Academic journal article Population

Chikungunya on Réunion Island: Social, Environmental and Behavioural Factors in an Epidemic Context

Academic journal article Population

Chikungunya on Réunion Island: Social, Environmental and Behavioural Factors in an Epidemic Context

Article excerpt

In February 2006, after several months of exponential growth in the number of cases of Chikungunya observed on Réunion Island, the national public authorities officially recognised the existence of a major epidemic and declared that immediate action was necessary. Chikungunya is an infectious disease of viral origin (arbovirosis) transmitted by the Aedes albopictus mosquito. When a mosquito bites an infected human in the viremic phase, it can then transmit the virus to one or more other people by biting them. In 2006, this emerging, and therefore still poorly understood, infectious disease was described as causing essentially a high fever, headache and arthralgia, resolving into spontaneous recovery within ten days of contamination. During the epidemic, no vaccine was available nor any therapeutic options other than symptomatic treatment (Parola et al., 2006; Bodenmann and Genton, 2006).

Two features were characteristic of the Chikungunya epidemic on Réunion Island. The first was its sudden onset coupled with its high intensity and short duration. Less than a year elapsed from the time the epidemic was publicly acknowledged (end of 2005), its peak (April 2006) and its disappearance. The second was its newness, since the disease had been unknown to the island's population before the outbreak.

The Chikungunya virus (CHIKV) was first identified in the biomedical literature during an epidemic which occurred in Tanzania in 1952 (Robinson, 1955). Since the Tanzania outbreak, several short epidemics of Chikungunya have been reported in Africa, Asia and Oceania (Thaikruea et al., 1997; Mackenzie et al., 2001). More recently, between June 2004 and March 2005, the results of epidemiological and entomological investigations in Kenya and in Comoro Islands confirmed the emergence of a Chikungunya epidemic caused by the same strain of the virus with an attack rate of close to 60%. In October 2005, a wave of epidemics occurred in India, and over a million cases due to the same viral strain were recorded (Yergolkar et al., 2006). In December 2006, epidemic outbreak sites were reported in Indonesia, Malaysia, Sri Lanka, and the Maldives, and imported cases were identified in several European countries and in North America.

The Réunion epidemic is without a doubt the largest ever documented in the scientific literature to date, and it struck ans island with a much more highly developed economic, technological and medical infrastructure than the other countries affected by the epidemic. Given that exposure to mosquito bites is a key environmental factor in contamination, adopting preventive measures is considered to be an effective way of avoiding infection. Therefore, from late 2005, warning bulletins, including advice on how to protect against mosquito bites and eliminate breeding sites, were regularly issued. They were rapidly followed by mosquito control campaigns with support from metropolitan France.

Within this unprecedented framework, a multidisciplinary Chikungunya research coordination unit was set up in March 2006. The role of the social sciences component was to identify the factors associated with contamination. More specifically, its aim was to determine, in a situation characterized by massive exposure, the degree to which Chikungunya epidemiology can be interpreted in terms of individuals' perceptions of the risk of contamination, while also evaluating whether certain social vulnerabilities can be associated with the distribution of Chikungunya within the population. Considering the rarity of social science-oriented studies based on epidemiological data in epidemic situations, we based our work on a broad theoretical framework in order to test in an unbiased manner the pertinence of the prevalent explanatory schemes used in the sociology of health and disease and in the psycho-sociology of risk.

I. Theoretical framework

During the last few decades, many social sciences-oriented studies have shown the importance of psychosocial factors in the morbidity associated with both chronic illnesses (diabetes, cancer, hypertension, etc. …

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