The global burden of Chikungunya fever among children: A systematic literature review and meta-analysis

Abstract

Chikungunya fever (CHIKF) is an arboviral illness that was first described in Tanzania (1952). In adults, the disease is characterised by debilitating arthralgia and arthritis that can persist for months, with severe illness including neurological complications observed in the elderly. However, the burden, distribution and clinical features of CHIKF in children are poorly described. We conducted a systematic literature review and meta-analysis to determine the epidemiology of CHIKF in children globally by describing its prevalence, geographical distribution, and clinical manifestations. We searched electronic databases for studies describing the epidemiology of CHIKF in children. We included peer-reviewed primary studies that reported laboratory confirmed CHIKF. We extracted information on study details, sampling approach, study participants, CHIKF positivity, clinical presentation and outcomes of CHIKF in children. The quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tool for case reports and National Institute of Health quality assessment tool for quantitative studies and case series. Random-effects meta-analysis was used to estimate the pooled prevalence of CHIKF among children by geographical location. We summarised clinical manifestations, laboratory findings, administered treatment and disease outcomes associated with CHIKF in children. We identified 2104 studies, of which 142 and 53 articles that met the inclusion criteria were included in the systematic literature review and meta-analysis, respectively. Most of the selected studies were from Asia (54/142 studies) and the fewest from Europe (5/142 studies). Included studies were commonly conducted during an epidemic season (41.5%) than non-epidemic season (5.1%). Thrombocytopenia was common among infected children and CHIKF severity was more prevalent in children <1 year. Children with undifferentiated fever before CHIKF was diagnosed were treated with antibiotics and/or drugs that managed specific symptoms or provided supportive care. CHIKF is a significant under-recognised and underreported health problem among children globally and development of drugs/vaccines should target young children.

Manifestaciones neurológicas asociadas a infección por virus chikungunya en una población pediátrica hospitalaria

“…En el presente reporte la convulsión fue la sintomatología neurológica más frecuente, y estuvo presente en más de la mitad de los pacientes, similar a otros reportes sobre CHIKV y afectación neuro- (2)(3)(4)8) lógica . En nuestro estudio se caracterizaron por ser característica generalizada y asociada a fiebre elevada .…”

“…Clínicamente, en su mayor parte, los lactantes y niños, presentan fiebre bifásica y una amplia gama de manifestaciones cutáneas. Como manifestaciones atípicas de la enfermedad, además de los cuadros neurológicos de la CHIKV, se describen otros tipos de afectación multisistémica como cardiovascular, respiratoria, adrenal, gastrointestinal, hepática, renal; sin embargo, al parecer, el trastorno del sistema nervioso se podría considerar la complicación más (2) común asociado a infección por virus chikungunya ; en los niños, entre las manifestaciones se citan encefalopatías, meningoencefalitis y convulsiones, siendo estas últimas, durante los primeros brotes de la infección, se vincularon invariablemente con fiebre (4) superiores a 40°. El espectro de enfermedades neurológicas por CHIKV es amplio, se los puede categorizar en afectación del sistema nervioso central puro, entre las que se encuentra la encefalopatía incluyendo la encefalitis, presentación más frecuente en población adulta como en niños, además de meningoencefalitis, cerebelitis, afectación del III par craneal; afectación del sistema nervioso periférico puro, como la mielopatía y mielitis, mieloneuropatía, polineuropatía incluyendo el Sindrome de Guillain Barre y variantes; o una combinación de éstas, como encefalomielopatia o encefalomieloneuropatía, la encefalomielitis diseminada aguda; inclusive, se han reportado casos pocos frecuentes de afectación (2) neuro-ocular como neuritis óptica, uveítis, retinitis .…”

Antiviral and Virucidal Activities of Uncaria tomentosa (Cat’s Claw) against the Chikungunya Virus

“…Children, who tend to be more vulnerable to central nervous system infections [ 8 ], present more neurologic manifestations when compared to adults [ 22 ]. Hemorrhagic and dermatological manifestations are also more common in this age group [ 22 , 23 ].…”