Chikungunya Detection during Dengue Outbreak in Sumatra, Indonesia: Clinical Manifestations and Virological Profile

Abstract

Chikungunya fever (CHIK) is an acute viral infection caused by infection with chikungunya virus (CHIKV). The disease affects people in areas where certain species mosquito vectors are present, especially in tropical and subtropical countries. Indonesia has witnessed CHIK disease since the early 1970s with sporadic outbreaks occurring throughout the year. The CHIK clinical manifestation, characterized by fever, headache, and joint pain, is similar to that of dengue (DEN) disease. During a molecular study of a DEN outbreak in Jambi, Sumatra, in early 2015, DENV-negative samples were evaluated for evidence of CHIKV infection. Among 103 DENV-negative samples, eight samples were confirmed (7.8%) as positive for CHIKV by both molecular detection and virus isolation. The mean age of the CHIK patients was 21.3 ± 9.1 (range 11-35 years). The clinical manifestations of the CHIK patients were mild and mimicked DEN, with fever and headache as the main symptoms. Only three out of eight patients presented with classical joint pain. Sequencing of the envelope glycoprotein E1 gene and phylogenetic analysis identified all CHIKV isolates as belonging to the Asian genotype. Overall, our study confirms sustained endemic CHIKV transmission and the presence of multiple arboviruses circulating during a DEN outbreak in Indonesia. The co-circulation of arboviruses poses a public health threat and is likely to cause misdiagnosis and underreporting of CHIK in DEN-endemic areas such as Indonesia.

Clinical and Epidemiologic Patterns of Chikungunya Virus Infection and Coincident Arboviral Disease in a School Cohort in Haiti, 2014–2015

“…As has been noted in multiple studies [8,22,23,[30][31][32], it can be difficult, particularly in endemic regions, to identify an infecting arbovirus based solely on clinical presentation. The current study made use of a school cohort, and consequently ages were concentrated between 3 years and 20 years, reflecting attendance in prekindergarten through "grade 13" (an additional year of school generally taken as part of the secondary education cycle).…”

The phylogenetic approach for viral infectious disease evolution and epidemiology: An updating review

“…The application of Bayesian statistical inference framework, can allow the reconstruction of the geographic history of the still ongoing and never reported before epidemic on the basis of the first isolates sampled at known times . It has been showed that CHIKV was imported to the Americas from South‐East Asia …”

“…180 It has been showed that CHIKV was imported to the Americas from South-East Asia. [181][182][183][184][185] During CHIKV outbreak in 2005 and 2006, nonsynonymous mutation (A226V) occurred both on La Reunion and in some Indian CICCOZZI ET AL.…”

Complete Genome Sequences of Two Chikungunya Viruses Imported into China

“…Of note, compared to the amino acid sequence of Ross, a 7-aa deletion was observed in the nsP3 of SZ1239, which was also found in other studies (GenBank accession no. HE806461, KM673291, and KX097982) ( 7 – 9 ). In addition, in the 3′ UTR of SZ1239, only two RSEs were observed, similar to those of the three CHIKV isolates mentioned above ( 7 – 9 ).…”

“…HE806461, KM673291, and KX097982) ( 7 – 9 ). In addition, in the 3′ UTR of SZ1239, only two RSEs were observed, similar to those of the three CHIKV isolates mentioned above ( 7 – 9 ). No A226V mutation in the envelope protein E1 was found in either strain.…”