A major chikungunya epidemic with high mortality in northeastern Brazil

Simião, Adriana Rocha; Barreto, Francisca Kalline de Almeida; Oliveira, Rhaquel de Morais Alves Barbosa; Cavalcante, John Washington; Neto, Antonio S. Lima; Barbosa, Rebeca Bandeira; Lins, Camila de Sousa; Meira, Anna Giulia; Araújo, Fernanda Montenegro de Carvalho; Lemos, Daniele Rocha Queiróz; Alencar, Carlos Henrique; Cavalcanti, Luciano Pamplona de Góes

doi:10.1590/0037-8682-0266-2019

Cited by 26 publications

(30 citation statements)

References 11 publications

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“…Studies have shown that the presence of comorbidities, such as diabetes, hypertension, and kidney disease, were significantly associated with death from CHIK 10,39,45 , and the number of comorbidities increased with age, which may explain the high number of deaths among individuals aged over 65 years in this study.…”

Section: Discussionmentioning

confidence: 60%

Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Frutuoso

Freitas

Cavalcanti

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: In 2014, the first cases of autochthonous chikungunya (CHIK) were recorded in Brazil. Lethality associated with this disease is underestimated. Thus, this study aimed to analyze the causes of death among individuals with CHIK in Brazil. Methods: A descriptive observational study was conducted on individuals with CHIK who died within 6 months from symptom onset. Data pairing between the Information System for Notifiable Diseases and the Mortality Information System was performed. Deaths were classified according to case confirmation criterion, mention of CHIK in the death certificates (DCs), and disease phase. The lethality rate per 1,000 cases was corrected for underreporting and was estimated according to region, sex, age, years of education, race/color, and cause groups. Results: We identified 3,135 deaths (mention of CHIK in the DCs, 764 [24.4%]). In 17.6% of these cases, CHIK was the underlying cause. Most deaths occurred in the acute (38.1%) and post-acute (29.6%) phases. The corrected LR (5.7; x1,000) was 6.8 times higher than that obtained from the Information System for Notifiable Diseases (0.8). The highest corrected LRs were estimated for among individuals living in the Northeast region (6.2), men (7.4), those with low years of education and those aged <1 year (8.6), 65-79 years (20.7), and ≥80 years (75.4). Conclusions: The LR of CHIK estimates based on information system linkage help to reveal the relevance of this disease as the direct cause or as a cause associated with serious or fatal events, provide timely interventions, and increase the knowledge about this disease.

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Section: Discussionmentioning

confidence: 60%

Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Frutuoso

Freitas

Cavalcanti

et al. 2020

Rev. Soc. Bras. Med. Trop.

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“…However, it was possible to identify spatial clusters for dengue presence and a spatial dispersion of chikungunya and Zika. The occurrence of outbreaks of chikungunya and Zika in both study sites could explain the widespread presence of cases in each city [17, 29, 32, 45–47]. However, the magnitude of chikungunya’s outbreak in Fortaleza was larger compared with the outbreak of Zika in the same city [45, 47] and to chikungunya and Zika in Medellin.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence of outbreaks of chikungunya and Zika in both study sites could explain the widespread presence of cases in each city [17, 29, 32, 45–47]. However, the magnitude of chikungunya’s outbreak in Fortaleza was larger compared with the outbreak of Zika in the same city [45, 47] and to chikungunya and Zika in Medellin. Although both sites are known for the presence of arboviruses, differences in disease distribution could be attributed to environmental differences including altitude and temperature or other socio‐environmental factors associated to vector presence and population’s immunological profile in each site [1, 2, 17, 44, 45, 47].…”

Section: Discussionmentioning

confidence: 99%

“…While chikungunya represented a major public health issue in Fortaleza, with higher rates and presence of spatial clustering, the rates in Medellin were low and evenly distributed. In fact, Fortaleza presented one of the highest rates of chikungunya in Brazil during 2017, with the highest reported mortality rate in the country [29, 45, 47, 49]. This differed from Medellin, where chikungunya rates were below the national average in Colombia [32].…”

Section: Discussionmentioning

confidence: 99%

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Spatiotemporal distribution and socioeconomic disparities of dengue, chikungunya and Zika in two Latin American cities from 2007 to 2017

Carabalí

Neto

Sousa

et al. 2020

Tropical Med Int Health

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Objective To assess the presence, pattern and magnitude of socioeconomic inequalities on dengue, chikungunya and Zika in Latin America, accounting for their spatiotemporal distribution. Methods Using longitudinal surveillance data (reported arboviruses) from Fortaleza, Brazil and Medellin, Colombia (2007–2017), we fit Bayesian hierarchical models with structured random effects to estimate: (i) spatiotemporally adjusted incidence rates; (ii) Relative Concentration Index and Absolute Concentration Index of inequality; (iii) temporal trends in RCIs; and (iv) socioeconomic‐specific estimates of disease distribution. The spatial analysis was conducted at the neighbourhood level (urban settings). The socioeconomic measures were the median monthly household income (MMHI) for Brazil and the Socio‐Economic Strata index (SES) in Colombia. Results There were 281 426 notified arboviral cases in Fortaleza and 40 887 in Medellin. We observed greater concentration of dengue among residents of low socioeconomic neighbourhoods in both cities: Relative Concentration Index = −0.12 (95% CI = −0.13, −0.10) in Fortaleza and Relative Concentration Index = −0.04 (95% CI = −0.05, −0.03) in Medellin. The magnitude of inequalities varied over time across sites and was larger during outbreaks. We identified a non‐monotonic association between disease rates and socioeconomic measures, especially for chikungunya, that changed over time. The Relative Concentration Index and Absolute Concentration Index showed few if any inequalities for Zika. The socioeconomic‐specific model showed increased disease rates at MMHI below US$400 in Brazil and at SES‐index below level four, in Colombia. Conclusions We provide robust quantitative estimates of socioeconomic inequalities in arboviruses for two Latin American cities. Our findings could inform policymaking by identifying spatial hotspots for arboviruses and targeting strategies to decrease disparities at the local level.

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“…In 2015, the Zika virus (ZIKV) started to circulate in the Northeast region of Brazil and, in the following years, caused an epidemic with more than 200,000 reported cases. This virus has been associated with many neurological disorders, including congenital syndrome caused by the Zika virus and Guillain-Barré syndrome [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Seroprevalence, spatial dispersion and factors associated with flavivirus and chikungunya infection in a risk area: a population-based seroprevalence study in Brazil

et al. 2020

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Background The State of Ceará, in Northeastern Brazil, suffers from a triple burden of arboviruses (dengue, Zika and chikungunya). We measured the seroprevalence of chikungunya, dengue and Zika and its associated factors in the population of Juazeiro do Norte, Southern Ceará State, Brazil. Methods A cross-sectional study of analytical and spatial analysis was performed to estimate the seroprevalence of dengue, Zika and chikungunya, in the year 2018. Participants were tested for IgM and IgG against these three viruses. Those with IgM and/or IgG positive tests results were considered positive. Poisson regression was used to analyze the factors associated with positive cases, in the same way that the spatial analysis of positive cases was performed to verify whether the cases were grouped. Results Of the 404 participants, 25.0% (103/404) were positive for CHIKV, 92.0% (373/404) for flavivirus (dengue or Zika) and of these, 37.9% (153/404) samples were classified as probable dengue infection. Of those who reported having had an arbovirus in the past, positive CHIKV cases had 58.7% arthralgia (PR = 4.31; 95% CI: 2.06–9.03; p = 0.000) mainly in the hands, ankles and feet. Age over 60 years had a positive association with cases of flavivirus (PR = 1.29; 95% CI: 1.09–1.54; p = 0.000). Fever, muscle pain, joint pain and skin rash were the most reported symptoms (46.1, 41.0, 38.3 and 28.41%, respectively). The positive cases of chikungunya and dengue or Zika were grouped in space and the city center was most affected area. Conclusions Four years after the introduction of CHIKV, where DENV has been in circulation for over 30 years, 1/4 of the population has already been exposed, showing the extent of the epidemic. The measured prevalence was much higher than that reported by local epidemiological surveillance.

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A major chikungunya epidemic with high mortality in northeastern Brazil

Cited by 26 publications

References 11 publications

Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Spatiotemporal distribution and socioeconomic disparities of dengue, chikungunya and Zika in two Latin American cities from 2007 to 2017

Seroprevalence, spatial dispersion and factors associated with flavivirus and chikungunya infection in a risk area: a population-based seroprevalence study in Brazil

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