Prevalence of chronic comorbidities in chikungunya: A systematic review and meta-analysis

Badawi, Alaa; Ryoo, Seung Gwan; Vasileva, Denitsa; Yaghoubi, Sahar

doi:10.1016/j.ijid.2017.12.018

Cited by 45 publications

(45 citation statements)

References 49 publications

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“…Comorbidities such as hypertension, diabetes (both type I and type II) and cardiac disease can contribute to chikungunya severity and admissions to the ICU 60 . For example, diabetes can increase the severity and duration of chikungunya and in patients with diabetes and hyperglycaemia, chikungunya infection is associated with worsening of diabetic symptoms (such as poor glycaemic control and acute complications) 61 .…”

Section: Comorbidities and Co-infections Comorbiditiesmentioning

confidence: 99%

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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Section: Comorbidities and Co-infections Comorbiditiesmentioning

confidence: 99%

Rheumatic manifestations of chikungunya: emerging concepts and interventions

2019

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“…Meanwhile, studies in other countries have shown that the rate of chronic cases is approximately 50% 5,9,10 . Deaths can occur in any of these phases, by direct or indirect action of the virus 11,12 . The age groups who are at higher risk of severe diseases include neonates who acquire the disease in the perinatal period, elderly 13 individuals, and those with pre-existing diseases 14 .…”

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confidence: 99%

Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Frutuoso

Freitas

Cavalcanti

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: In 2014, the first cases of autochthonous chikungunya (CHIK) were recorded in Brazil. Lethality associated with this disease is underestimated. Thus, this study aimed to analyze the causes of death among individuals with CHIK in Brazil. Methods: A descriptive observational study was conducted on individuals with CHIK who died within 6 months from symptom onset. Data pairing between the Information System for Notifiable Diseases and the Mortality Information System was performed. Deaths were classified according to case confirmation criterion, mention of CHIK in the death certificates (DCs), and disease phase. The lethality rate per 1,000 cases was corrected for underreporting and was estimated according to region, sex, age, years of education, race/color, and cause groups. Results: We identified 3,135 deaths (mention of CHIK in the DCs, 764 [24.4%]). In 17.6% of these cases, CHIK was the underlying cause. Most deaths occurred in the acute (38.1%) and post-acute (29.6%) phases. The corrected LR (5.7; x1,000) was 6.8 times higher than that obtained from the Information System for Notifiable Diseases (0.8). The highest corrected LRs were estimated for among individuals living in the Northeast region (6.2), men (7.4), those with low years of education and those aged <1 year (8.6), 65-79 years (20.7), and ≥80 years (75.4). Conclusions: The LR of CHIK estimates based on information system linkage help to reveal the relevance of this disease as the direct cause or as a cause associated with serious or fatal events, provide timely interventions, and increase the knowledge about this disease.

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“…A recent systematic review and meta-analysis found the following as the most prevalent comorbidities associated with CHIKV infection: hypertension (31.3%), diabetes (20.5%), heart diseases (14.8%), and asthma (7.9%), and this prevalence increased with age. 22 It is described that patients with CHIKV infection who are older have cardiovascular, neurologic, and respiratory disorders or with diabetes tend to present complications. 2 A recent study in our region found association between increasing number of deaths attributed to type 2 diabetes mellitus and CHIKV infection in Brazil in the same period, and this could be explained by the fact that the presence of comorbidities increases the severity of the infection.…”

Section: Discussionmentioning

confidence: 99%

“…23 Diabetes was also associated with chikungunya severity in another study. 22 Previous studies show that CHIKV cause osteoarticular disturbances, which are very frequent. Cardiovascular disease is also considered common, and infrequent manifestations of CHIKV infection include neurologic complications, skin lesions, kidney involvement, and gastrointestinal, hepatic, and hematologic disturbances.…”

Section: Discussionmentioning

confidence: 99%

Impact of Chronic Kidney Disease on Chikungunya Virus Infection Clinical Manifestations and Outcome: Highlights during an Outbreak in Northeastern Brazil

Silva

Pinto

Mota

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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The northeastern region of Brazil has faced in the last 2 years the largest outbreak of chikungunya virus (CHIKV) infection in its history. There are still few studies on kidney involvement in CHIKV. The aim of this study is to describe the impact of chronic kidney disease (CKD) on CHIKV clinical manifestations and outcome. This is a cross-sectional study conducted in the State of Ceara, northeastern Brazil, including all registered cases of CHIKV infection in the period from January 2016 to December 2017. Clinical manifestations were collected from the notification reports from official data bank from the State Secretary of Health of Ceara: National System of Diseases Notification and Laboratory Manager. A total of 182,731 cases were notified. Patients' mean age was 32.4 ± 14.6 years, and 62.2% were female. The most common clinical manifestations were fever (88.6%), headache (72.9%), intense arthralgia (69.5%), and myalgia (65.6%). Hospital admission was required for 3,080 cases (3.3%), and death occurred in 383 cases (0.2%). Chronic kidney disease was reported in 691 cases (0.3%). Patients with CKD had a higher frequency of almost all clinical manifestations, including fever, myalgia, exanthema, vomiting, nausea, back pain, conjunctivitis, arthritis, severe arthralgia, petechiae, and retro-orbital pain. They also had a significantly higher frequency of diabetes, hematological disorders, liver diseases, hypertension, peptic ulcer disease, and autoimmune diseases. Mortality was significantly higher among CKD patients than patients without CKD (3.0% versus 0.2%, < 0.0001).

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Prevalence of chronic comorbidities in chikungunya: A systematic review and meta-analysis

Cited by 45 publications

References 49 publications

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Impact of Chronic Kidney Disease on Chikungunya Virus Infection Clinical Manifestations and Outcome: Highlights during an Outbreak in Northeastern Brazil

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