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

• Published in: Clinical Infectious Diseases 2019-03, Vol.68 (6), p.919-926
• Main Authors: Ball, Jacob D., Elbadry, Maha A., Telisma, Taina, White, Sarah K., Chavannes, Sonese, Anilis, Marie Gina, Prosperi, Mattia, Cummings, Derek A. T., Lednicky, John A., Morris, J. Glenn, de Rochars, Madsen Beau
• Format: Article
• Language: English
• Subjects: Adolescent; and Commentaries; Arbovirus Infections - diagnosis; Arbovirus Infections - epidemiology; Arbovirus Infections - history; Arbovirus Infections - virology; ARTICLES AND COMMENTARIES; Chikungunya Fever - diagnosis; Chikungunya Fever - epidemiology; Chikungunya Fever - history; Chikungunya Fever - virology; Chikungunya virus - classification; Chikungunya virus - genetics; Child; Child, Preschool; Coinfection - diagnosis; Coinfection - epidemiology; Coinfection - history; Coinfection - virology; Dengue Virus - classification; Dengue Virus - genetics; Disease Outbreaks; Female; Geography; Haiti - epidemiology; History, 21st Century; Humans; Male; Public Health Surveillance; Schools; Seasons; Symptom Assessment; Young Adult; Zika Virus - classification; Zika Virus - genetics
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy582

Abstract Background Beginning in December 2013, an epidemic of chikungunya virus (CHIKV) infection spread across the Caribbean and into virtually all countries in the Western hemisphere, with >2.4 million cases reported through the end of 2017. Methods We monitored a cohort of school children in rural Haiti from May 2014, through February 2015, for occurrence of acute undifferentiated febrile illness, with clinical and laboratory data available for 252 illness episodes. Results Our findings document passage of the major CHIKV epidemic between May and July 2014, with 82 laboratory-confirmed cases. Subsequent peaks of febrile illness were found to incorporate smaller outbreaks of dengue virus serotypes 1 and 4 and Zika virus, with identification of additional infections with Mayaro virus, enterovirus D68, and coronavirus NL63. CHIKV and dengue virus serotype 1 infections were more common in older children, with a complaint of arthralgia serving as a significant predictor for infection with CHIKV (odds ratio, 16.2; 95% confidence interval, 8.0-34.4; positive predictive value, 66%; negative predictive value, 80%). Conclusions Viral/arboviral infections were characterized by a pattern of recurrent outbreaks and case clusters, with the CHIKV epidemic representing just one of several arboviral agents moving through the population. Although clinical presentations of these agents are similar, arthralgias are highly suggestive of CHIKV infection. Data were obtained for 252 Haitian children with acute febrile illness from May 2014 through February 2015. Findings document passage of the major 2014 Chikungunya virus epidemic (82 laboratory-confirmed cases), as well as ongoing outbreaks/cases of Dengue, Zika, and Mayaro.