The 2013–2014 chikungunya outbreak represented the first recorded outbreak of the disease outside of tropical Africa and Asia. In December 2013, the first locally transmitted case of chikungunya in the Americas was detected in Saint Martin. Shortly after the first case the disease began to spread rapidly throughout the Caribbean region. By the end of the year, it had spread to Martinique and Guadeloupe, with suspected cases in Saint Barthélemy. By the end of January 2014, cases had been confirmed in Saint Barthélemy, as well as the British Virgin Islands, Dominica, and French Guiana. On the basis of 4,000 confirmed cases and over 30,000 suspected cases, the Caribbean Public Health Agency (CARPHA) declared a Caribbean-wide epidemic of the virus in early May. By the end of May, four cases of chikungunya had been confirmed in Florida. By July 2014 there were an estimated 355,000 cases in the Caribbean. By August 2014, 25 Caribbean countries had confirmed at least one case. The epidemic was over by 2015. Background Chikungunya is an arbovirus common to tropical regions of Africa and Asia. It is spread to humans by Aedes mosquitoes (primarily Aedes aegypti) that breed in stagnant water. The virus was first isolated in 1953, and likely first arose during the 1700s. Chikungunya is characterized by a sudden high fever and intense joint pain, between four and seven days after infection. It can also cause headaches, muscle pain, fatigue, and rashes. Most infected patients recover within 10 days, and deaths are rare. However, in some cases joint pain can linger for months or years. There is no vaccine or treatment for chikungunya and preventing its spread is difficult. Outbreaks are primarily dealt with through preventive measures, such as wearing long-sleeved clothing, and vector population control. First cases In early December 2013, health officials confirmed two cases of locally transmitted chikungunya on the French half of Saint Martin. It was announced to the public on December 17, by which time 10 cases had been confirmed and many more suspected cases were undergoing lab tests. Vice President Guillaume Arnell declared that his country had an "obligation" to prevent the disease from spreading. "It started here so we have to contain it here", he said. Swift action was taken, and a Pan American Health Organization representative said she was satisfied by the response. Even so, there were 66 confirmed cases by the end of the month,