Outbreak of Chikungunya Fever in North-East Italy

Between July 4th and September 3rd, 151 cases of chikungunya fever were reported from the province of Ravenna, in the region of Emilia-Romagna in North-East Italy, of whom 27 were laboratory confirmed.

The villages of Castiglione di Ravenna and Castiglione di Cervia have reported most of the cases. The main symptoms of the patients were high fever and joint pain, as well as headache, muscle pain, rash and less frequently gastrointestinal symptoms. One death was reported in a 83-year old individual with underlying medical conditions. Local mosquitoes are most likely responsible for transmitting the infection; tests are being carried out to confirm this. If confirmed, this situation represents the first time that local transmission of Chikungunya virus through mosquitoes has been described in Europe. Therefore, the province of Ravenna in the Emilia-Romagna region of North-East Italy should now be considered as an area where Chikungunya virus transmission is occurring. Recommendations to visitors to areas with chikungunya transmission Visitors to any area where there is transmission of Chikungunya virus are advised to take the following preventive measures to minimise the exposure to mosquito bites while there:

1. Use of anti-mosquito devices (insecticide-treated bed nets, spray, repellents etc.) and wearing long sleeve – long leg clothes, especially during the hours of highest mosquito activity.
2. Mosquito repellent based on a 30% DEET concentration is recommended. Before using repellents, pregnant women and children under the age of 12 years should consult a physician or pharmacist. For newborn children under three months, repellents are not recommended; instead, insecticide-treated bed nets and protective clothing should be used.
3. Pregnant women, immuno-deprived people and people suffering from a severe chronic illness should consult their physicians prior to the travel in order to assess their risk and get recommendations on personal preventive measures.

Recommendations for those who return from the area Persons who have visited any area where Chikungunya virus transmission occurs, and who develop a high fever along with unexplained joint pain in the 12 days after their return are advised to seek medical attention. It is especially important for these persons to take preventive measures to reduce mosquito bites while symptomatic in order to avoid possible further mosquito transmission to others (with appropriate protective clothing, use of repellent and anti-mosquito devices such as insecticide-treated bed nets, spray, repellents, etc – see above). (Source: European Centre for Disease Prevention and Control : September 2007)