Chikungunya in Georgia: Preventing Local Transmission through Rapid Response, 2014

BACKGROUND:   In December 2013 local transmission of Chikungunya, a mosquito-borne virus, was first detected in the Americas. Transmission of the virus in the Caribbean also brought the threat of travel-related cases and local transmission in the US. In June 2014, the Georgia Department of Public Health (DPH) was notified of several suspect Chikungunya cases among travelers. Competent mosquito vectors, Aedes aegypti and Aedes albopictus, are found in Georgia. This prompted DPH epidemiologists to immediately develop a Chikungunya Response Plan to prevent local transmission within the state.

METHODS:   The Response Plan was developed for use by state and local public health staff. Included was disease background, questionnaires for suspect cases and companion travelers, laboratory testing guidance, mosquito avoidance education, case report forms, and media talking points. DPH staff collaborated with the state public health laboratory to arrange testing through DPH and CDC until capacity was developed at commercial laboratories. Mosquito control programs are not found in all Georgia counties, so protocols were developed to fill gaps in local response. A one-page guidance document was sent to physicians state-wide alerting them to increased risk of illness in travelers and providing laboratory guidance and contact information for consultation from DPH. Trainings were completed with local public health staff empowering them to triage new suspect cases and field questions from healthcare providers. An outbreak log was created within the state’s electronic notifiable disease system to serve as a centralized location for tracking new suspect cases across districts.

RESULTS:   Within the first 2 weeks of the response, the Response Plan was disseminated as DPH epidemiologists investigated 19 suspect cases of Chikungunya, several identified through companion traveler investigations. Nine were found to be positive through testing at CDC and commercial laboratories. All suspect cases and travel companions were provided with mosquito avoidance education upon investigation. As of January 6, 2015 there have been 26 confirmed travel-related cases of Chikungunya and no suspect or confirmed cases of local transmission in Georgia.

CONCLUSIONS:   Despite the presence of competent mosquito vectors and a large number of suspect and confirmed cases of Chikungunya, the rapid release of the Response Plan along with structured collaboration throughout investigations of suspect cases has aided in the prevention of local transmission in the state. Although local transmission may occur in the future, organized protocols, widespread education, and collaboration with mosquito control partners will help minimize the number of secondary cases in the state.