Crippling Caribbean Virus: Opportunity for Clinical Research

I recently visited the Caribbean isles, a popular destination for tourists this time of year, and on my way at the airport, I noticed prominent CDC disclaimers about an equatorial viral disease: Chikungunya. With existing global Ebola threats, the Chikungunya warning dampened my excitement about my visit to the Caribbean  Nonetheless, I decided to investigate the epidemic while in the Caribbean.

Chikungunya: A Debilitating Illness

First discovered in Southern Tanzania in 1952, Chikungunya is a viral disease that causes high fever, excruciating joint pain, fatigue, headache, muscle pain, and nausea [1]. Chikungunya is spread by infected mosquitos; for example, a mosquito becomes infected with Chikungunya for its entire lifetime when it bites a person infected with Chikungunya. Once infected, the mosquito is capable of spreading the virus to another person in as little as a single bite [2].

The effects of Chikungunya on human productivity are crippling. Albeit the virus causes classic signs of a viral infection (i.e., fever, muscle aches, etc.), a notable side effect includes joint pain that can last for months, and even years [3]. “I could not get out of bed for one week; it has been four months since I was sick, I still feel pain in my wrists and it is difficult to hold things,” said Claudette Beauchamps, a Saint Barthelemy resident who was infected with Chikungunya.

Global Chikungunya Outbreaks

According to a Eurosurveillance report, Chikungunya infections are on the rise and outbreaks are occurring in India, Mauritius, Mayotte, Reunion, Indonesia, Singapore, the Philippines, and even Italy and France [

4

] (

Figure 1

). 

Figure 1: Historical overview of the Chikungunya outbreaks prior to the emergence of Chikungunya virus in the Caribbean in December 2013 (Courtesy of Eurosurveillance)

In November of 2013, the first Caribbean incident of Chikungunya was reported in Saint Martin, and the outbreak rapidly spread to other Caribbean islands including Saint Barthelemy, Guadeloupe, Anguilla, Martinique and many more countries in the region [4]. Chikungunya incidences have reached the US with local outbreaks occurring in Florida [7]. In October 2014, the CDC issued a Level 1 Warning for travelers visiting the Caribbean [5]. “The outbreak was very bad this year; many people were sick with Chikungunya,” said Celeste Moreau of Saint Martin. 

Currently, there is no vaccine for Chikungunya. The CDC and other health agencies have issued health warnings on preventing Chikungunya transmissions, which involve exercising protective actions against mosquito bites, such as wearing insect repellant, and long sleeved shirts.

Chikungunya Clinical Trials and the Business Opportunity for Vaccinations

Despite growing outbreaks, minimal clinical research has been conducted on Chikungunya vaccinations; the only adult human trial on Chikungunya vaccinations was an NIH sponsored Phase I trial that enrolled 25 patients.

The business opportunity for Chikungunya should not go unnoticed. Thus far in 2014, more than 15 million tourists visited the Caribbean (not including people arriving on cruises), and millions of people in outbreak regions are in need of vaccinations. With some vaccinations costing approximately $100 per shot [6], potential market share for tourists visiting the Caribbean in 2014 can equate up to $1.5 billion, and global revenue potential far exceeding the aforementioned amount.

While Chikungunya is not as deadly as Ebola, the debilitating effects of Chikungunya significantly impact human function and productivity for prolonged periods. Preventing mosquito bites does not offer much protection; albeit, I took the necessary precautions offered by the CDC to protect myself, I was still bit six times by mosquitoes while in the Caribbean. An available vaccine would have been a necessity if it were available.

References:

[1] http://www.who.int/mediacentre/factsheets/fs327/en/

[2] http://www.pbs.org/wgbh/nova/next/body/chikungunya-outbreak/

[3] http://www.who.int/mediacentre/factsheets/fs327/en/

[4] http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20759

[5] http://wwwnc.cdc.gov/travel/notices/watch/chikungunya-saint-martin

[6] http://health.costhelper.com/yellow-fever-vaccine.html

[7] http://www.cdc.gov/chikungunya/geo/united-states.html

[8] images courtesy of www.freerangestock.com