Grenada International Elective in the Caribbean Ryan Gill, MS4

Chikungunya - an emerging disease Emerging infectious viral disease spread by mosquitos Until the 2000s, was not known to exist in the Western hemisphere Establishment in the US likely inevitable

Chikungunya virus - what is it? Virus with many mammalian reservoirs, including humans Spread by the bite of Aedes genus mosquitos

Chikungunya infection Symptoms/signs classic triad of pruritic maculopapular rash, fever, and arthralgias (debilitating) flu-like symptoms, HA, GI distress rarely, hepatitis, neurologic sequelae (encephalitis) Infection is self-limiting within 4-10 days Prognosis is excellent ~10% experience chronic arthralgias Caglioti, C., Lalle, E., Castilletti, C., Carletti, F., Capobianchi, M. R., & Bordi, L. (2013). Chikungunya virus infection: an overview. New Microbiol, 36(3), 211-27.

Chikungunya infection

Chikungunya - Epidemiology Previously isolated to Eastern hemisphere: Africa, Asia, India, surrounding areas Occasional epidemics In early 2000s, outbreak on Reunion Island R0 = ~3. Influenza R0 = ~3. Infectious!

Chikungunya - Epidemiology 2005 - epidemics across various Indian Ocean islands, Indian subcontinent, Southeast Asia December 2013 - first autochthonous case of Chikungunya reported in St Martin first reported case in the Western hemisphere 2014 - autochthonous cases on most Caribbean islands, mainland South America Cauchemez, S., Ledrans, M., Poletto, C., Quenel, P., de Valk, H., Colizza, V., & Boëlle, P. Y. (2014). Local and regional spread of chikungunya fever in the Americas. Euro Surveill, 19, 28.

Chikungunya - new epidemic strain These epidemics are caused by a single previously undescribed strain of CHIKV Single base pair substitution grants new vector specificity to Aedes albopictus Establishment in the US is inevitable already reports of sporadic autochthonous cases Tsetsarkin, K. A., Vanlandingham, D. L., McGee, C. E., & Higgs, S. (2007). A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS pathogens, 3(12), e201.

http://www.cdc.gov/chikungunya/pdfs/CHIKV_VectorControl.pdf

Cultural barriers Primary prevention of CHIKV = mosquito control, mosquito bite prevention Poor public acceptance of mosquito as vector Common to perceive cause of disease as a supernatural phenomenon in parts of Caribbean

Clinical experience St Augustine’s Medical Services (SAMS) Only private hospital on the island Provides outpt, inpt, OBGYN, specialty services Lab services, x-ray, CT, pharmacy

Clinical experience Worked with hospital owner Primarily worked in outpt clinic with rounding on inpts throughout day Opportunities to work with specialists who hold clinic or surgeries at SAMS Can attend rounds at St. George’s General Hospital

Profound clinical experience Working with Dr. Diez, a Venezuelan cardiothoracic surgeon who holds clinic at SAMS Spoke about the issues of scale in regards to the practice of medicine, island medicine Advice for intern year Cardiology without stress testing

Profound cultural experience Met Nigel Mathlin, co-founder of GrenCHAP, only LGBT advocacy group on island Spoke at length about status of LGBT individuals in Grenadian society Island is socially conservative Many LGBT individuals seek asylum in other countries

GrenCHAP Attended unveiling of PSAs for Love Without Fear campaign Several government officials in attendance Will be broadcasted on local TV channels, as internet advertisements, social media