03 Chikungunya Hills 508

CDC ACIP — Vaccine Advisory Committee

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National Center for Emerging and Zoonotic Infectious Diseases
CHIKUNGUNYA VIRUS INFECTIONS 
AMONG LABORATORY WORKERS
Susan Hills, MBBS, MTH
CDC Lead , Chikungunya Vaccines Work Group
Arboviral Diseases Branch
Division of Vector -Borne Diseases
Fort Collins, Colorado
ACIP meeting, June 22, 2023
Chikungunya virus management in the laboratory
Handled at biosafety level (BSL) -3 
High viral loads in blood samples increase risk for 
l
aboratory -acquired infections1
1. Simmons G et al, Emerg Infect Dis 2016; Appassakij H et al, Transfusion 2013
2
Information on laboratory worker infections
Summary article published in 1980 by Subcommittee on 
Arb
ovirus Laboratory Safety (SALS)1
Case report in a publication on exposures to pathogens in a U
.S. laboratory2
Cases reported to the U.S. national arboviral disease s
urveillance system
1.The Subcommittee on Arbovirus Laboratory Safety of the American Committee on Arthropod -B orne Viruses. Am J Trop Med Hyg 1980
2.Rusnak JM, et al. J O ccup Environ Med 2004 3
SALS report1
Methods
–Conducted literature review and two surveys
–Surveys sent to national and international labs in 1976 and 1978
39 chikungunya virus disease cases or infections
–38 (97%) disease cases, no deaths
–1 (3%) asymptomatic infection
Route of transmission
–7 (18%) aerosol
–32 (82%) not identified/unknown
1. The Subcommittee on Arbovirus Laboratory Safety of the American Committee on Arthropod -Borne Viruses. Am J Trop Med Hyg 1980
4
Case report from worker in a U.S. laboratory
Occurred during 1989 –2002 
Needlestick injury 
Full recovery after slow convalescence with intermittent joint 
p
ains, headaches, and blurred vision for several months
Rusnak JM, et al. J Occup Environ Med 20045
Reports to national arboviral disease surveillance 
system, 2015 –2022 
Four disease cases
–One case hospitalized for observation
–No deaths 
Route of transmission
–Needlestick (n=2)
–Other percutaneous (n=1)
–Unknown (n=1) 
Photo credit: Getty Images
6
Reported cases likely underrepresent all infections in 
laboratory workers
Underreporting of cases to national arboviral disease surveillance system
Asymptomatic infections not reportable to surveillance system
No formal laboratory surveillance system
Reluctance to publish
7
Summary
Laboratory workers at risk for chikungunya virus infections 
a
nd disease
–At least 44 reports, including 4 cases during last 8 years
Documented modes of transmission include aerosol and pe
rcutaneous routes
Likelihood of disease vs. asymptomatic infection probably h
igh
8
Thank you
Getty 
Images