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Arthropod-borne viruses (arboviruses) are the causative agents of some of the most important emerging infectious diseases and are responsible for significant global public health problems (Gubler, 2001). Of these viruses, the genus Alphavirus belongs in the family Togaviridae, and the species in this genus cause diseases ranging from mild febrile illness to severe polyarthritis to encephalitis. One alphavirus, chikungunya virus (CHIKV), caused recent outbreaks associated with severe morbidity. Traditionally, CHIKV causes a febrile illness similar to that seen in dengue virus infections. The hallmark feature of CHIKV disease is a debilitating and prolonged arthralgic syndrome that primarily affects the peripheral small joints. While the acute febrile phase of the illness normally resolves within a few days, the pain associated with CHIKV infection of the joints typically persists for weeks or months causing serious economic and social impact on both the individual and the affected communities. During the 2005–2007 explosive epidemics on the Indian Ocean islands and in India, anecdotal cases of CHIKV-associated deaths, encephalitis and neonatal infections were reported. Here, we review outbreaks of CHIKV disease and present a comprehensive analysis and comparison of clinical presentation, virus– vector associations and viral genetics to assess the possibility of further expansion and re-emergence of CHIKV illness.

Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus