Overview
If you have ever had a fever come on suddenly, followed by joint pain so severe that walking or even holding a cup feels difficult, chikungunya is one of the illnesses worth knowing about. It spreads through the same mosquitoes that carry dengue, and in places where both circulate, it is easy to mistake one for the other.
Disease Summary
- Category
- Infectious Disease
- Cause
- Chikungunya virus (CHIKV), an alphavirus spread by infected mosquitoes
- Transmission
- Bites from infected Aedes aegypti or Aedes albopictus mosquitoes
- Body System
- Joints and Musculoskeletal System
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
Most people with chikungunya experience one or more of the following symptoms, usually starting three to seven days after a mosquito bite.
Sudden Fever
Fever often begins abruptly and can rise quickly, sometimes above 39°C.
Severe Joint Pain
Often the most disabling symptom, typically affecting several joints at once, including the hands, wrists, and ankles.
Muscle Pain
Muscle aches commonly accompany the fever and joint pain.
Headache
Headaches are common during the initial days of illness.
Rash
A rash can appear on the trunk and limbs, usually a few days after the fever begins.
Danger Signs
Seek urgent medical attention if any of the following develop.
Illness in a Newborn
Babies infected around the time of birth face a higher risk of severe illness and need prompt evaluation.
Confusion or Severe Drowsiness
Neurological complications are uncommon but have been reported, and require urgent attention.
Eye Pain or Vision Changes
Eye complications have occasionally been reported and should be assessed promptly.
Joint Pain That Prevents Movement
Pain severe enough to stop normal movement, particularly in older adults or people with underlying health conditions, warrants medical assessment.
Diagnosis
Clinical Assessment
Diagnosis usually starts with a review of symptoms, timing, and recent travel or exposure history, since chikungunya, dengue, and Zika can look very similar in the early days.
RT-PCR Testing
A test that detects the virus itself in the blood. It is most reliable during the first week of illness.
Antibody Testing
Detects the body’s immune response to the virus. Antibodies typically become detectable after the first week and can be found for around two months afterward.
Laboratory Tests
RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction)
Detects the virus’s genetic material directly in the blood, most useful in the first week of illness.
IgM Antibody Test
Identifies an early immune response to the virus, typically detectable from about a week after symptoms begin.
IgG Antibody Test
Can indicate a past infection and help confirm the diagnosis alongside other tests.
Complete Blood Count (CBC)
Does not confirm chikungunya on its own, but helps rule out other causes of fever.
Treatment
Pain and Fever Relief
Paracetamol is generally recommended over NSAIDs for fever and pain until dengue has been ruled out, since NSAIDs can increase the risk of bleeding.
Supportive Care
Rest and plenty of fluids support recovery. Hospitalisation is occasionally needed for people with severe symptoms or underlying health conditions.
Prevention
Eliminate mosquito breeding sites
Emptying, covering, or cleaning containers that collect standing water on a weekly basis reduces mosquito breeding around the home.
Use mosquito repellent
Repellents containing DEET, IR3535, or icaridin, applied to exposed skin according to label instructions, offer effective protection.
Wear protective clothing
Clothing that covers the arms and legs reduces skin exposure to mosquitoes, which bite mainly during daylight hours.
Use screens and treated nets
Window and door screens, along with insecticide-treated nets for anyone who sleeps during the day, help keep mosquitoes out.
Risk Factors
Higher Risk of Severe Illness
These groups face a greater chance of severe illness if infected.
- Newborns infected around the time of birth
- Adults aged 65 and older
- People with existing conditions such as high blood pressure, diabetes, or heart disease
Increased Chance of Infection
These groups have a higher chance of being exposed to infected mosquitoes.
- People living in or travelling to areas with active mosquito-borne virus transmission
- People who spend significant time outdoors during the day
Exposure Factors
Conditions that increase the risk of mosquito bites.
- Standing water near the home that allows mosquitoes to breed
- Limited access to window screens or mosquito nets
Complications
Persistent Joint Pain
Joint pain and stiffness can persist for months, and sometimes years, after the initial infection clears, occasionally resembling arthritis.
Eye Complications
Inflammation affecting the eyes has occasionally been reported.
Neurological Complications
Rarely, chikungunya has been associated with complications affecting the nervous system.
When to Seek Medical Care
Severe or Worsening Joint Pain
Pain that prevents normal movement, or does not improve, should be assessed by a healthcare provider.
Illness in a Newborn
Babies infected around the time of birth need prompt medical evaluation.
Confusion or Severe Weakness
Neurological symptoms, though rare, require urgent attention.
Underlying Health Conditions
Older adults or people with existing health conditions should seek care promptly if symptoms develop, since they face a higher risk of severe illness.
Prognosis
Good for Most People
Most people feel better within a week, though joint pain can sometimes last longer.
Joint Pain May Persist
Some people experience joint pain and stiffness for months or years after the initial illness.
Immunity After Recovery
Available evidence suggests that people who recover from chikungunya are likely to be immune to future infection with the same virus.
Differential Diagnosis
Dengue Fever
Dengue causes a similar pattern of sudden fever, headache, and muscle pain, and circulates in many of the same regions, making the two easy to confuse without testing.
Zika Virus
Zika shares mosquito vectors and overlapping symptoms with chikungunya, though joint pain is typically less severe.
Malaria
Malaria also causes fever in the same mosquito-endemic regions and should be considered and ruled out, particularly where it is the dominant presumptive diagnosis.
References
World Health Organization (WHO)
World Health Organization fact sheet on chikungunya transmission, symptoms, diagnosis, treatment, and prevention.
Centers for Disease Control and Prevention (CDC)
Clinical and public health guidance on chikungunya causes, symptoms, diagnosis, and prevention.
European Centre for Disease Prevention and Control (ECDC)
Factsheet for health professionals on chikungunya virus disease.
Frequently Asked Questions
Is chikungunya contagious from person to person?
No. Chikungunya spreads only through the bite of an infected mosquito, not through direct contact between people.
How long does chikungunya last?
Most people feel better within a week, though joint pain and stiffness can persist for months or, in some cases, longer.
Is there a cure for chikungunya?
There is no specific antiviral treatment, but most people recover fully with rest, fluids, and appropriate pain relief.
Can chikungunya be prevented with a vaccine?
Two vaccines have received regulatory approval in some countries, but they are not yet widely available. Avoiding mosquito bites remains the main way to prevent infection.