Video Transcript

My name is Maíra Sant Anna Genaro de Brito, I'm a rheumatologist graduated from the University of Cuiabá, with a residency in Internal Medicine at the University General Hospital, a residency in Rheumatology from the University of Brasília and I hold a master's and a PhD from the Federal University of Mato Grosso.

I have been monitoring the cases of Chikungunya since 2017. It started here in Mato Grosso, in Brazil, in mid-2014, 2015. And since then, as the number of cases increased, especially in 2025, the number of cases increased a lot.

We have had over 100,000 probable cases and over 100 deaths reported in our region by September. During the rainy seasons, when the vector is present and the number of cases increases, there has been a much higher demand for specialized healthcare services in recent years.

And what we most commonly observe is that many patients initially do not seek specialized care and often go to emergency rooms until they can access a specialist. As a result, they may need prolonged follow-up to control the clinical condition, and poor adherence in the initial phase, due to fear of introducing symptomatic therapy, such as nonsteroidal anti-inflammatory drugs and corticosteroids, often means these patients don't follow the correct course of the disease. So, for this reason, they fail initial therapies and later require much longer follow-up due to the perpetuation of local inflammation, and this [can leave] the patient unfit for work, and social activities, maintaining a state of chronic pain, pain that [can persist] for more than three months.

The long-term effects of the Chikungunya virus, can occur in up to 50% of patients. This varies widely in the literature, but what we observe is a perpetuation of joint and musculoskeletal complaints in these patients. So, the persistence of this inflammatory process can cause pain, morning stiffness, restricted range of motion. And if this inflammatory process is not controlled during this period, it can progress to structural damage. This makes this disease closely resemble rheumatoid arthritis, where the arthritic condition persists for more than six weeks, with an inflammatory process that progresses to structural damage and functional disability.

There are other arboviruses with clinical manifestations similar to Chikungunya, especially Dengue and Zika. Dengue is much more characterized by muscle pain than joint pain. Zika also has its particularities. It is important to note that Zika is a disease that usually lasts 5 to 7 days. It is characterized more by fever followed by skin changes, with much more rash, itching, and ophthalmological involvement.

We generally advise patients who need to travel to or reside in an endemic region, for several diseases in Brazil, that they should get vaccinated regardless of the cost. Why? Because of the risk of developing a disease that can last a long time. There are studies in the literature reporting symptom persistence for up to 13 years. There are case reports of patients with structural damage and functional disability.

Video Transcript

My name is Marvin Bittner. I’m a medical doctor with a specialty in internal medicine and a subspecialty in infectious diseases.

And because of that background, one of my professional activities is seeing patients in a travel clinic, so I see folks who are going to various countries in the world. Might have somebody going to the Amazon and they wonder, "Do I need to take malaria medicine?", for example.

Travel can be a delightful experience. However, some trips can expose a traveler to various diseases. So, it’s important that healthcare providers take advantage of opportunities to talk with travelers about what they’re planning and talk with travelers about how they can reduce the risk of various diseases.

Some patients come to the travel clinic with a list of vaccines they’d like to get. However, in many cases, there are other vaccines that could make a big difference. And to find out the entire list of vaccines that somebody ought to be getting, it’s important for me to find out what countries they plan to visit and where in those countries their itinerary will take them.

Some travelers arrive in the clinic with detailed travel plans and a list of vaccines to obtain, but often, they may not be aware of all the vaccines that are appropriate for travel to the places they plan to visit. The length of travel or the type of activity planned may be a consideration. Also, the age of the traveler is important.

I ask a traveler about the list of countries they plan to visit. Often, I follow up and ask about specific locations in the countries that are in the itinerary, and indeed, it's common for me recognize that a traveler may need vaccines they hadn't known about when they made their clinic appointment. So, often I’ll point out that the CDC recommends those additional vaccines. Sometimes, I'll show them maps that show where certain risks call for considering certain vaccines.

At times, I may be recommending a vaccine that the patient is unfamiliar with, like chikungunya, and that means that I have to discuss the vaccine with them and talk about why it's important and what it involves and what the risks are of not getting it. For example, I could talk to them about what the consequences for that disease could be in terms of impairing their quality of life.

I could talk to them about some stories I've heard some years ago of some dental students who went on a trip to a country where there was a risk of chikungunya, and at that time, was no vaccine available. They came back, had not just a few days of fever but wound up with joint pain that persisted, and the result, this impaired their ability to use their hands for some weeks.

There are certain details that I listen for when I talk with a patient about their travel plans that have an effect on my decision to recommend chikungunya vaccine. For chikungunya, the key detail is the itinerary. Is the patient going to an area where public health authorities recommend the vaccine? Another detail is the length of travel. Longer stays translated to more risk, and this is reflected in public health recommendations for the vaccine. Also, the vaccine has an age indication, and so the traveler's age is important.