Differences in Transmission and Disease Severity Between 2 Successive Waves of Chikungunya

Gordon, Aubree; Gresh, Lionel; Ojeda, Sergio; Chowell, Gerardo; González, Karla; Sánchez, Nery; Saborío, Saira; Mercado, Juan Carlos; Kuan, Guillermina; Balmaseda, Ángel; Harris, Eva

doi:10.1093/cid/ciy356

Cited by 31 publications

(34 citation statements)

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“…High proportions of inapparent CHIKV infections have been observed in multiple settings with different study designs over the last 15 years (10,14,(20)(21)(22)(23)(24)(25)(26)(27); however, the expected range of 3 to 28% was based (17) only on three studies conducted in the late 1990s and mid-2000s (30)(31)(32). This range has repeatedly been cited in subsequent reviews (15,16,18) and the Centers for Disease Control and Prevention's Yellow Book (19), despite recent serosurveys reporting higher levels of inapparent infections.…”

Section: Discussionmentioning

confidence: 99%

“…The title/abstract screen was performed twice to increase the probability of finding relevant articles. After reviewing the text of the above-mentioned articles, 21 articles were deemed relevant to our search, including one (14) that included two populations of interest. Whenever more than one study reported on the same outbreak, we selected the most thorough one to include in our analysis; in these cases, all reports were reviewed for information that might supplement data in the most thorough report.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological Evidence for Lineage-Specific Differences in the Risk of Inapparent Chikungunya Virus Infection

Carrillo

Collado

Sánchez

et al. 2019

J Virol

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In late 2013, chikungunya virus (CHIKV) was introduced into the Americas, leading to widespread epidemics. A large epidemic caused by the Asian chikungunya virus (CHIKV) lineage occurred in Managua, Nicaragua, in 2015. Literature reviews commonly state that the proportion of inapparent CHIKV infections ranges from 3 to 28%. This study estimates the ratio of symptomatic to asymptomatic CHIKV infections and identifies risk factors of infection. In October to November 2015, 60 symptomatic CHIKV-infected children were enrolled as index cases and prospectively monitored, alongside 236 household contacts, in an index cluster study. Samples were collected upon enrollment and on day 14 or 35 and tested by realtime reverse transcription-PCR (rRT-PCR), IgM capture enzyme-linked immunosorbent assays (IgM-ELISAs), and inhibition ELISAs to detect pre-and postenrollment CHIKV infections. Of 236 household contacts, 55 (23%) had experienced previous or very recent infections, 41 (17%) had active infections at enrollment, and 21 (9%) experienced incident infections. Vehicle ownership (multivariable-adjusted risk ratio [aRR], 1.58) increased the risk of CHIKV infection, whereas Ն4 municipal trash collections/ week (aRR, 0.38) and having externally piped water (aRR, 0.52) protected against CHIKV infection. Among 63 active and incident infections, 31 (49% [95% confidence interval {CI}, 36%, 62%]) were asymptomatic, yielding a ratio of symptomatic to asymptomatic infections of 1:0.97 (95% CI, 1:0.56, 1:1.60). Although our estimate is outside the 3% to 28% range reported previously, Bayesian and simulation analyses, informed by a systematic literature search, suggested that the proportion of inapparent CHIKV infections is lineage dependent and that more inapparent infections are associated with the Asian lineage than the East/Central/South African (ECSA) lineage. Overall, these data substantially improve knowledge regarding chikungunya epidemics. IMPORTANCE Chikungunya virus (CHIKV) is an understudied threat to human health. During the 2015 chikungunya epidemic in Managua, Nicaragua, we estimated the ratio of symptomatic to asymptomatic CHIKV infections, which is important for understanding transmission dynamics and the public health impact of CHIKV. This index cluster study identified and monitored persons at risk of infection, enabling capture of asymptomatic infections. We estimated that 31 (49%) of 63 atrisk participants had asymptomatic CHIKV infections, which is significantly outside the 3% to 28% range reported in literature reviews. However, recent seroprevalence studies, including two large pediatric cohort studies in the same setting, had also found percentages of inapparent infections outside the 3% to 28% range. Bayesian and simulation analyses, informed by a systematic literature search, revealed that Downloaded from the percentage of inapparent infections in epidemic settings varies by CHIKV phylogenetic lineage. Our study quantifies and provides the first epidemiological evidence that chikungunya epidemic characteristic...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiological Evidence for Lineage-Specific Differences in the Risk of Inapparent Chikungunya Virus Infection

Carrillo

Collado

Sánchez

et al. 2019

J Virol

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“…Other factors that could affect FoI were not included in our simulation models, such as vector control. Because CHIKV (29) and Zika virus (ZIKV) caused enormous epidemics in the PDCS when they were introduced in 2014-2015 and 2016, respectively, we do not believe that vector control fully accounts for the decline in FoI. However, CHIKV and ZIKV were novel invading pathogens and may have had different transmission dynamics.…”

Section: Discussionmentioning

confidence: 99%

Dynamics and determinants of the force of infection of dengue virus from 1994 to 2015 in Managua, Nicaragua

Katzelnick

Ben‐Shachar

Mercado

et al. 2018

Proc. Natl. Acad. Sci. U.S.A.

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Dengue virus (DENV) is the most prevalent human vector-borne viral disease. The force of infection (FoI), the rate at which susceptible individuals are infected in a population, is an important metric for infectious disease modeling. Understanding how and why the FoI of DENV changes over time is critical for developing immunization and vector control policies. We used age-stratified seroprevalence data from 12 years of the Pediatric Dengue Cohort Study in Nicaragua to estimate the annual FoI of DENV from 1994 to 2015. Seroprevalence data revealed a change in the rate at which children acquire DENV-specific immunity: in 2004, 50% of children age >4 years were seropositive, but by 2015, 50% seropositivity was reached only by age 11 years. We estimated a spike in the FoI in 1997–1998 and 1998–1999 and a gradual decline thereafter, and children age <4 years experienced a lower FoI. Two hypotheses to explain the change in the FoI were tested: (i) a transition from introduction of specific DENV serotypes to their endemic transmission and (ii) a population demographic transition due to declining birth rates and increasing life expectancy. We used mathematical models to simulate these hypotheses. We show that the initial high FoI can be explained by the introduction of DENV-3 in 1994–1998, and that the overall gradual decline in the FoI can be attributed to demographic shifts. Changes in immunity and demographics strongly impacted DENV transmission in Nicaragua. Population-level measures of transmission intensity are dynamic and thus challenging to use to guide vaccine implementation locally and globally.

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“…Acute chikungunya in children (from 1 to 18 years old) is comparable with disease in adults 50,54,55 , although the rate of asymptomatic infection might be higher overall than in adults 27,56 . Children (aged 2 months to 12 years) seem to generate stronger innate immune responses than adults 55 , which might explain the reduced severity of arthritis and lower rates of chronic arthropathy (5-11%) in children 50,57 .…”

Section: Disease In Infants and Childrenmentioning

confidence: 94%

Rheumatic manifestations of chikungunya: emerging concepts and interventions

2019

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Chikungunya virus (CHIKV) is a member of a group of globally distributed, mosquito-transmitted arthritogenic alphaviruses that cause sporadic outbreaks of primarily rheumatic disease every 2-50 years 1-4. The largest epidemic of CHIKV disease (hereafter simply referred to as chikungunya) ever recorded began on Lamu Island, Kenya, in 2004 (Fig. 1). The epidemic expanded across four continents, with cases still being reported in 2019 (Fig. 1; Supplementary Table 1). Three major genotypes of CHIKV are now recognized-the Asian, the West African and the Asian and East-Central South African (ECSA) genotypes 5-but a new lineage, the Indian Ocean Lineage (IOL), also emerged from the ECSA genotype during the 2004-2019 epidemic 6. The epidemic reached >100 countries (Supplementary Table 1), caused >10 million cases (Supplementary Table 2), and might arguably be called a pandemic. An estimated 1.3 billion people are at risk of chikungunya 7. Climate change modelling suggests that many more areas of the world (including parts of China, sub-Saharan Africa, South America and the United States) might become able to accommodate transmission of CHIKV in the future 8,9. Chikungunya was previously often viewed as (and for many patients remains) a relatively benign and selflimiting rheumatic disease. However, a considerably more complex spectrum of less common atypical and severe manifestations is now recognized in subgroups of patients, with chikungunya often complicated by comorbidities and co-infections. Hospitalization rates for chikun gunya range from 0.6% to 13% 10-14 and estimates of chikungunya-related mortality range from 0.024% to 0.7% 10,12,15-17. In addition, many patients develop protracted rheumatic disease lasting many months, occasionally years, with a number of sequelae now also recognized 18-22. Estimates for the total economic costs (direct and indirect) of chikungunya have ranged from a median of US$67 for adults and $258 for children in Columbia 23 , to a mean of $150 per outpatient and $3,300 per inpatient in 2006 in Réunion Island 11. In a large study of a chikungunya outbreak in Bangladesh in 2017, >10 days of productivity were lost in ~30% of patients with chikung unya because of severe arthropathy 24. Such costs might be viewed as relatively modest by Western standards; however, the occasionally high attack rate of chikungunya, with up to 30-75% of a given population affected by chikungunya disease at any one time 1,25 , can result in a substantial economic burden, especially in resource-poor communities that are often affected by the disease 26. Considerable research in patients and animal models has now provided extensive insights into the complex Pandemic An epidemic of disease that has spread across a large region; for instance, multiple continents, or even worldwide. Attack rate The total number of new cases of a disease divided by the total population (that is, the percentage of a defined population that is affected by a disease).

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Differences in Transmission and Disease Severity Between 2 Successive Waves of Chikungunya

Abstract: The intensity of transmission and severity of clinical presentation varied between the 2 epidemics, with higher transmission intensity associated with greater disease severity.

Cited by 31 publications

References 45 publications

Epidemiological Evidence for Lineage-Specific Differences in the Risk of Inapparent Chikungunya Virus Infection

Epidemiological Evidence for Lineage-Specific Differences in the Risk of Inapparent Chikungunya Virus Infection

Dynamics and determinants of the force of infection of dengue virus from 1994 to 2015 in Managua, Nicaragua

Rheumatic manifestations of chikungunya: emerging concepts and interventions

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