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BACKGROUND: Chikungunya is an acute febrile illness, caused by mosquito-transmitted chikungunya virus (CHIKV). In December 2013, the first locally transmitted cases in the Western hemisphere were identified in the Caribbean islands. To date, we have investigated 52 individuals as possible cases among Tennessee residents. Here we describe preparedness activities, the outbreak, response measures, and lessons learned for future outbreaks.
METHODS: In anticipation of travelers returning from areas with ongoing outbreaks and the potential for local transmission, the Tennessee Department of Health (TDH) developed and delivered a tabletop exercise on chikungunya to statewide partners in March 2014. Feedback from this exercise informed the development of a statewide surveillance and response plan, which was distributed in May.
RESULTS: TDH began investigating potential cases the first week of June, and confirmed the first case in a Tennessee resident on June 13. The State Health Operations Center was activated and an Incident Command System (ICS) was established. To date, there have been 17 confirmed, 6 probable, and 16 suspect cases among residents of Tennessee. Case age ranged from 11 to 82 years, with a median age of 35 years. The length of the illness ranged from 4 – 28 days, with a median length of 8.5 days. Thirty-eight (97%) reported fever, 33 (85%) reported joint pain, and 30 (77%) reported rash. Symptom onset dates ranged from May 10 to July 11. Laboratory testing was performed by a commercial laboratory for 6 of the cases and by CDC for 17. IFA/ELISA, PCR, and PRNT tests were used, depending on the timing of specimen collection relative to symptom onset date.
CONCLUSIONS: Of the 39 confirmed, probable, and suspect cases, 33 (84%) traveled to Haiti and two to the Dominican Republic. Twenty-eight (72%) were traveling for humanitarian reasons (with a non-profit organization, a church group, or as part of adoption proceedings). Ten group trips were identified, and follow-up was conducted with trip leaders to identify additional cases. During the course of the response, TDH developed and disseminated educational materials and a testing algorithm. Regional and local health department staff performed case investigations and home visits to share educational materials related to mosquito avoidance. Information was shared with partners through statewide calls and communication channels established through ICS, and with the public through media press releases.