Infection with chikungunya virus in Italy: an outbreak in a temperate region.
BACKGROUND
Chikungunya virus (CHIKV), which is transmitted by Aedes spp mosquitoes, has recently caused several outbreaks on islands in the Indian Ocean and on the Indian subcontinent. We report on an outbreak in Italy.


METHODS
After reports of a large number of cases of febrile illness of unknown origin in two contiguous villages in northeastern Italy, an outbreak investigation was done to identify the primary source of infection and modes of transmission. An active surveillance system was also implemented. The clinical case definition was presentation with fever and joint pain. Blood samples were gathered and analysed by PCR and serological assays to identify the causal agent. Locally captured mosquitoes were also tested by PCR. Phylogenetic analysis of the CHIKV E1 region was done.


RESULTS
Analysis of samples from human beings and from mosquitoes showed that the outbreak was caused by CHIKV. We identified 205 cases of infection with CHIKV between July 4 and Sept 27, 2007. The presumed index case was a man from India who developed symptoms while visiting relatives in one of the villages. Phylogenetic analysis showed a high similarity between the strains found in Italy and those identified during an earlier outbreak on islands in the Indian Ocean. The disease was fairly mild in nearly all cases, with only one reported death.


CONCLUSIONS
This outbreak of CHIKV disease in a non-tropical area was to some extent unexpected and emphasises the need for preparedness and response to emerging infectious threats in the era of globalisation.
Department of Infectious, Parasitic, and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
G
G
Rezza
L
L
Nicoletti
R
R
Angelini
R
R
Romi
A C
AC
Finarelli
M
M
Panning
P
P
Cordioli
C
C
Fortuna
S
S
Boros
F
F
Magurano
G
G
Silvi
P
P
Angelini
M
M
Dottori
M G
MG
Ciufolini
G C
GC
Majori
A
A
Cassone
D000293:Adolescent; D000328:Adult; D000330:Aedes / Q000821:virology*; D000368:Aged; D000369:Aged, 80 and over; D018354:Alphavirus Infections / Q000453:epidemiology* / Q000503:physiopathology; D000818:Animals; D002646:Chikungunya virus / Q000302:isolation & purification / Q000472:pathogenicity*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014195:Travel