updatings their website software. but wiping the feeling of unease away will not be easy. nick spicer, al jazeera paris. >> remember you can get everything we're covering on our website, the address is aljazeera.com. aljazeera.com. >> it's a name americans are still learning, but if epidemiologists are right, it's one that we'll know all too well. chicken gunia. that's inside story. >> hello, i'm ray suarez.

it causes excruciating pain, fever, no cure, little treatment. so far no one has caught the disease called chikundunya in the united states. the sufferers have contracted it while suffering and brought it home. but public health authorities in the u.s. know its just a matter of time before it's here. chikungunya. the name comes from the language of the miconda people of tanzania. it means to become distorted. it is transmitted to humans by infected mosquitoes, causes fever, severe long- term joint pain. headache, rash, nausea. there is no cure for the disease, which is not fatal. it cannot be transmitted through human contact. it was first seen in 1952, but only arrived in the western

hemisphere in 2015 on the caribbean island of st. maarten. >> and in the u.s. there were only 2,000 cases last year. but only a tiny percentage of those originated here. by the end of this program you might be thinking, why haven't i heard about this? a lot? before today? chikungunya can bring di billtation to working people, pain that can last a long time, and it all starts with the bite of a mosquito active in the daytime. let's look at chikungunya with scott weaver, david haimer

and amish adalga . david haimer. let me start with you. how do we figure out in this time of jet travel, big ocean liners, pleasure cruisers coming and going, how many people have gotten it, where they've gotten it, and how sick they got? >> that's a challenging question. we have some reporting mechanisms that are useed to report current cases in local areas, transmission into the united states or into europe. there are also some surveillance networks, including one that i'm part of called geo sentinel that looks at migrants a by way as sentinels reporting infection. getting an accurate number is challenging.

>> is it in part because so few physicians in the united states have even seen the disease? >> that's definitely part of it, however, familiarity with with it as more and more cases are imported over the last few months and so. >> if someone presents in the hospital with a set of symptoms that resemble this would you at least put chikungunya on the list of possibilities? >> it a variable. in florida the awareness is much higher. i can't speak to the entire united states being aware, and the medical centers and physicians have to be alert to this. there used to be 30 cases of

chikungunya, but now it's skyrocket, and it behooves all physicians to learn more about this disease and learn how to test for it. >> when the disease is on its way, when the united states is the bull's eye, it's not quite here yet in really large numbers, how do we gear up for it? do we have a weapon to fight it a set of protocols so we know what to do when we see it? >> yes, well, ever since the first of the recent outbreaks that began in 2005 the u.s. has done quite a bit to gear up for the a rival. we expected the a rival of chikungunya to be earlier in 2007 and 2008 when there were many travelers returning from india and asia. the national institutes of health put chikungunya on the list of priority path then list, which means that it is targeted

for special funding because of an emerging disease it was considered a threat to the united states. so many scientists, including we here at the university of texas medical branch began working on chikungunya many years ago. for example, in my laboratory we started developing a vaccine in 2008, and thanks to funding from the nih and also a partnership with a large pharmaceutical company we now have a vaccine varily close to beginning human clinical trials, and several other laboratories both government and academic develop promising vaccines, and some of those are partnered with companies. >> not to alarm people unduly, but we should talk more about what the course of this disease is like. what is a sufferer likely to

experience? >> well, i haven't interviewed patience in the acute stage of the disease, but i had the opportunity to visit the dominican republic late last spring when the outbreak was really starting to peak there, and many of the people who had been infected told me that there was a very sudden on set of the disease. they could remember literally to the hour when they began feeling sick, and they developed very high fever, typically a headache, severe aches in the joints and muscles, and what's different about chikungunya is a similar disease, especially dangy, for example, several weeks to a couple of months after they became infected these people in the dominican republic still had severe swelling and pain in their joints, especially in the wrists, ankles and hands. we know now from studies during

outbreaks in the indian association basin where the outbreaks of chikungunya began in 2005 to 2006 there, even three years after infection many people still suffer from pain and sometimes swelling of their joints. this is a very chronic disease. it's different than most infectious diseases that we think of, flu-like diseases where we feel terrible for a week or two, then we return to normal fairly quickly after that. this is a chronic disease affecting people's health, mobility and ability to care for their families for years. >> that's the scary part of this. as i've read on this and the after effects, the long-term illness that you experienced makes it different from the things that we're used to getting in north america. >> this is correct. and actually, scott alluded to

some of the studies done on the islands in the indian ocean, and patients have been followed, and some of them will develop persistent inflammatory arthritis in their joint with associated pain. it may taper off for a year or so, but for some it lasts for several years afterwards. it's such a big issue, and part of that initial outbreak began in islands associated with france, so the french have done studies. many have guidelines for these patients because it's chronic and destructive arthritis, the results. >> have we efficiently study the effect the climate in the united states may be having or may have in the future on the spread of the kind of mosquito that gives

you the virus? >> so the chikungunya is spread by mosquitoes that are already in the united states. the aedes aegypti is already in the united states. a traveler comes back. they're bitten by the right mosquito, and then there is a local outbreak. that's what we've seen in florida. we've seen dengay fever. but the united states was a prone country. even during george washington's presidency yellow fever basically shut down the federal government. so infectious diseases are not something new to the united states. >> but that idea of what it takes for a human being, a host

with the virus circulateing in their system, to be bitten by a mosquito, and then to pass it on. they've been wrestling with this with malaria over the world, is there a way to clip that chain to make it less likely that that kind of transmission is going to happen? >> i think there are definite ways to control the vector. we do a lot of mosquito-tarted activities looking for breeding sites of mosquitoes, standing water, and making sure no standing water is persistent in the environment so mosquitoes don't have a place to breed. a lot of this happened with dengue fever. it's also spread by the mosquito. key west had an outbreak of denge, and they had an aggressive campaign to get the you community to get rid of standing water to stop the breeding of these mosquitoes.

that's the way we can prevent the spread, to stop the mosquito from breeding. >> we'll be back with more "inside story" on al jazeera. now that we've given you the basic bad news about a new disease headed to the mainland what do we do about it? if the warmest areas of the country have seen widespread infections what are the consequences going to be? is there anything we can do to fight back. we'll follow up with our health practitioner. stay with us. >> al jazeera america presents a breakthrough television event. borderland. six strangers. >> let's just send them back to mexico. >> experience illegal immigration up close and personal. >> it's overwhelming to see this many people that have perished. >> lost lives are relived. >> all of these people shouldn't be dead. >> will there differences bring them together or tear them apart? >> the only way to find out is to see it yourselves. >> which side of the fence are you on? borderland, sunday at 9

eastern, only on al jazeera america.

>> you're watching inside story. we're talking about a motor vehicle-born disease headed to the united states. day-time biters from two mosquito species carrying chikungunya taking root in the caribbean and heading to the usa.

now what now? we talked earlier of a vaccine. to whom would it be given? would it be given to kids to protect against the wide variety of diseases? >> i think it depends on where you live in the world. here in the united states, for example, i don't think we're going to see wide epidemics of chikungunya, certainly not in the northern end of the country. it might be targeted to florida and southern texas where again as with dengue, which is a disease that is transmitted in the same manner by mosquitoes, among people, we have a long history, and we know more or less what to expect with the chikungunya outbreaks. >> why is that? we're just hearing that the mosquitoes that spread this disease are fairly widespread and well established in the united states. why would there have to be that geographically-specific

response, at least to start with? >> well, the strain that arrived in the caribbean late last fall is one that based on experimental work that we and others have done, we think it's primarily going to be transmit transmitted by aedes aegypti. it cannot survive winters, so you won't see it in the north. a mosquito that can survive cold temperatures so it occurred in temperate parts of the country so if we see different strains of chikungunya coming into the country we could see it going further north. but regardless of which mosquito is transmitting and which strain of chikungunya we see here in the u.s. there is just enough air conditioning and screening of houses that we don't have the between mosquitoes and people as you

would see in the caribbean and latin america. we won't see the same efficiency of transmission, therefore , i don't think that we'll see the size of outbreaks that we'll see. for example, in the dominican republic there were an estimated half million cases in the past year. we'll see the same kind of outbreaks that we see with dengue, which are small number of people in places like florida, houston, or the rio grand valley in texas. involving perhaps a few dozen up to a few thousand people. but not up into the very large numbers that we're going to be seeing in latin america where they're going to be tens of millions of people exposed to this virus. >> david hamer environmentally ecologically, south florida is very much like puerto rico cuba, the other islands of the caribbean. there are winds that carry eggs

and see seeds and plants, the boats, the airplanes, the human commerce that covers that tight sea is something that could easily spread a disease like this, isn't it? >> it is, yes, but as scott has said, dengue has landed in parts of key west and other areas, and in most of those outbreaks have been snuffed out fairly quickly, and there has been relatively little local transmission. i want to add a point about the vaccine, and that is, yes, it would be useful for select populations in high risk areas in the united states, but we have to think about travelers. we have a large population of the united states that travels to the caribbean and south south america and other parts of the

world where this disease is being transmitted. if we had an effective vaccine we would be using it for the traveling population. >> it's one thing to go to key west, a pretty small community even if a popular one. but if a disease like this gets established in miami, tampa, isn't it a whole different--a whole different happening, a whole different medical event that needs a different scale of response? >> well, mosquito control is going to be more difficult in areas that are highly urbanized. we did see during the dengue outbreak that there were cases in miami-dade county, and they were aggressive in controlling the mosquitoes. if you have those resources in place to get rid of standing water, educate the public about the danger of mosquito bites you can usually take care of it.

the american lifestyle of air conditioning being indoors and screening windows does a lot to stop these mosquitoes from causing disease the way they can in places like puerto rico and u.s. and virgin islands. >> when you have many more people per square mile, doesn't it raise the chance that a mosquito, when it alights on someone's arm or shoulder or the back of their neck, is going to get a sip of chikungunya virus at a higher rate of chance than it would in key west? >> if there are people that are harboring the virus in miami, for example, if there are more people, there are more chances of it being picked up. but it's all based upon the travel patterns right now because we don't have much local transmission. where are the travelers in the caribbean coming to, and where are they harboring the virus. that's the question. that's what is important about recognizing with this disease so

they're not walking around with the chikungunya in their blood any way. they're not going to be because it's debilitating, and you'll be in bed and you won't have access to mosquitoes. you'll be inside of a house with screens and air conditioning, and the mosquitoes won't be able to get to you when you're sick. >> when we come back, do we have to write a new playbook on infectious disease to respond to the demands of a world where people never had a chance to breathe on each other before now do. can they now just get on a plane while swimming through someone's blood stream, and then at the end of the day be halfway around the world. stay with us. >> every monday night, al jazeera america brings you conversations you won't find anywhere else. >> it's nice to be doing something everybody is so aware of. >> is anybody doing this better? >> "talk to al jazeera".

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>> we're back with inside story on al jazeera america. i'm ray suarez. we're getting the latest of chikungunya on this program.

while some americans are freaked out about ebola, a dangerous disease that infected and killed a tiny number of people in this country, chikungunya, painful and debilitating is on its way and almost no one is talking about it, outside of the medical profession, we're fixing that. with us, our guests . >> david hamer, in a world where people spread disease the way they do in this new mobile way where sars was in toronto. h1n1 was in philadelphia in a

matter of days after it broke out in a big farming area in mexico, do we have to retry both our early warning symptoms which is incident intimately connected with the work that you do. >> i think that we do to an extent. i think that the bole epidemic has highlighted the need to have good procedures in place to track the disease . chikungunya presents a different kind of problem because it can spread fairly quickly as it has

on the islands in the indian ocean, so we may need to change our symptoms in response. and our response needs to be timely in order to control the vector of the mosquito control that was described. >> amesh, we were talking earlier just how long this disease can stick with you, and the possible, really long-term effects of discomfort, pain, swelling of an arthritis-like condition for a long time. does that help us when we have to turn around and talk to the public about draining standing water in the backyard, about making sure that people take precautions, that they use bug spray when they go to certain places in the caribbean. does the down stream help us in the messaging to the public

about why it is so vital to stop its spread? >> when people are faced knowing that they may be exposed to a virus that will leave them with debilitateing aches and pains, and people with lingering problems, that gives them incentives to take care of their backyard, dump the standing water, get rid of the old tires that may be collecting water but it's not just chikungunya but dengue and west nile, the mosquito disease that was introduced in the united states in 1999, and it has spread to basically every state. we have to get rid of mosquito-born illnesses, because it has not been that long that we have malaria and yellow fever in the united states, for example. >> well, scott weaver, given what we've been talking about and given how terrible this disease sounds, has it gotten

the right amount of attention from big pharma? from the federal government, has it gotten the right amount of investment so we're ready when the mosquitoes are landing? >> chikungunya is a good example of several different emerging infectious diseases where it's not the same kind of financial incentive for big pharma to invest as there are for common diseases like influenza and cancer and so forth. it's a sporadic disease. it sweeps through a region, and it may not be detected in that region for 10 or 20 years afterwards. so if you're thinking as a business person working for big pharma, you have to think what is the market going to be not today but in five or ten years are americans or caribbean or latin american people going to

be able to invest in the chikungunya vaccine. they have to think about the cost of developing and licensing the vaccine which typically costs in the hundreds of millions of dollars. in the case of chikungunya how would you test the vac teen in order to show that it protects people to have it licensed. so government needs to become involved. what we're starting to see with ebola we're also going to see with chikungunya. different groups of countries partnering with big pharma are going to have to develop a novel, innovative way to fund and get these vaccines to market. >> unless i missed my guess, knowing a couple of people who have it will make money less of an object. amesh, scott

thank thank you for being with us today. i'm ray suarez. >> coming up at 6:00 p.m. eastern. 6:00 p.m. eastern. >> joint military exercises between united states and south korea are regular occurrences. this one, codenamed max thunder - took place in november at the kunsan air force base 150 miles south of seoul... >> this type of exercise takes place every year but for the north korean government they consider this a