Primary prevention

Avoidance of mosquito bites

  • Infection is prevented by avoidance of mosquito bites.

  • Potential measures include: reducing time of outdoor exposure (mosquitoes can transmit infection throughout the day, not just at dusk or dawn); wearing long-sleeved shirts and pants; use of Environmental Protection Agency (EPA)-registered insect repellents; use of permethrin on clothing; decreasing conditions in or around the household that may favour the breeding of larvae (such as removing containers that hold water); use of mosquito nets and air conditioning; and redoubling efforts while travelling in endemic areas.​[35][41]

Vaccines

  • Chikungunya virus infection can be prevented by vaccination. Vaccination should be considered in travellers at significant risk of exposure to the virus, and laboratory workers who are exposed to the virus.

  • Two vaccines are available globally for the prevention of disease caused by chikungunya virus.

    • An adjuvanted recombinant virus-like particle vaccine (known commercially as Vimkunya®): approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) for people aged ≥12 years.

    • A live-attenuated vaccine (known commercially as Ixchiq®): approved by EMA for people aged ≥12 years. The vaccine has been suspended in the US due to safety concerns and is no longer available (as of 22 August 2025).[42] However, the vaccine continues to be available in countries where it is licensed.​[43]

  • Both vaccines were approved based on anti-chikungunya virus neutralising antibody titres rather than prevention of clinical disease. Continued approval may be contingent upon verification of clinical efficacy in confirmatory studies.

    • A phase 3 randomised pivotal clinical trial using the live-attenuated vaccine enroled 4128 participants. Specific neutralising antibodies against chikungunya virus showed a 471-fold increase compared with baseline at day 29, and remained up to 107-fold increase as compared with the baseline at day 180. The vaccine was safe and well tolerated and no safety concerns were raised. The most common adverse effects included headache, fatigue, muscle pain, joint pain, fever, nausea, and injection-site tenderness.[44]​ The trial lacked clinical endpoints; however, a surrogate marker of protection is considered acceptable for approval under the FDA’s accelerated approval process.

    • Two phase 3 randomised placebo-controlled clinical trials using the adjuvanted virus-like particle vaccine enroled 3667 participants. The studies met their primary endpoint; 97.8% of vaccinated participants produced neutralising antibodies. However, clinical efficacy was only inferred from a specific neutralising antibody titre threshold selected as a surrogate marker. The most common adverse effects included headache, muscle pain, and injection site pain. These studies are yet to be published, and post-marketing efficacy studies are required to confirm the vaccine’s effectiveness.[45][46]

    • Clinical trials in children aged <12 years are ongoing.

  • The US Advisory Committee on Immunization Practices (ACIP) makes the following recommendations for vaccination:[47]

    • Virus-like particle vaccine: recommended for people aged ≥12 years travelling to a country or territory where there is a chikungunya outbreak occurring, and laboratory workers with potential for exposure to the virus. It may also be considered in people aged ≥12 years travelling to a country or territory without an outbreak, but with an elevated risk for US travellers if planning to stay for an extended period of time (e.g., ≥6 months).

    • Live-attenuated vaccine: the vaccine has been suspended in the US due to safety concerns and is no longer available (as of 22 August 2025).[42]

    • Vaccination recommendations may vary in other countries, and you should consult your local immunisation schedules for more information. The live-attenuated vaccine continues to be available in countries where it is licensed.[43]

  • Vaccination should only be considered when an individual is at significant risk of chikungunya virus infection, and only after a careful assessment of the risks and benefits.[47]​​[48]​​

    • The decision should take into consideration the person’s risk of exposure to chikungunya virus, the risk of severe or chronic disease outcomes if infected, and the risks of severe or prolonged chikungunya-like illness that may be caused by vaccination.

    • Factors to consider include level of disease activity at the destination, duration of travel/residence, and likelihood of exposure to mosquitoes.

  • ​The live-attenuated vaccine (Ixchiq®) has been associated with serious adverse events. Its license has been suspended in the US due to these safety concerns and it is no longer available there (as of 22 August 2025).[42]​ However, it continues to be available in countries where it is licensed.[43]​ Where it is available, it should be used with caution in people aged ≥65 years, and only after careful consideration of the risks and benefits.[48]

    • Several post-marketing reports of serious, and sometimes fatal, adverse events have been reported in older adults including hospitalisation for cardiac or neurological events, some of which were consistent with severe complications of chikungunya virus infection (e.g., atrial flutter, meningitis, encephalitis). Most patients were aged ≥65 years and had multiple or uncontrolled medical conditions. The adverse effects led to a worsening of the patients’ medical conditions or a deterioration in their general health, sometimes leading to hospitalisation and death.

    • Use of the live-attenuated vaccine in older adults was temporarily paused by the FDA and EMA in May 2025 while a thorough safety review was conducted. The restrictions were subsequently lifted by both agencies and the prescribing information updated to reflect this new information.[52][53][50][48]​​ However, in August 2025, the FDA suspended the biologics license of the live-attenuated vaccine due to subsequent reports of serious adverse events, determining that the vaccine is not safe and continued administration would pose a danger to public health.[42]

  • Both vaccines are given as a single intramuscular dose. The live-attenuated vaccine is contraindicated in immunocompromised people. The virus-like particle vaccine should be used with caution in immunocompromised people.[47]

  • The decision to use the vaccines during pregnancy should take the person’s risk of wild-type chikungunya virus infection, gestational age, and risks to the fetus or neonate from vertical transmission of wild-type chikungunya virus into consideration. There are no clinical studies in pregnant women. Neonates should be monitored closely for 7 days after birth if they are born within 14 days of the mother receiving the live-attenuated vaccine; it is unknown whether the vaccine virus can be vertically transmitted and cause fetal or neonatal adverse events. Animal studies of the adjuvanted virus-like particle vaccine have shown no potential issues. If both vaccines are available, the virus-like particle vaccine is preferred for pregnant women as live vaccines are typically not recommended in pregnant women.[47]

  • Severe or prolonged chikungunya-like adverse effects that may prevent daily activities or require medical intervention are possible after vaccination. Further post-marketing studies are required to assess the serious risk of severe chikungunya-like adverse reactions following administration.

Vaccines in development

  • Other vaccines are in late preclinical or clinical development.

  • Leading candidates include BBV87 (an inactivated whole virion vaccine).[56]

  • A chimeric vaccine using measles virus encoding chikungunya structural proteins (MV-CHIK), has also shown safety and tolerability in randomised phase 2 trials and produced immunogenicity in the majority of recipients after a single injection.[57]

Secondary prevention

Community education is important to identify the burden of the problem and to set actions to prevent proliferation of mosquitoes and avoid exposure.[75]

Especially in non-endemic areas, infected individuals should stay away from biting mosquitoes while they are ill, to prevent new local outbreaks.

Travellers need to be educated about their risk and the basic precautions they should take. They also need to identify symptoms and seek care if required.[33] CDC: Yellow Book: health information for international travel Opens in new window​​

Sanitary authorities need to be aware of the risk of transmission via blood transfusion and assess the need for donor screening in epidemic situations.[27]

It is a notifiable disease in some countries.

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