Severe Manifestations of Chikungunya Fever in Children, India, 2016

Sharma, Pradeep; Kumar, Maneesh; Kumar, Vinay; Srivastava, Rajendu; Sahani, Ashish Kumar; Goyal, Rohit

doi:10.3201/eid2409.180330

Cited by 17 publications

(18 citation statements)

References 8 publications

(7 reference statements)

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“…Common acute atypical manifestations include vomiting and seizures 54 . Severe disease primarily involves the CNS 44,54,58 , but chikungunya can also affect multiple systems and lead to severe viral sepsis and septic shock 53,59 .…”

Section: Disease In Infants and Childrenmentioning

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: Disease In Infants and Childrenmentioning

confidence: 99%

Rheumatic manifestations of chikungunya: emerging concepts and interventions

2019

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“…Surveillance data released by WHO in 2019, however, point to a significantly higher CFR among the Sudanese population, setting the value of 18 per 1,000 clinical infections as the credible upper bound for CFR [ 44 ]. Although the fever, rash, and joint pain associated with acute infection are usually self-limited and last only 1 to 2 weeks [ 45 ], CHIKV can result in neurologic [ 17 ], renal [ 46 ], cardiac [ 47 ], respiratory [ 48 ], and hematologic [ 49 ] complications that may result in death or necessitate aggressive medical interventions. Moreover, the acute symptoms of CHIKV often progress to long-term rheumatism, including severe arthritis that can persist for several years.…”

Section: Resultsmentioning

confidence: 99%

“…For many of these nations, however, nearly no routine surveillance data are available. Given the findings of various seroprevalence studies and detected outbreaks in countries like Sudan, Yemen, India, and Thailand, it is very likely that a large number of infections occur across the world each year that are missed in global burden assessments [ 14 , 44 , 48 , 75 , 80 , 81 ]. Unequal distribution of disease burden is a potential limitation of a DALY-based approach, which requires a standardized methodology across regions.…”

Section: Discussionmentioning

confidence: 99%

Measuring the global burden of chikungunya and Zika viruses: A systematic review

Puntasecca¹,

King²,

LaBeaud³

2021

PLoS Negl Trop Dis

123

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Throughout the last decade, chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have spread globally, causing a spectrum of disease that ranges from self-limited febrile illness to permanent severe disability, congenital anomalies, and early death. Nevertheless, estimates of their aggregate health impact are absent from the literature and are currently omitted from the Global Burden of Disease (GBD) reports. We systematically reviewed published literature and surveillance records to evaluate the global burden caused by CHIKV and ZIKV between 2010 and 2019, to calculate estimates of their disability-adjusted life year (DALY) impact. Extracted data on acute, chronic, and perinatal outcomes were used to create annualized DALY estimates, following techniques outlined in the GBD framework. This study is registered with PROSPERO (CRD42020192502). Of 7,877 studies identified, 916 were screened in detail, and 21 were selected for inclusion. Available data indicate that CHIKV and ZIKV caused the average yearly loss of over 106,000 and 44,000 DALYs, respectively, between 2010 and 2019. Both viruses caused substantially more burden in the Americas than in any other World Health Organization (WHO) region. This unequal distribution is likely due to a combination of limited active surveillance reporting in other regions and the lack of immunity that left the previously unexposed populations of the Americas susceptible to severe outbreaks during the last decade. Long-term rheumatic sequelae provided the largest DALY component for CHIKV, whereas congenital Zika syndrome (CZS) contributed most significantly for ZIKV. Acute symptoms and early mortality accounted for relatively less of the overall burden. Suboptimal reporting and inconsistent diagnostics limit precision when determining arbovirus incidence and frequency of complications. Despite these limitations, it is clear from our assessment that CHIKV and ZIKV represent a significant cause of morbidity that is not included in current disease burden reports. These results suggest that transmission-blocking strategies, including vector control and vaccine development, remain crucial priorities in reducing global disease burden through prevention of potentially devastating arboviral outbreaks.

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“…Chikungunya can lead to complications like sepsis, shock, liver failure, and encephalopathy. In a study conducted on 49 children with chikungunya by Sharma et al, 13 children had severe disease, with 11 having severe sepsis with shock and 2 with acute liver failure [ 14 ]. In the present study, most children with shock in the chikungunya group responded well to fluid boluses, whereas the majority required inotropes in the chikungunya-scrub typhus coinfection group.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Chikungunya Only and Chikungunya-Scrub Typhus Coinfection in Children: Findings from a Hospital-Based Observational Study from Central Nepal

Pathak

Chaudhary

Dhakal

et al. 2021

International Journal of Pediatrics

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Objectives. Chikungunya and scrub typhus infection are important causes of undifferentiated fever in tropical zones. The clinical manifestations in both conditions are nonspecific and often overlap. This study compares the clinical manifestations and the outcome of chikungunya with chikungunya-scrub typhus coinfection in children. Methods. A hospital-based observational study was conducted in children below 15 years of age over 16-month duration in 2017-2018. Chikungunya was diagnosed by IgM ELISA. All positive chikungunya cases were subjected to scrub typhus testing, dengue testing, leptospira testing, and malaria testing. Clinical manifestations and outcomes of all patients were recorded. Results. Out of the 382 admitted cases with fever, 11% ( n = 42 ) were diagnosed with chikungunya, and the majority ( n = 30 , 71.4%) were male. Among the 42 chikungunya cases, 17 (40.5%) tested positive for scrub typhus and one positive for falciparum malaria. Out of a total of 42 chikungunya cases, myalgia, nausea/vomiting, headache, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, and edema were 81%, 73.8%, 66.7%, 64.3%, 59.5%, 52.4%, 40.5%, and 38.1%, respectively. Besides, altered sensorium (31%), jaundice (26.2%), dry cough (21.4%), shortness of breath (19%), and seizures (16.7%) were other clinical manifestations present in this group of children. Patients with chikungunya-scrub typhus coinfection reported headaches, pain in the abdomen, dry cough, shortness of breath, seizures, and splenomegaly, significantly more ( p value < 0.05) compared to those with chikungunya only. Thirteen (31%) children developed shock, five in the chikungunya group and eight in the chikungunya-scrub typhus coinfection group. Six children in the coinfection group received inotrope. Among the chikungunya-only cases, 22 recovered and one died, whereas in the chikungunya-scrub typhus coinfection group, fourteen recovered and three died. Conclusions. Both the chikungunya and scrub typhus coinfection groups shared many similar clinical manifestations. In children, coinfection with scrub typhus often leads to modification of the clinical profile, complications, and chikungunya outcome.

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Severe Manifestations of Chikungunya Fever in Children, India, 2016

Abstract: Chikungunya is a relatively benign disease, and a paucity of literature on severe manifestations in children exits. We describe a cohort of pediatric chikungunya fever patients in New Delhi, India, who had severe sepsis and septic shock, which can develop during the acute phase of illness.

Cited by 17 publications

References 8 publications

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Measuring the global burden of chikungunya and Zika viruses: A systematic review

Comparative Study of Chikungunya Only and Chikungunya-Scrub Typhus Coinfection in Children: Findings from a Hospital-Based Observational Study from Central Nepal

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