SciELO - Scientific Electronic Library Online

vol.14 número1 índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados




  • No hay articulos citadosCitado por SciELO

Links relacionados

  • No hay articulos similaresSimilares en SciELO


Revista de salud publica del Paraguay

versión impresa ISSN 2224-6193versión On-line ISSN 2307-3349

Rev. salud publica Parag. vol.14 no.1 Asunción abr. 2024 


Battling the Rising Tide: Challenges in Controlling Chikungunya in Latin America

Luchando contra la marea creciente: desafíos para controlar el chikungunya en América Latina

Alfonso J. Rodriguez-Morales1  2  *

1 Universidad Científica del Sur. Lima, Perú.

2 Fundación Universitaria Autónoma de las Américas, Facultad de Medicina, Grupo de Investigación Biomedicina. Pereira, Colombia. .

Chikungunya, a mosquito-borne viral disease, has rapidly emerged as a pressing public health concern in Latin America since late 2013, posing significant challenges to control efforts across the region1,2. The rapid spread of the disease during 2024-2025, coupled with limited resources, infrastructure, and other factors, has exacerbated the situation. However, the Latin American public health community has demonstrated remarkable resilience, requiring a coordinated and multifaceted approach to combat this persistent threat3.

One of the primary challenges in controlling Chikungunya in Latin America lies in the complex interaction between the virus, its vectors, and the environment. Environmental factors such as temperature and humidity influence the distribution and abundance of Aedes mosquitoes, the primary vectors of the Chikungunya virus (CHIKV). In regions with favorable environmental conditions, vector populations thrive, increasing the risk of disease transmission. Urbanization and population growth have also created breeding grounds for mosquitoes, further facilitating the spread of Chikungunya. Addressing these environmental determinants requires not just efforts but sustained and persistent efforts in vector surveillance and control and community engagement to promote environmental management practices. The urgency of this task cannot be overstated4,5.

The current situation in the region is concerning. In 2023, 410,754 cases were reported in the Americas region (Table 1). The highest number is in Brazil (265,503), followed by Paraguay (140,095). In 2023, 419 deaths were associated with CHIKV (Table 1). During the ongoing 2024, in just a few months, 204,889 cases have been reported (Table 2), 201,092 in Brazil and 3,206 in Paraguay (Table 2). Additionally, 75 deaths due to CHIKV have already been reported in 2024 (Table 2).

Despite that, multiple countries have reported CHIKV in 2022-2024 (Figure 1), showing the relevant geographical spread in the region. CHIKV has become a significant arboviral disease in the region, and after dengue, it is a significant concern in the context of arboviruses circulating6.

Furthermore, the mobility of populations within and across borders presents a significant challenge to Chikungunya control efforts in Latin America. Migration, trade, and tourism contribute to the rapid dissemination of the virus, which has been analyzed in some countries of the region7. High levels of human movement facilitate the introduction of the virus into new areas where susceptible populations may lack immunity, leading to outbreaks and epidemics8

Effective surveillance systems and cross-border collaboration are essential for early detection and response to imported cases, preventing the establishment of sustained transmission chains. As public health professionals, policymakers, researchers, and stakeholders, your role in this is crucial. Moreover, addressing migration's social and economic drivers, such as poverty and conflict, can help mitigate the underlying risk factors for Chikungunya transmission9,10.

The burden of Chikungunya falls disproportionately on vulnerable populations in Latin America, including the poor, marginalized communities, and indigenous groups11,12,13,14. Multiple studies highlight the social determinants of health contributing to the unequal distribution of Chikungunya burden, including inadequate housing, limited access to healthcare, and poor sanitation conditions11-14. These disparities exacerbate the disease's impact, leading to higher morbidity and mortality rates among disadvantaged populations. Addressing health inequities requires a comprehensive approach that integrates health promotion, access to healthcare services, and social welfare programs to improve the resilience of vulnerable communities and reduce their vulnerability to Chikungunya and other vector-borne diseases11-14. In addition, CHIKV may lead to chronic infection, which has been previously observed and confirmed in some countries in the region 15,16,17,18,19,20,21,22.

Inadequate healthcare infrastructure and diagnostic capacity pose significant challenges to the timely detection and management of Chikungunya cases in Latin America. Some studies highlight the limitations of current diagnostic methods for Chikungunya, particularly in resource-limited settings where access to laboratory facilities is limited23. Misdiagnosis and underreporting of cases hamper surveillance efforts and hinder the implementation of targeted control measures. Strengthening laboratory capacity, training healthcare workers, and enhancing public awareness are essential components of an effective response to Chikungunya, enabling early detection, diagnosis, and treatment of cases23.

In conclusion, the control of Chikungunya in Latin America presents multifaceted challenges that require a comprehensive and coordinated response from governments, healthcare systems, and communities7. Addressing environmental, social, and healthcare factors is essential for mitigating the disease's impact and preventing future outbreaks. By investing in vector surveillance and control, strengthening healthcare infrastructure, and addressing health inequities, Latin American countries can enhance their resilience to Chikungunya and improve the health and well-being of their populations24.

Table 1 Chikungunya cases by country or territory in 2023, according to the Pan American Health Organization ( 

Table 2 Chikungunya cases by country or territory in 2024 (first trimester), according to the Pan American Health Organization ( 

Figure 1 Geographic distribution of Chikungunya cases in the Americas, 2022-2024, according to the Pan American Health Organization ( 


1. Alfaro-Toloza P, Clouet-Huerta DE, Rodríguez-Morales AJ. Chikungunya, the emerging migratory rheumatism. Lancet Infect Dis. 2015;15(5):510-2. [ Links ]

2. Clouet-Huerta D, Alfaro-Toloza P, Rodríguez-Morales AJ. [Chikungunya in the Americas: preparedness, surveillance and alert in Chile]. Rev Chilena Infectol. 2014;31(6):761-2. [ Links ]

3. Mourad O, Makhani L, Chen LH. Chikungunya: An Emerging Public Health Concern. Curr Infect Dis Rep. 2022;24(12):217-28. [ Links ]

4. Cohnstaedt LW, Alfonso-Para C, Fernandez-Salas I. Mosquito Vector Biology and Control In Latin America-A 26th Symposium. J Am Mosq Control Assoc. 2016;32(4):315-22. [ Links ]

5. Allan R, Budge S, Sauskojus H. What sounds like Aedes, acts like Aedes, but is not Aedes? Lessons from dengue virus control for the management of invasive Anopheles. Lancet Glob Health. 2023;11(1):e165-e9. [ Links ]

6. Musso D, Rodriguez-Morales AJ, Levi JE, Cao-Lormeau VM, Gubler DJ. Unexpected outbreaks of arbovirus infections: lessons learned from the Pacific and tropical America. Lancet Infect Dis. 2018;18(11):e355-e61. [ Links ]

7. Fernández-Salas I, Danis-Lozano R, Casas-Martínez M, Ulloa A, Bond JG, Marina CF, et al. Historical inability to control Aedes aegypti as a main contributor of fast dispersal of chikungunya outbreaks in Latin America. Antiviral Res. 2015;124:30-42. [ Links ]

8. Ribeiro GS, Hamer GL, Diallo M, Kitron U, Ko AI, Weaver SC. Influence of herd immunity in the cyclical nature of arboviruses. Curr Opin Virol. 2020;40:1-10. [ Links ]

9. Tsiodras S, Pervanidou D, Papadopoulou E, Kavatha D, Baka A, Koliopoulos G, et al. Imported Chikungunya fever case in Greece in June 2014 and public health response. Pathog Glob Health. 2016;110(2):68-73. [ Links ]

10. Jourdain F, de Valk H, Noël H, Paty MC, L'Ambert G, Franke F, et al. Estimating chikungunya virus transmission parameters and vector control effectiveness highlights key factors to mitigate arboviral disease outbreaks. PLoS Negl Trop Dis. 2022;16(3):e0010244. [ Links ]

11. Rodriguez-Morales AJ, Villamil-Gómez WE, Franco-Paredes C. The arboviral burden of disease caused by co-circulation and co-infection of dengue, chikungunya and Zika in the Americas. Travel Med Infect Dis. 2016;14(3):177-9. [ Links ]

12. Cardona-Ospina JA, Villamil-Gómez WE, Jimenez-Canizales CE, Castañeda-Hernández DM, Rodríguez-Morales AJ. Estimating the burden of disease and the economic cost attributable to chikungunya, Colombia, 2014. Trans R Soc Trop Med Hyg. 2015;109(12):793-802. [ Links ]

13. Cardona-Ospina JA, Diaz-Quijano FA, Rodríguez-Morales AJ. Burden of chikungunya in Latin American countries: estimates of disability-adjusted life-years(DALY) lost in the 2014 epidemic. Int J Infect Dis. 2015;38:60-1. [ Links ]

14. Cardona-Ospina JA, Rodriguez-Morales AJ, Villamil-Gómez WE. The burden of Chikungunya in one coastal department of Colombia (Sucre): Estimates of the disability adjusted life years (DALY) lost in the 2014 epidemic. J Infect Public Health. 2015;8(6):644-6. [ Links ]

15. Rodriguez-Morales AJ, Cardona-Ospina JA, Fernanda Urbano-Garzon S, Sebastian Hurtado-Zapata J. Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2016;68 (12):1849-58. [ Links ]

16. Rodriguez-Morales AJ, Villamil-Gomez W, Merlano-Espinosa M, Simone-Kleber L. Post-chikungunya chronic arthralgia: a first retrospective follow-up study of 39 cases in Colombia. Clin Rheumatol. 2016;35(3):831-2. [ Links ]

17. Rodriguez-Morales AJ, Gil-Restrepo AF, Ramirez-Jaramillo V, Montoya-Arias CP, Acevedo-Mendoza WF, Bedoya-Arias JE, et al. Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. F1000Res. 2016;5:360. [ Links ]

18. Rodriguez-Morales AJ, Simon F. Chronic chikungunya, still to be fully understood. Int J Infect Dis. 2019;86:133-4. [ Links ]

19. Rodriguez-Morales AJ, Cardona-Ospina JA, Villamil-Gomez W, Paniz-Mondolfi AE. How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America? Rheumatol Int. 2015;35(12):2091-4. [ Links ]

20. Rodriguez-Morales AJ, Restrepo-Posada VM, Acevedo-Escalante N, Rodriguez-Munoz ED, Valencia-Marin M, Castrillon-Spitia JD, et al. Impaired quality of life after chikungunya virus infection: a 12-month follow-up study of its chronic inflammatory rheumatism in La Virginia, Risaralda, Colombia. Rheumatol Int. 2017;37(10):1757-8. [ Links ]

21. Consuegra-Rodriguez MP, Hidalgo-Zambrano DM, Vasquez-Serna H, Jimenez-Canizales CE, Parra-Valencia E, Rodriguez-Morales AJ. Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia. Travel Med Infect Dis. 2018;21:62-8. [ Links ]

22. Rodriguez-Morales AJ, Mejia-Bernal YV, Meneses-Quintero OM, Gutierrez-Segura JC. Chronic depression and post-chikungunya rheumatological diseases: Is the IL-8/CXCL8 another associated mediator? Travel Med Infect Dis. 2017;18:77-8. [ Links ]

23. Guaraldo L, Wakimoto MD, Ferreira H, Bressan C, Calvet GA, Pinheiro GC, et al. Treatment of chikungunya musculoskeletal disorders: a systematic review. Expert Rev Anti Infect Ther. 2018;16(4):333-44. [ Links ]

24. Pineda C, Muñoz-Louis R, Caballero-Uribe CV, Viasus D. Chikungunya in the region of the Americas. A challenge for rheumatologists and health care systems. Clin Rheumatol. 2016;35(10):2381-5 [ Links ]

0Responsible editor: Julieta Méndez-Romero.

2Declaración: Las opiniones expresadas en este manuscrito son responsabilidad del autor y no reflejan necesariamente los criterios ni la política de la RSPP y/o del INS.

4Financiación: Ninguna.

Received: April 15, 2024; Accepted: April 25, 2024

Corresponding author:,

Contribuciones: AJRM: concepción, redacción y aprobación final del manuscrito.

Conflictos de interés: No se declaran conflictos de intereses.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License