in the Americas. Locally acquired infections have been confirmed in fourteen Caribbean countries and dependent territories, Guyana and French Guiana, in which a large number of North American travelers vacation. Should some travelers become infected with chikungunya virus, they could potentially introduce it into the United States, where there are competent Aedes mosquito vectors, with the possibility of local transmission.

Methods: We analyzed historical data on airline travelers departing areas of the Caribbean and South America, where locally acquired cases of chikungunya have been confirmed as of May 12th, 2014. The final destinations of travelers departing these areas between May and July 2012 were determined and overlaid on maps of the reported distribution of Aedes aeygpti and albopictus mosquitoes in the United States, to identify potential areas at risk of autochthonous transmission.

Results: The United States alone accounted for 52.1% of the final destinations of all international travelers departing chikungunya indigenous areas of the Caribbean between May and July 2012. Cities in the United States with the highest volume of air travelers were New York City, Miami and San Juan (Puerto Rico). Miami and San Juan were high travel-volume cities where Aedes aeygpti or albopictus are reported and where climatic conditions could be suitable for autochthonous transmission.

Conclusion: The rapidly evolving outbreak of chikungunya in the Caribbean poses a growing risk to countries and areas linked by air travel, including the United States where competent Aedes mosquitoes exist. The risk of chikungunya importation into the United States may be elevated following key travel periods in the spring, when large numbers of North American travelers typically vacation in the Caribbean.

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Figures

Volume of Travelers from Chikungunya Indigenous Areas of the Caribbean* to the United States and Canada in May†
Volume of Travelers from Chikungunya Indigenous Areas of the Caribbean* to the United States and Canada in May†
* As of May 12th 2014 † Using historic air travel data from May 2012
Volume of Travelers from Chikungunya Indigenous Areas of the Caribbean* to the United States and Canada in June†
Volume of Travelers from Chikungunya Indigenous Areas of the Caribbean* to the United States and Canada in June†
* As of May 12th 2014 † Using historic air travel data from June 2012
Volume of Travelers from Chikungunya Indigenous Areas of the Caribbean* to the United States and Canada in July†
Volume of Travelers from Chikungunya Indigenous Areas of the Caribbean* to the United States and Canada in July†
* As of May 12th 2014 † Using historic air travel data from July 2012
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