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Tennessee has turned up more cases of the mosquito-borne chikungunya virus, bringing the statewide count to 12, health officials said.

Related: Best ways to protect from mosquitoes

All of the cases are associated with travel to the Caribbean.

Health officials worry chikungunya will become established in the United States like West Nile virus. The U.S. Centers for Disease Control and Prevention warned in December that chikungunya — a virus originating from Africa — was circulating in the Caribbean for the first time.

Chikungunya: State's 2nd confirmed case in Knoxville area

Symptoms include fever, headache, fatigue, nausea, vomiting, muscle pain, rash and joint pain.

The only prevention is avoiding mosquito bites.

Prior cases were found in Knoxville and Madison County.

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