Chikungunya outbreak in Delhi, India, 2016: report on coinfection status and comorbid conditions in patients

Abstract

Chikungunya fever is a major public health issue in India affecting billions. After 2010, the infection was in a decline until in 2016, when a massive outbreak affected the country. In this report, we present serologic and molecular investigations of 600 patient samples for chikungunya and dengue viruses along with clinical and comorbidity features. We recruited 600 patients during this outbreak and evaluated them for chikungunya and dengue virus antibodies and virus RNA through IgM, NS1 antigen and quantitative real-time PCR (qPCR). We further evaluated Zika virus RNA by qPCR. Additionally, we documented all clinical and comorbid features that were observed during the outbreak in the hospital. We report a total incidence rate of 58% of chikungunya during the outbreak in our hospital. Within the recruited patients, 70% of the patients were positive for chikungunya virus IgM whereas 24.17% were positive by qPCR. None of the samples was positive for Zika virus RNA. Additionally, coinfection of dengue and chikungunya was seen in 25.33% of patients. Analysis of clinical features revealed that 97% of patients had restricted movements of the joints with other features like swelling, itching and rashes of varying severity observed. Twelve patients presented with comorbid conditions, and two fatalities occurred among these comorbid patients. The high incidence of coinfection in the current outbreak warrants implementation of routine testing of both chikungunya and dengue virus in suspected patients for better patient management. The post–acute phase complications reported in the hospitals require in-depth studies to understand the actual impact of the current outbreak.

Emergence of Chikungunya Virus, Pakistan, 2016–2017

“…Chikungunya should be considered as a diagnosis in persons who report fever, rash, or arthralgia, especially those returning from travel to virus-endemic areas (14). Chikungunya cases increased in Karachi and adjoining areas of Pakistan within months after massive outbreaks in India in 2016 (15). CHIKV in those outbreaks had high sequence homology to isolates from Pakistan, ascribing to the ECSA Indian Ocean lineage.…”

Global prevalence and distribution of coinfection of malaria, dengue and chikungunya: a systematic review

“… Kalawat [ 77 ] Tirupati, India 2011 Retrospective analysis 72 2 3 All ages IgM ELISA / IgM ELISA NM 7. Kaur [ 78 ] Delhi, India Aug-Dec. 2016 Cross sectional 600 152 25 11–68 IgM ELISA, NS1 ELISA, PCR/IgM ELISA, PCR NM 8. Londhey [ 79 ] Mumbai, India June 2010–April 2015 Prospective observational study 300 30 10 All ages IgM ELISA, PCR/ IgM ELISA, PCR NM 9.…”

Evaluation of an immunochromatography rapid diagnosis kit for detection of chikungunya virus antigen in India, a dengue-endemic country

“…Since its first report in Delhi in 2009, a total of 272,384 confirmed CF patients have been reported [ 11 ]. Apart from these CF outbreaks that occur from time to time, the additional burden of co-infections with DENV makes patient management a huge concern [ 12 ] The current approach of CF diagnosis is either by detecting the viral RNA using quantitative PCR or by detecting the antibodies against the virus using ELISA. Both the above-mentioned methods have their own caveats making early diagnosis of CF cumbersome and/or ineffective, especially during outbreaks involving large number of individuals.…”