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Document "Assessment of the Chikungunya transmission risks in Belgium": English Abstract
During the past few months, the Superior Health Council of Belgium (SHC) has worked on an advisory report concerning the state of knowledge on the Chikungunya virus in Belgium as well as the transmission risks involved, especially those resulting from transfusions or transplantations. In the light of recent events in Italy, this advisory report is being issued at a most appropriate time.

The disease

Chikungunya is a viral disease that is transmitted by two Aedes mosquitoes that also play a role in other tropical diseases. The complaint manifests itself as high fever and severe joint pain (especially in the wrists and ankles).

Since 2005, a severe epidemic has raged in the Indian Ocean region (especially in La Reunion and in India). In view of the virulence of the virus strain, the European Centre for Disease Prevention and Control (ECDC) informed the member countries of the European Union as early as the spring of 2006 that there was a potential risk of transmission of the disease through travellers.

What are the risks of transmitting the virus through transfusions and transplantations in Belgium?

With all cases of the disease found on Belgian soil subject to surveillance and prevention measures, the risk that the virus will spread is minimal.

In particular, a combination of exclusion criteria for blood donors * constitute an efficient means of avoiding the risk of asymptomatic travellers from high-risk areas transmitting the disease. In contrast to viruses like the influenza virus, the Chikungunya virus is not transmitted directly through human-to-human contact: instead, it is transmitted by mosquitoes belonging to the species mentioned above.

However, members of the medical profession could be insufficiently aware of the extent of the problem (e.g. with respect to current events in high-risk areas), which could result in their not always considering establishing a differential diagnosis.

Until now, no permanent source of the vector mosquitoes has been identified in Belgium.

Recommendations

- The SHC recommends that the medical profession be given up-to-date information in order to increase screening for imported cases;
- A previous advisory report of the SHC has already advised the implementation of a temporary exclusion measure for blood donors who have stayed abroad *. This measure should also apply to organ, cell and tissue donations.
- The SHC takes the view that virus inactivation constitutes an additional safety measure in case of indigenous transmission of the virus (i.e. transmission of the virus via local mosquitoes), thus reducing the risk even further.
- The SHC supports the entomological surveillance programme that is currently being organised in Belgium (especially the increased surveillance of tyre depots).

* See the SHC advisory report No. 8307 on the (temporary) exclusion of blood donors having travelled abroad.

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