Review Details Chikungunya's Global Resurgence as US Surveillance Evolves

A review published in Future Integrative Medicine consolidates current knowledge on the etiology, pathogenesis, clinical manifestations, and management of chikungunya fever, pointing to a July 2025 outbreak in Guangdong Providence, China, as a pivotal moment in the virus’s epidemiology.¹

A Record Outbreak Signals a Broader Shift

Chikungunya virus is an arbovirus transmitted by Aedes mosquitoes, first identified in Tanzania in 1952, and it has since spread to over 119 countries, affecting millions across the Indian Ocean region, the Americas, and Europe. Global estimates indicate approximately 18.7 million annual cases and roughly 1.95 million disability-adjusted life years lost between 2011 and 2020.¹

In July 2025, an outbreak centered in Foshan City, Guangdong Province, became the largest local chikungunya epidemic ever recorded in China, with more than 4000 confirmed cases traced to a single imported case. The authors describe this as a transition from sporadic imported cases—which China had documented since 2008—to sustained local transmission, underscoring the vulnerability of populations with no prior immunity in regions where competent mosquito vectors are established.¹

Clinically, the disease progresses through acute, subacute, and chronic phases, with the acute phase marked by high fever, rash, and severe polyarthralgia affecting the wrists, ankles, and phalanges. Between 40% and 80% of patients advance to a chronic phase involving rheumatic symptoms lasting more than 3 months, sometimes for years, which the authors identify as the primary driver of long-term morbidity. Mortality is low overall, ranging from 0.024% to 0.8%, though severe complications can occur in neonates, older adults, and patients with comorbidities.¹

Traditional Chinese Medicine as a Complementary Strategy

Although conventional treatment for chikungunya remains predominantly supportive, the review highlights the integration of traditional Chinese medicine (TCM) as a promising complementary strategy for alleviating both acute symptoms and chronic polyarthralgia. The National Health Commission of the People's Republic of China has incorporated TCM into its Diagnosis and Treatment Protocol for Chikungunya Fever (2025 Edition), which provides phase-specific herbal formulas for the febrile and recovery stages of illness.¹

The authors caution, however, that high-quality international evidence supporting these TCM interventions remains limited, and they call for rigorous, multicenter randomized controlled trials to validate global efficacy and safety. The review concludes that addressing the expanding threat of chikungunya requires a multipronged public health strategy integrating standard clinical and preventive measures with evidence-based TCM therapies.¹

Vaccine Landscape With Ixchiq and Vimkunya

There have been 2 chikungunya vaccine approvals that have reshaped prevention options in the United States. In February 2025, the FDA approved the chikungunya vaccine, recombinant (Vimkunya), as the first virus-like particle single-dose vaccine against chikungunya for patients 12 years and older, based on 2 phase 3 clinical trials. Paul Chaplin, president and CEO of Bavarian Nordic, said the approval reflects how "climate change continues to expand the reach of mosquito-borne illnesses like chikungunya" for travelers and vulnerable populations.²

In a trial (NCT05072080), 3254 patients were randomized to receive either a single intramuscular injection of Vimkunya or a placebo. Vaccination was highly immunogenic up to 22 days postvaccination, with neutralizing antibodies detected in 98% of vaccinated patients, 97% at 2 weeks postvaccination, and 86% at 6 months. A second study (NCT05349617) showed that 87% of adults 65 years and older had neutralizing antibodies 22 days postvaccination.²

Two months later, in April 2025, the Advisory Committee on Immunization Practices voted to recommend a single dose of Vimkunya for patients 12 years and older traveling to a country with an ongoing chikungunya outbreak or traveling to or living in a place without an outbreak but with an elevated risk for US travelers. Chaplin called the vote a milestone, noting that "chikungunya is an emerging public health threat around the world.”³

Ixchiq, a live-attenuated, single-dose vaccine, was the first chikungunya vaccine licensed in the United States, approved in 2023 for adults 18 years and older at increased risk of exposure. Of the 4115 patients enrolled in its trial, the most commonly reported adverse effects included headache, fatigue, muscle pain, joint pain, fever, nausea, and injection-site tenderness.³

What This Means for US Pharmacists

CDC surveillance data show that chikungunya has remained a largely imported threat in the United States. Chikungunya virus disease is a nationally notifiable condition, and the most recent locally acquired case in a US state was reported in 2025. In 2025, ArboNET recorded 1 locally acquired case and 466 travel-associated cases among US states, with no locally acquired or travel-associated cases reported in US territories.⁴

Local transmission in the continental United States has historically been limited, with Florida and Texas each reported locally acquired cases in 2014 and 2015, respectively, and no state has reported local transmission since. This surveillance picture positions vaccination as primarily a travel-medicine consideration for US pharmacists, particularly for patients heading to regions with active outbreaks or elevated exposure risk, such as the Guangdong outbreak described in the new review.¹

Currently, there are no antiviral treatments for chikungunya, and most patients recover within approximately 1 week, though joint pain can persist long-term. Pharmacists counseling travelers can use this context to reinforce both vaccination eligibility criteria and standard mosquito-bite prevention measures.²

REFERENCES

1. Xia & He Publishing Inc. Chikungunya fever: etiology, pathogenesis, and management, with a particular focus on evidence-based application of traditional Chinese medicine. News release. EurekAlert!. July 8, 2026. Accessed July 9, 2026. https://www.eurekalert.org/news-releases/1135269

2. Gallagher A. FDA approves recombinant chikungunya vaccine, Vimkunya. Drug Topics. February 17, 2025. Accessed July 9, 2026. https://www.drugtopics.com/view/fda-approves-recombinant-chikungunya-vaccine-vimkunya

3. Gallagher A. ACIP votes to recommend Vimkunya for prevention of chikungunya virus. Drug Topics. April 18, 2025. Accessed July 9, 2026. https://www.drugtopics.com/view/acip-votes-to-recommend-vimkunya-for-prevention-of-chikungunya-virus

4. Centers for Disease Control and Prevention. Chikungunya in the United States. Chikungunya Virus. February 24, 2026. Accessed July 9, 2026. https://www.cdc.gov/chikungunya/data-maps/chikungunya-us.html