Hard Luck Reunion Island: Massive Chikungunya Epidemic

Tourism agencies for France’s overseas department in the Indian Ocean called “Reunion Island” (formerly “Bourbon Island” and “Bonaparte Island”) give four reasons for visiting: 1) There is no place like it on Earth. 2) No one else in your circle of family and friends has ever heard of it, let alone been there. 3) Getting there from East Africa is easy—a few hours’ plane ride and a fascinating counterpoint to the beauty of Seychelles, the wilds of the African savannah or the luxuries of Mauritius. 4) It is a place “where adventures come true, where dreams are lived and where ‘unforgettable’ is every moment of every day.” (1)

Unforgettable indeed. This little island, slightly smaller than the size of Rhode Island, has hazards galore, including epidemics caused by mosquitoes, erupting volcanoes, annual cyclones, intermittent tsunamis, and riots. On the other hand, Reunion is where the process to make vanilla from orchids was discovered in 1841 (more below).

1. Chikungunya Epidemic

Chikungunya is a viral disease transmitted to humans by the bite of infected mosquitoes of the “Aedes aegypti” persuasion, which bite during the day and have cute little white stripes down their little black legs. Symptoms occur less than a week after being bitten and include the sudden onset of fever and chills, headache, and severe pain in the joints, especially of the ankles and wrists, which leads to a hunched over posture when those stricken attempt to walk. Nausea, vomiting, and a hard time holding a glass of water and getting around to find some water leads to dehydration of chik victims, which makes them feel even worse. Chikungunya lasts for about a week and is seldom fatal.

Dr. Stephen Higgs, a vector biologist with the Center for Biodefense & Emerging Infectious Diseases at the University of Texas Medical Branch in Galveston (see SEMP Biot #322: Galveston National Laboratory: “The Best Little Bug House in Texas”? January 19, 2006, at: http://www.semp.us/biots/biot_322.html) helpfully points out that the virus is “kind of strange” because it doesn’t seem to have animal reservoirs. Instead, it circulates between people and diurnal mosquitoes, infecting the mosquitoes when they bite people carrying high levels of the virus in their blood. (2)

As a vector biologist, Dr. Higgs studies viruses, such as Dengue and West Nile which also are transmitted by arthropods (insects), and in particular, mosquito-pathogen-vertebrate interactions. You can bet that Dr. Higgs and his colleagues have scooped up from Reunion Island some chik-infected mosquitoes and fresh infected human blood and saliva to study on Galveston Island, hopefully in their Biosafety Level 4 digs. Obtaining their specimens shouldn’t be difficult as, shockingly, the World Health Organization on February 17, 2006 estimated that approximately 110,000 of the island’s 770,000 residents have been infected. (3) The ongoing chik outbreak is the largest in recorded history.

Chikungunya is NOT an emerging virus. It has been around for a long time, ever since it was first recognized in epidemic form in East Africa in 1952-1953, and placed in the family Togaviridae, genus Alphavirus. (4) Chik caused problems for the US military and US Peace Corps volunteers in Asia, particularly Southeast Asia, during their forays in those parts of the world. For example, three Peace Corps volunteers in the Philippines came down with the chik in 1986. Their cases were the first reported from the Philippines in 18 years. However, one of the Peace Corp volunteers reported that “many cases of chikungunya-like illness, locally termed “Chinese fever” or “Asian flu”, occur and probably go unreported. (5)

In the mid-1980’s, scientists at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland, developed the only known chikungunya vaccine. Sixty-six year-old Robert Edelman of the University of Maryland’s Center for Vaccine Development in Baltimore tested the vaccine on 73 volunteers and published his results in 2000, but further development of the vaccine “fell flat”, according to David Vaughn, head of the infectious disease program at the Army’s Medical Research and Materiel Command. (2) The Reunion outbreak has given new life to these researchers’ who have tens of millions of doses of the vaccine on hand and need some break to “reactivate the research effort and to bring the vaccine to licensure.” (2)

French President Jacques Chirac has sent more than 4000 people, including 800 troops, to the island to eradicate mosquito nesting grounds. (6) American vaccine scientists have informed the Chirac administration about the opportunity to use the American chik vaccine and help bring it to market. The French have responded that the vaccine needs further testing, but added “we won’t turn down any lead” and confirmed the government is talking to the U.S. Army. (2)

The Centers for Disease Control and Prevention in Atlanta, Georgia, provides helpful information for people who must travel to areas of the world with chikungunya and other mosquito-borne infections. (7) Among suggested measures are wearing long-sleeved shirts and long pants, staying in air-conditioned hotels so that windows need not be opened to let in the mosquitoes, using insecticide-treated bed nets and well-screened rooms if an air-conditioned location is not available, and using insect repellant containing DEET.

Is a quarantine of the island necessary? Consider that a person infected with chik leaves Reunion to go to another country (recall that the symptoms of chik occur up to 7 days following infection), and otherwise healthy mosquito living in that other country bites the chik-infected person. The mosquito acquires the chik virus, and then later bites another person, thereby injecting the chik virus into that second person in the second country. In this way, the chik virus hops along, from country to country, quite happily meeting its needs. Since the Reunion outbreak, the chik virus has already surfaced in Madagascar and India, and efforts are underway to prevent its spread to the French Antilles and Guiana in South America. Could it come to the US? Sure. How else did the West Nile arrive to our shores?

2. Reunion is an Active Volcanic Island

The unwary reader might think that the chik epidemic on Reunion is its only problem. Unfortunately, this is not true. Reunion Island is a twin shield volcano! Le Piton des Neiges, now considered extinct, is the volcano that created the island. It is 10,070 feet tall as measured above sea level (but it continues down beneath the sea). A second volcano, Piton de la Fournaise (“The Furnace”) is in full eruption mode and is one of the most active volcanoes in the world. It has erupted 153 times since 1640, as recently as May 2004. Over time there have been two catastrophic eruptions, the first resulting in a nested caldera. Within this caldera formed a cone called Moyen, which suffered a similar fate and left a circular caldera measuring 4.3 miles in diameter. Piton de la Fournaise has been actively monitored by a modern volcano observatory since 1980. (8) The photos of the volcanic topography of Reunion are breathtaking.

3. Reunion Island Cyclones

Reunion is pummeled with hurricanes every year mid-November through April. For example, one storm, packing winds of up to 155 mph, struck the island on January 23, 2002, causing widespread property damage and energy outages. Although only two people were injured, 2,500 people were in emergency shelters as downed trees toppled power lines and mudslides obliterated roads. Sugar cane crops, the island’s main source of revenue, were completely destroyed by the cyclone, just like the island’s coffee plantations of the early 19th century. Following the 2002 hurricane, French President Jacques Chirac issued a message to the people of Reunion in which he expressed his “deepest personal sympathy as well as the support and full solidarity of the country.” (9)

 4. Reunion Island Tsunamis

The Indian Ocean tsunami of December 2004 struck Reunion Island, sinking over 200 boats and damaging port facilities. (10) No one was killed. On January 16, 2005, France was considering setting up a United Nations global natural disaster center on Reunion Island to alert countries about tsunamis and other catastrophic phenomena. (11)

5. Reunion Island Civil Unrest

The history of Reunion Island is a gloomy story (except for the discovery of how to make vanilla from orchids by a 12 year-old Reunion slave named Edmond Albuis in 1841!) that helps explain the island’s difficult recent social circumstances, including deadly anti-French government riots in 1991.

The island was visited, but not settled, by early Malay, Arab and European mariners. (12) Reunion is actually a part of an archipelago that also includes Mauritius and Rodrigues. The archipelago was “christened the Mascarenes by Portuguese navigator Pedro de Mascarenhas, following its European discovery in 1512. In 1642 the French settled the island when La Comagnie des Indes Orientales (the French East India Company) sent its ship, the St-Louis, and the King of France named it Ile Bourbon. There was no great rush to populate and develop the island and, from 1685, Indian Ocean pirates began using [it] as a trading base. Until 1715, the French East India Company was content to provide only for its own needs and those of passing ships, but then coffee was introduced, and between 1715 and 1730 it became the island’s main cash crop and as a result the economy changed dramatically. The French enslaved Africans to do the intensive labor required for coffee cultivation…

“As a result of poor management and the rivalry between France and Britain during the 18th century, as well as the collapse of the French East India Company, the government of the island passed directly to the French crown in 1764. After the French Revolution, it came under the jurisdiction of the Colonial Assembly. In the late 18th century, there were a number of slave revolts…The coffee plantations were destroyed by cyclones very early in the 19th century, and in 1810, during the Napoleonic Wars, Bonaparte lost the island to the British.” “Under British rule, sugar cane was introduced to Reunion and quickly supplanted food production as the primary crop. The Desbassyns brothers rose to success as the island’s foremost sugar barons. The vanilla industry was introduced in 1819. Slavery was outlawed in 1848. When the Suez Canal opened in 1879, Reunion’s trade collapsed.

The island remains an overseas French department today. According to The World Factbook published by the US CIA, Reunion Island is populated by 776,948 French, African, Malagasy, Chinese, Pakistani, and Indian people, 86% of whom profess Roman Catholicism, and 14% profess Hindu, Islam, or Buddhism. (13) “Its economy has traditionally been based on agriculture (sugarcane, vanilla, tobacco, tropical fruits, vegetables, and corn), but services now dominate. Sugarcane has been the primary crop for more than a century, and in some years it accounts for 85% of exports. The government has been pushing the development of a tourist industry to relieve high unemployment, which amounts to one-third of the labor force.

“The gap in Reunion between the well-off and the poor is extraordinary and accounts for the persistent social tensions. The white and Indian communities are substantially better off than other segments of the population, often approaching European standards, whereas minority groups suffer the poverty and unemployment typical of the poorer nations of the African continent. The outbreak of severe rioting in February 1991 illustrates the seriousness of socioeconomic tensions. The economic well-being of Reunion depends heavily on continued financial assistance from France.” (13)

The anti-government rioting of February 1991 occurred in St-Denis and left 10 people dead. A reactionary visit by the French prime minister, socialist Michel Rocard, drew jeers from crowds. By 1993, “things appeared to have calmed down but there were still undercurrents of discontent.” (12)

Summary

The Chikungunya epidemic is a blow that Reunion Island people don’t need. The island would be an excellent place for anthropologists and sociologists to study disaster cultures.

1. “Reunion Magic” at: http://www.reunionmagic.net/; accessed March 11, 2006.

2. “Martin Enserink: “Massive Outbreak Draws Fresh Attention to Little-Known Virus” in Science Magazine, vol. 311 February 24, 2006, p. 1085.

3. World Health Organization: “Chikungunya in La Reunion Island (France), February 17, 2006, available at: http://www.who.int/csr/don/2006_02_17a/en/index.html; accessed March 11, 2006.

4. Robinson MC: “An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-1953. I. Clinical features. Trans Royal Society Top Med Hyg 1955; 49:28-32.

5. “Chikungunya Fever among US Peace Corps Volunteers—Republic of the Philippines”; MMWR Weekly, September 12, 1986/35(36); 573-4; available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00000794.htm; accessed March 11, 2006.

6. “Chikungunya” at: http://en.wikipedia.org/wiki/Chikungunya; accessed March 11, 2006.

7.  “Chikungunya Outbreak Highlights Importance of Mosquito Protection Measures”; Centers for Disease Control, National Center for Infectious Diseases, Division of Global Migration and Quarantine” February 8, 2006, information current as of March 11, 2006. Available at: http://www.cdc.gov/travel/other/2006/chikungunya_mosquito.htm; accessed March 11, 2006.

8. “Piton de la Fournais (Reunion), Indian Ocean” at: http://volcano.und.nodak.edu/vwdocs/volc_images/img_Reunion.html and http://volcano.und.nodak.edu/vwdocs/volc_images/africa/img_reunion2.html; accessed March 11, 2006.

9. “Reunion island counts cost after cyclone”; ReliefWeb, January 23, 2002. Available at: http://www.reliefweb.int/rw/rwb.nsf/AllDocsByUNID/264fbdb5df98ad21c1256b4a0050d32b; accessed March 11, 2006.

10.  “The Tsunami Page: Dr. George” at: http://www.drgeorgepc.com/Tsunami2004Indonesia.html; accessed March 11, 2006.

11. “France suggests putting global tsunami warning center on its Reunion Island” in “The Tocqueville Connection”, January 16, 2005. Available at: http://www.ttc.org/cgi-binloc/searchTTC.cgi?displayZop+22032; accessed March 11, 2006.

12. “Reunion History” at: http://www.travelocity.com/TEU_destGuide/0,4179,TCYUK|1|607|4580|1,00.html; accessed March 11, 2006.

13. “Reunion (Overseas department of France)”. “The World Factbook” website at: http://www.cia.gov/cia/publications/factbook/geos/re.html; accessed March 11, 2006.