Surveillance for Chikungunya and Dengue During the First Year of Chikungunya Virus Circulation in Puerto Rico

Abstract

After chikungunya virus (CHIKV) transmission was detected in Puerto Rico in May 2014, multiple surveillance systems were used to describe epidemiologic trends and CHIKV-associated disease. Of 28 327 cases reported via passive surveillance, 6472 were tested for evidence of CHIKV infection, and results for 4399 (68%) were positive. Of 250 participants in household cluster investigations, 70 (28%) had evidence of recent CHIKV infection. Enhanced surveillance for chikungunya at 2 hospitals identified 1566 patients who tested positive for CHIKV, of whom 10.9% were hospitalized. Enhanced surveillance for fatal cases enabled identification of 31 cases in which CHIKV was detected in blood or tissue specimens. All surveillance systems detected a peak incidence of chikungunya in September 2014 and continued circulation in 2015. Concomitant surveillance for dengue demonstrated low incidence, which had decreased before CHIKV was introduced. Multifaceted chikungunya surveillance in Puerto Rico resolved gaps in traditional passive surveillance and enabled a holistic description of the spectrum of disease associated with CHIKV infection.

Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia

“…This passive facility‐based fever surveillance conducted in Piedecuesta – Colombia allowed identification of incident arboviral diseases in more than half of the participants ( n = 486; 58%), of which 60% ( n = 295) were dengue cases. Although the distribution of these diseases could vary according to the setting and the time when the study was conducted , this finding aligns with the documented predominant presence of DENV in the study area, and the introduction of CHIKV around the study period .…”

“…The presence of all four serotypes in the study area, even at the time of chikungunya introduction, confirms an ongoing dengue presence and its endemicity. Although the frequency distribution of dengue serotypes will in general depend of multiple factors including the viral load, patient's DOF, and the method used for identification , the higher frequency of DENV1 observed in our study was also observed in other studies conducted in the Americas around the same period , which could be associated with a regional pattern of dengue distribution .…”

“…In which case it is also possible to consider that dengue's force of infection could influence its predominance in Latin America . However, given the nature of these studies, these findings are influenced by individual immunological status and a health seeking behaviour that has not been widely studied in our context , and therefore should be interpreted with caution.…”

Clinical and Epidemiologic Patterns of Chikungunya Virus Infection and Coincident Arboviral Disease in a School Cohort in Haiti, 2014–2015

“…In December 2013, CHIKV infections were confirmed for the first time in the western hemisphere [4,25]. It is clear from our study, and other longitudinal studies [7,26], that as the epidemic moved through islands and countries it was the dominant cause of AFI for a period of 2-4 months. However, in both longitudinal and cross-sectional studies [7,26,27], what also emerges is a more complex picture of a mélange of arboviral infections, with frequent coinfections and cases and case clusters attributable to other viruses surrounding the CHIKV epidemic peak.…”

“…Moreira et al [6] have recently summarized results of studies on the epidemiology of acute febrile illness (AFI) in Latin America [6][7][8][9][10][11]. Although these studies have provided a basis for identifying the major pathogens responsible for febrile illness in the region, diagnostic criteria and approaches have differed widely, with no study having the ability to screen for previously unidentified pathogens; across all 17 studies evaluated by Moreira [6], the median number of pathogens tested per individual was 3.5.…”