Chikungunya: important lessons from the Jamaican experience

Abstract

Objectives. To describe the clinical presentation of chikungunya virus (CHIKV) illness in adults during the 2014 outbreak in Jamaica and to determine the predictive value of the case definition. Methods. A cross-sectional study was conducted using clinical data from suspected cases of CHIKV that were reported to the Ministry of Health in April – December 2014. In addition, charts were reviewed of all individuals over 15 years of age with suspected CHIKV based on a diagnosis of CHIKV or “acute viral illness” that presented to four major health centers in Jamaica during the week prior to and the peak week of the epidemic. Data abstracted from these charts using a modified CHIKV Case Investigation Form included demographics, clinical findings, and laboratory tests. Results. In 2014, the Ministry of Health of Jamaica received 4 447 notifications of CHIKV infection. PCR testing was conducted on 137 suspected CHIKV cases (56 men and 81 women; median age 28 years) and was positive for 89 (65%) persons. In all, 205 health charts were identified that met the selection criteria (51 men and 154 women, median age 43 years). The most commonly reported symptoms were arthralgia (86%) and fever (76%). Of those who met the epidemiologic case definition for CHIKV as defined by the Pan American Health Organization, only 34% had this diagnosis recorded. Acute viral illness was the most frequently recorded diagnosis (n = 79; 58%). Conclusions. Broader case definitions for acute CHIKV illness may be needed to identify suspected cases during an outbreak. Standardized data collection forms and validation of case definitions may be useful for future outbreaks.

Occurrence of Chronic Stage Chikungunya in the General Population of Martinique during the First 2014 Epidemic: A Prospective Epidemiological Study

“…Only rare community-based prospective studies were found to be reported in the scientific literature concerning insular Caribbean populations. [36][37][38][39][40][41] In other world regions, past exploratory research on chronicity was conducted either prospectively on hospitalized and circumscribed patient samples or retrospectively amidst the general population. 5,[12][13][14] In light of the emerging public health burden of CHIK disease for the Caribbean region and the Americas, the present study aims mainly to provide a more comprehensive description of the epidemiological characteristics and health outcomes of chronic stage CHIK cases in the general population of Martinique.…”

“…Similar results were reported on Reunion Island and during other investigations. 12,14,20,[36][37][38]43,[47][48][49][50] These trends could be explained by the fact that a higher humoral immune response during acute CHIK infection phase could be associated with evolution toward chronic stage CHIK and persistent arthlagia. 51 Indeed, women, as compared with men, are known to have a stronger humoral immune system linked to female hormones.…”

“…best knowledge, the Martinique study is the only one to examine longitudinally such a large cohort of participants (N = 509), with a broad geographical assessment of the study population all over the island (recruiting GPs were located in different areas of the territory). [36][37][38][39][40][41] The approach to gathering late illness symptoms and QoL attributes (diverse range of physical and psychological health outcomes) has also been rarely conducted by other research teams. However, less than half of the eligible subjects identified by GPs finally participated in the follow-up phase, with 705 participants (58.1%) lost to follow-up between the initial recruitment and the followup phases.…”

Chikungunya Virus Infection-associated Arthralgia in Adult Jamaicans Post-outbreak

“…The characteristics and consequences of CHIKV infection in Caribbean populations have been described (5,(12)(13)(14). However, only two English-speaking Caribbean countries [US Virgin Islands (USVI) and Jamaica] have published reports of the infection (15)(16)(17). Duncan et al highlighted the clinical presentation of CHIKV illness during the acute phase of the disease in Jamaica (17).…”

“…However, only two English-speaking Caribbean countries [US Virgin Islands (USVI) and Jamaica] have published reports of the infection (15)(16)(17). Duncan et al highlighted the clinical presentation of CHIKV illness during the acute phase of the disease in Jamaica (17). An investigation by Feldstein et al of the long-term outcomes of the disease in the USVI showed a 2.5-and 2.9-fold increased risk for persistent arthralgia at 6 and 12 months, respectively, after the acute phase (16).…”