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 sleeves; consistent use of repellents containing DEET (30% to 50%), picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol; 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.[25][34][40]
The Public Health Department of California has extensive guidelines for mosquito surveillance, detection, and eradication that could be used by local health departments.[41]
Vaccines
Two vaccines are available for the prevention of disease caused by chikungunya virus.
A live-attenuated vaccine (known commercially as Ixchiq®): approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) for adults ≥18 years of age (and children ≥12 years of age in Europe). Safety restrictions currently apply in some regions regarding use in adults aged ≥60 years (see below).
An adjuvanted recombinant virus-like particle vaccine (known commercially as Vimkunya®): approved by the FDA and EMA for children ≥12 years of age and adults.
Both vaccines were approved in the US under an accelerated approval process based on anti-chikungunya virus neutralising antibody titres. The same data were used for European approval. 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.[42] 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.[43][44]
The US Advisory Committee on Immunization Practices (ACIP) recommends the live-attenuated vaccine for people aged ≥18 years to <60 years travelling to a country or territory where there is a chikungunya outbreak, and laboratory workers with potential for exposure to the virus. The live-attenuated vaccine may also be considered in people aged ≥18 years to <60 years travelling to a country or territory without an outbreak, but with evidence of chikungunya virus transmission among humans within the last 5 years, who are staying for a cumulative period of ≥6 months.[45]
ACIP made a recommendation for the use of the adjuvanted virus-like particle vaccine at its April 2025 meeting, but it has not been adopted by the Centers for Disease Control and Prevention (CDC) at the time of publication.
Potential safety signals have been reported with the live-attenuated vaccine (Ixchiq®). Serious adverse events, including cardiac and neurological events, have been reported during post-marketing use in people aged ≥60 years who have received the vaccine.
As of 7 May 2025, 17 serious adverse events, including two that have resulted in death, have been reported worldwide in people aged between 62 and 89 years of age. Six of these reports have been from the US. Many of the people had pre-existing comorbidities. It is unknown whether there is a causal relationship with the vaccine as yet, but drug regulatory agencies are currently investigating the issue.[46][47]
In the US, the FDA and CDC are recommending a pause in the use of Ixchiq® in people aged ≥60 years while the agencies investigate the postmarketing reports of serious adverse events. The FDA will conduct an updated assessment of the benefits and risks for use in people aged ≥60 years.[46]
In Europe, the EMA has recommended that Ixchiq® must not be used in people aged ≥65 years. Its use is now contraindicated in this age group as a temporary measure while it is reviewing the situation.[47]
Ixchiq® may still be used in people aged <60 years (in the US) or <65 years (in Europe) within its marketing authorisation. The safety restrictions do not affect the adjuvanted virus-like particle vaccine (Vimkunya®), and this vaccine may still be used in people aged ≥65 years.
Consult your local public health authority for more detailed and up-to-date information as this situation may change.
Both vaccines are given as a single intramuscular dose. The live-attenuated vaccine is contraindicated in immunocompromised people.
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.
Severe or prolonged chikungunya-like adverse effects that may prevent daily activities or require medical intervention are possible after vaccination. 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).[48]
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.[49]
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.[66]
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.[32] 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.[26]
It is a notifiable disease in some countries.
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