1. Grenada International Elective in the Caribbean
Ryan Gill, MS4

4. 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

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

6. 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),

7. Chikungunya infection

8. 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!

9. Chikungunya - Epidemiology
epidemics across various Indian Ocean islands, Indian subcontinent, Southeast Asia
December first autochthonous case of Chikungunya reported in St Martin
first reported case in the Western hemisphere
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.

11. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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