Latest figures (5 Sep) show that a total of 197 cases of Chikungunya Fever have been reported from the province of Ravenna, in North-East Italy. Of these, 166 are either confirmed or highly probable cases (meet the case definition). The villages of Castiglione di Ravenna and Castiglione di Cervia have reported 147 of the cases, with a further 19 cases from the neighbouring suburbs of the towns of Cesena and Cervia. The remaining 31 suspected cases are scattered throughout the province.

In most cases the disease has been mild, with patients experiencing fever and rash for a few days. However, some patients have experienced intense joint pain which persisted after the fever had subsided. One death has occurred, in an 83 year-old man with severe underlying conditions. The peak of infection is believed to have passed, with a falling number of new cases being reported in Castiglione di Ravenna and Castiglione di Cervia.

The virus was detected in local “tiger” mosquitoes (Aedes albopictus), which are considered to be responsible for transmitting the infection. This situation represents the first time that the Chikungunya virus has been transmitted by mosquitoes in Europe.

An active surveillance system based on doctors and hospital emergency units was set up across the province on 29 August. Implemented control measures include the use of insecticides in public as well as private sites within 100 metres around the residence of all confirmed and suspected cases, and communication to the public to inspire active involvement in mosquito control measures and general health education.

Considering the above, the province of Ravenna in the region of Emilia-Romagna in North-East Italy is considered as an area where Chikungunya virus transmission is occurring, and where the following recommendations should be considered:

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:

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.

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.

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).