Chikungunya Virus: Reporting and Surveillance

DHS surveillance resources

• Arboviral Infection EpiNet, P-01930 (PDF): An arboviral infection case reporting and investigation protocol for health professionals.
• Arbovirus Management Protocol, P-00894 (PDF): Information for arboviral disease management, including surveillance, testing, reporting, and follow-up, in humans and animals.

CDC provider resources

• Clinical Signs and Symptoms of Chikungunya Virus: Information from the CDC (Centers for Disease Control and Prevention) on clinical disease.
• Clinical Testing and Diagnosis of Chikungunya Virus: Recommendations for health care providers on laboratory testing and diagnosis from the CDC.

Laboratory diagnosis of acute chikungunya virus

Laboratory diagnosis of acute chikungunya virus most often involves the detection of viral RNA or IgM antibodies against chikungunya virus. Molecular methods, commonly reverse-transcription polymerase chain reaction (RT-PCR), should ideally be performed on acute specimens collected in the first 8 days of symptoms. Chikungunya virus IgM antibodies typically develop after 5-8 days of illness and remain elevated for at least 12 weeks after illness onset. Often, collection of both acute and convalescent specimens may be necessary to make a diagnosis of chikungunya infection, especially if acute-phase specimens are negative.

For further information on laboratory diagnosis of chikungunya infection, visit CDC Chikungunya Laboratory Guidance.

Chikungunya testing at the Wisconsin State Laboratory of Hygiene

Chikungunya virus testing is available at some commercial labs. Chikungunya virus testing can also be requested through the Wisconsin State Laboratory of Hygiene (WSLH) using a RT-PCR panel (includes tests for chikungunya, dengue, and Zika viruses) or chikungunya IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA). Chikungunya IgM antibody testing is performed at CDC. Specimens positive for chikungunya IgM antibodies will be tested using plaque reduction neutralization test (PRNT) for serologic confirmation.

The Arbovirus PCR panel (test code SS02310) is available at the WSLH either fee-for-service (no prior approval needed) or fee-exempt (prior approval needed). Prior approval is not required to submit specimens to WSLH for chikungunya, dengue, and Zika virus PCR testing, unless fee-exempt testing is being requested.

Chikungunya virus IgM testing is available at WSLH only fee-exempt, and requires clinicians to obtain prior authorization before specimen submission to WSLH.

Providers may request fee-exempt chikungunya testing for patients who:

• Have symptoms consistent with chikungunya, and
• Traveled to an area with a risk of chikungunya within 14 days of illness onset, and
• Would not otherwise have access to testing for financial reasons (for example, lack insurance coverage).

Public health officials may request fee-exempt chikungunya testing for patients with:

• Chikungunya positive test results from a clinical or commercial lab (performed at laboratories other than the WSLH) for laboratory confirmation, or
• Laboratory evidence of an arboviral infection who are part of a public health investigation.

To request fee-exempt testing at WSLH, contact a DHS Division of Public Health vectorborne disease epidemiologist at 608-267-9003 or email DHSDPHBCD@dhs.wisconsin.gov prior to specimen submission.

Instructions for collection and shipping of clinical specimens to the WSLH

• Submit 2-5 mL of serum in sterile screw-capped vials on ice using a WSLH kit #22 or equivalent within five days of collection. If shipping more than five days after collection, freeze specimen at -20°C and ship on dry ice. Specimens should be triple packaged as a Category B Biological Substance (include UN3373 label).
• Fee-exempt testing submissions must include a WSLH Enhanced Wisconsin Arbovirus Surveillance form provided by a DPH vectorborne disease epidemiologist in addition to the WSLH Requisition Form B.
• Fee-for-service testing submissions must include a WSLH CDD Requisition Form B. Please contact the WSLH Clinical Orders at 800-862-1088 or 608-224-4275 to obtain the WSLH CDD Requisition Form B and to order specimen shipping kits.
• It is essential that the lab requisition form be as complete as possible, including patient name, city, date of birth, specimen type, submitting agency, onset date, signs and symptoms, collection date, and recent travel history. Note: Testing for chikungunya virus may be delayed on specimens missing the above data until information is available.
• Ship specimens with the appropriate, completed forms to:
  Wisconsin State Laboratory of Hygiene
  2601 Agriculture Drive
  PO Box 7904
  Madison, WI 53718
  Customer Service: 800-862-1013

Diagnosis of chikungunya should be considered if a patient has acute onset of fever and arthralgia, and has recently traveled to an area with a risk of chikungunya virus transmission. Diagnosis of chikungunya can be complicated by the fact that dengue and Zika viruses are transmitted by the same mosquitoes, have overlapping geographical ranges, and have similar clinical presentations. Chikungunya IgM antibodies can cross-react with related viruses, requiring confirmatory laboratory testing and/or convalescent specimen collection.

Compared to dengue and Zika virus infections, chikungunya virus infection is more likely to cause high fever, severe arthralgia, arthritis, and lymphocytopenia. A patient’s clinical signs and symptoms and risk activities can help to inform a preliminary diagnosis prior to laboratory confirmation. For additional information on clinical presentation and diagnosis of chikungunya, visit CDC Chikungunya Clinical Guidance.

There is currently no specific treatment for chikungunya virus. Clinical management is supportive care, including rest, fluids, and over-the-counter pain relievers to relieve acute pain and fever. If a patient has traveled to a dengue-endemic area, acetaminophen is the preferred first-line treatment for fever and joint pain until dengue can be ruled out.

Patients with suspected chikungunya virus disease should be managed as dengue until dengue virus infection has been ruled out. See CDC's fact sheet on Clinical Management of Chikungunya in Dengue-Endemic Areas (PDF) for more information.

There is now a vaccine available for adults aged 18 years and older to prevent chikungunya virus infection in the U.S. called IXCHIQ. Regardless of vaccination status, travelers should still use protective measures to prevent mosquito bites during and after their trip