How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?

Abstract

Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08-50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835-429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015-2016 could be, given the timeframe of median time of occurrence.

Genetic Characterization of Northwestern Colombian Chikungunya Virus Strains from the 2014–2015 Epidemic

“…55,56 Nevertheless, the Colombian burden of CHIKF in terms of disability-adjusted life years and the cost of treatment should be estimated along with studies throughout the Americas to determine if the Asian CHIKV lineage differs from the IOL in virulence. [57][58][59][60] Infections in Colombia with CHIKV could also be influenced by the presence of other pathogens. The alphaviruses MAYV and CHIKV, closely related in the Semliki Forest complex, could cross-protect to some degree.…”

Post-chikungunya chronic arthralgia: a first retrospective follow-up study of 39 cases in Colombia

“…Until today, no observational studies in the region have described its prevalence, but recent estimations indicated that probably about 48 % of infected people in Latin America in a median of 20 months would develop it [2]. In this scenario, where over one million cases of CHIK were reported in the Americas during 2014, observational studies describing this rheumatologic consequence are urgently needed.…”

“…Among the studies assessing pCHIK-CIR, its relative frequency is highly variable, ranging from 14.4 to 87.2 % (including variable number of patients and follow-up times) [2,4,5]. Unfortunately, only studies assessing acute polyarthralgia (96 %) and arthritis (47 %) have been published in Latin America during the current CHIK epidemics [6], even without laboratory serological or molecular confirmation, which is highly relevant [7].…”

Chikungunya virus: epidemiology, replication, disease mechanisms, and prospective intervention strategies

“…Although viremia is usually cleared 5-7 days after infection and most acute symptoms resolve within 2 weeks, rheumatic manifestations can persist for months to years in a subset of individuals (7-10, 37, 103, 126, 127). The percentage of CHIKV-infected patients reported to develop protracted illness varies greatly (~14% to ~87%), but an average prevalence of approximately 48% among infected patients has been estimated (128). Risk factors for chronic CHIKV disease include age (>45 years), preexisting chronic inflammatory arthropathy, and severity of symptoms during the acute phase (129,130).…”