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Mosquito-borne chikungunya latest threat to outdoor workers

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Employers with outdoor workers should prepare for chikungunya, a mosquito-borne disease that began spreading stateside last year.

The U.S. Centers for Disease Control and Prevention calls chikungunya an emerging infectious disease, putting it in the same category as Ebola and Middle East respiratory syndrome, “which respect no national boundaries (and) can challenge efforts to protect workers, as prevention and control recommendations may not be immediately available.”

Chikungunya infections have been reported in Africa, Asia, Europe, islands in the Indian and Pacific oceans and the Caribbean, and the Americas, according to the CDC.

Some 2,492 cases of the virus were reported in U.S. states last year, including 11 locally transmitted cases in Florida — the first time chikungunya was transmitted within the U.S., according to the CDC. The rest were from travelers infected abroad.

In addition, there were 4,513 chikungunya cases reported in U.S. territories last year. All but 46 were locally transmitted cases.

There have been no locally transmitted U.S. cases so far this year, but sources say that likely will change as it gets warmer, so employers with outdoor workers should take steps to recognize and prevent such infections.

With incubation of three to seven days, the virus can cause fever, severe joint and muscle pain, headaches, joint swelling and rash for about one to two weeks, said Morgan Hennessey, Fort Collins, Colorado-based epidemic intelligence service officer at the CDC.

While death is rare, chikungunya symptoms are “debilitating,” Mr. Hennessey said of the illness the CDC is investigating to determine why some people have longer, more severe symptoms.

Infected Aedes aegypti and Aedes albopictus mosquitoes — the same ones that carry dengue and yellow fever — are likely to be found in the U.S. South around houses and buildings, Mr. Hennessey said. Unlike other species, these mosquitoes tend to bite during the day, making chikungunya an even bigger concern for outdoor workers, he said.

Sources speculate the workers compensation industry will handle the disease in the same way as West Nile, also a mosquito-borne virus that's been in the U.S. about 15 years.

“Over the past 15 years since the West Nile virus was first identified in North Texas in 2002, the City of Dallas has had only one West Nile virus workers compensation claim filed (and) that claim was unsubstantiated,” spokesmen for the City of Dallas said in an email.

Claims for mosquito-borne diseases are rare since it can be difficult to prove a bite occurred at work — unless other people witnessed the bite, there is an immediate adverse reaction or several workers are affected simultaneously, said Dr. Teresa Bartlett, Troy, Michigan-based senior vice president and medical director of Sedgwick Claims Management Services Inc.

People who spend time outdoors during their free time decrease the likelihood that a bite would be found compensable, said Edward Canavan, Riverside, California-based vice president of workers compensation practice and compliance at Sedgwick.

Still, employers should educate workers about the risks to avoid liability, sources said.

Employers should provide insect repellent and encourage workers to wear light-colored clothing, with long sleeves and pants when possible, according to the CDC. Workers should be discouraged from wearing fragrances and to discard food to avoid attracting insects. It's also a good idea to empty standing water from containers so they don't become breeding grounds for mosquitoes.

While the chikungunya infections have not yet resulted in litigation, West Nile infections have. (see story, page 4)

Just like there's no treatment for chikungunya beyond managing symptoms, there's no way to prevent it beyond avoiding mosquito bites, sources said.

Employers need to realize that even if a case of chikungunya isn't found to be work-related, “it's going to create worker disability,” said Dr. Maury Guzick, Dallas-based branch manager and physician adviser at Genex Services L.L.C., a managed care services provider. “Employers have to be cognizant that this may take an individual out of the workforce for a number of weeks.”