Should Visitors From India Be Tested for Chikungunya

While the United States only reported 199 Chikungunya fever cases last year, recent research indicates this low number may be related to under-testing.

The U.S. Centers for Disease Control and Prevention (CDC) says that among the cases reported in 2024, a higher-than-expected number of Chikungunya cases occurred among returning travelers from India, where the National Center for Vector-Borne Diseases Control in India reported 192,343 CHIKV cases in 2024.

Although not listed as a hemorrhagic fever virus, the Chikungunya virus (CHIKV) can be easily confused with more well-known diseases, such as dengue or yellow fever.

According to the CDC, a Chikungunya diagnosis should be made by nucleic acid testing during the acute phase of infection or by serologic testing after the first week of illness.

Additionally, a positive CHIKV-specific IgM antibody test result should be confirmed by neutralizing antibody testing at a state public health laboratory or

Therefore, the CDC says healthcare providers should consider CHIKV infection in patients with acute onset of fever and polyarthralgia for appropriate clinical management. Providers are also encouraged to report suspected Chikungunya cases to health departments to facilitate diagnosis and mitigate the risk of local transmission.

These CDC recommendations are challenging as most CHIKV infections are related to international travelers visiting over 100 countries in Africa, Asia, and the Americas. 

Furthermore, Pune's National Institute of Virology has indicated that CHIKV variants are causing more cases and lingering symptoms in 2024. A  study published on October 19, 2024, identified Chikungunya's "Indian Ocean lineage" as the primary cause of the recent surge in cases and lingering symptoms.

This novel CHIKV lineage, first identified in 2006, has also spread globally.

These experts have determined that the incidence of post-chikungunya chronic rheumatism and fatigue and the impact on quality of life and chronic fatigue in adults seven years after infections were significant.

To alert travelers of this health risk, the CDC updated its Level 2 Travel Health Advisory regarding outbreaks in various Indian states, such as Maharashtra and Telangana. These areas are very popular destinations for international travelers.

In 2025, the CDC recommends travelers to Chikungunya outbreak areas speak with a travel vaccine expert about immunization options since the U.S. FDA has approved one effective vaccine commercially offered at clinics and pharmacies.

A more straightforward and less expensive CDC recommendation to reduce Chikungunya disease cases this year is to avoid mosquito bites when traveling abroad.