ArticlePDF Available

Battling the Rising Tide: Challenges in Controlling Chikungunya in Latin America

Authors:
Alfonso J. Rodriguez-Morales at Fundación Universitaria Autónoma De Las Américas
Alfonso J. Rodriguez-Morales
Download full-text PDF
Read full-text
Download citation

Abstract

Chikungunya, a mosquito-borne viral disease, has rapidly emerged as a pressing public health concern in Latin America since late 2013, posing significant challenges to control efforts across the region (1, 2). The rapid spread of the disease during 2024-2025, coupled with limited resources, infrastructure, and other factors, has exacerbated the situation. However, the Latin American public health community has demonstrated remarkable resilience, necessitating a coordinated and multifaceted approach to combat this persistent threat (3). One of the foremost challenges in controlling Chikungunya in Latin America lies in the complex interplay between the virus, its vectors, and the environment. Environmental factors such as temperature and humidity influence the distribution and abundance of Aedes mosquitoes, the primary vectors of the Chikungunya virus (CHIKV). In regions with favourable environmental conditions, vector populations thrive, increasing the risk of disease transmission. Urbanisation and population growth have also created breeding grounds for mosquitoes, further facilitating the spread of Chikungunya. Addressing these environmental determinants requires not just efforts but sustained and relentless efforts in vector surveillance and control and community engagement to promote environmental management practices. The urgency of this task cannot be overstated (4, 5).
Content uploaded by Alfonso J. Rodriguez-Morales
Author content
All content in this area was uploaded by Alfonso J. Rodriguez-Morales on Apr 26, 2024
Content may be subject to copyright.
6 Esta obra está bajo una Licencia Creative Commons Atribución 4.0 Internacional
Rev. salud publica Parag. | Vol. 14 N° 1 | Ene - Abr 2024
EDITORIAL / EDITORIAL
Battling the Rising Tide: Challenges in Controlling Chikungunya in Latin America
Luchando contra la marea creciente: desafíos para controlar el chikungunya en América Latina
Alfonso J. Rodriguez-Morales.1,2,*
1Masters Clinical Epidemiology and Biostatistics, Universidad Científica
del Sur, Lima, Perú.
2Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación
Universitaria Autónoma de las Américas-Institución Universitaria Visión
de las Américas, Pereira, Colombia.
Corresponding author: arodriguezmo@cientifica.edu.pe,
alfonso.rodriguez@uam.edu.co
Responsible editor: Julieta Méndez-Romero.
How to reference this article: Rodriguez-Morales AJ. Battling the
Rising Tide: Challenges in Controlling Chikungunya in Latin America
Rev. salud publica Paraguay. 2024; 14 (1): 6-9.
Recibido: 15/04/2024. Aceptado: 25/04/2024.
Chikungunya, a mosquito-borne viral disease, has rapidly
emerged as a pressing public health concern in Latin
America since late 2013, posing significant challenges to
control efforts across the region1, 2. The rapid spread of the
disease during 2024-2025, coupled with limited
resources, infrastructure, and other factors, has
exacerbated the situation. However, the Latin American
public health community has demonstrated remarkable
resilience, requiring a coordinated and multifaceted
approach to combat this persistent threat3.
One of the primary challenges in controlling Chikungunya
in Latin America lies in the complex interaction between
the virus, its vectors, and the environment. Environmental
factors such as temperature and humidity influence the
distribution and abundance of Aedes mosquitoes, the
primary vectors of the Chikungunya virus (CHIKV). In
regions with favorable environmental conditions, vector
populations thrive, increasing the risk of disease
transmission. Urbanization and population growth have
also created breeding grounds for mosquitoes, further
facilitating the spread of Chikungunya. Addressing these
environmental determinants requires not just efforts but
sustained and persistent efforts in vector surveillance and
control and community engagement to promote
environmental management practices. The urgency of this
task cannot be overstated4, 5.
The current situation in the region is concerning. In 2023,
410,754 cases were reported in the Americas region
(Table 1). The highest number is in Brazil (265,503),
followed by Paraguay (140,095). In 2023, 419 deaths
were associated with CHIKV (Table 1). During the ongoing
2024, in just a few months, 204,889 cases have been
reported (Table 2), 201,092 in Brazil and 3,206 in
Paraguay (Table 2). Additionally, 75 deaths due to CHIKV
have already been reported in 2024 (Table 2).
Table 1. Chikungunya cases by country or territory in 2023, according to the Pan American Health Organization
(https://opendata.paho.org/en)
Rev. salud publica Parag. 2024; 14(1) 7
Rev. salud publica Parag. | Vol. 14 N° 1 | Ene - Abr 2024
Rev. salud publica Parag. 2024; 14(1):6-9 8
Rev. salud publica Parag. | Vol. 14 N° 1 | Ene - Abr 2024
Battling the Rising Tide: Challenges in Controlling Chikungunya in
Latin America
Table 2. Chikungunya cases by country or territory in 2024 (first trimester), according to the Pan American Health
Organization (https://opendata.paho.org/en)
Despite that, multiple countries have reported CHIKV in
2022-2024 (Figure 1), showing the relevant geographical
spread in the region. CHIKV has become a significant
arboviral disease in the region, and after dengue, it is a
significant concern in the context of arboviruses
circulating6.
Furthermore, the mobility of populations within and across
borders presents a significant challenge to Chikungunya
control efforts in Latin America. Migration, trade, and
tourism contribute to the rapid dissemination of the virus,
which has been analyzed in some countries of the region7.
High levels of human movement facilitate the introduction
of the virus into new areas where susceptible populations
may lack immunity, leading to outbreaks and epidemics8.
Figure 1. Geographic distribution of Chikungunya cases in the Americas, 2022-2024, according to the Pan
American Health Organization (https://opendata.paho.org/en)
7 Rev. salud publica Parag. 2024; 14 (1)
Rev. salud publica Parag. | Vol. 14 N° 1 | Ene - Abr 2024
Battling the Rising Tide: Challenges in Controlling Chikungunya in
Latin America
Effective surveillance systems and cross-border
collaboration are essential for early detection and
response to imported cases, preventing the establishment
of sustained transmission chains. As public health
professionals, policymakers, researchers, and
stakeholders, your role in this is crucial. Moreover,
addressing migration's social and economic drivers, such
as poverty and conflict, can help mitigate the underlying
risk factors for Chikungunya transmission9, 10.
The burden of Chikungunya falls disproportionately on
vulnerable populations in Latin America, including the
poor, marginalized communities, and indigenous groups11-
14. Multiple studies highlight the social determinants of
health contributing to the unequal distribution of
Chikungunya burden, including inadequate housing,
limited access to healthcare, and poor sanitation
conditions11-14. These disparities exacerbate the disease's
impact, leading to higher morbidity and mortality rates
among disadvantaged populations. Addressing health
inequities requires a comprehensive approach that
integrates health promotion, access to healthcare
services, and social welfare programs to improve the
resilience of vulnerable communities and reduce their
vulnerability to Chikungunya and other vector-borne
diseases11-14. In addition, CHIKV may lead to chronic
infection, which has been previously observed and
confirmed in some countries in the region15-22.
Inadequate healthcare infrastructure and diagnostic
capacity pose significant challenges to the timely
detection and management of Chikungunya cases in Latin
America. Some studies highlight the limitations of current
diagnostic methods for Chikungunya, particularly in
resource-limited settings where access to laboratory
facilities is limited23. Misdiagnosis and underreporting of
cases hamper surveillance efforts and hinder the
implementation of targeted control measures.
Strengthening laboratory capacity, training healthcare
workers, and enhancing public awareness are essential
components of an effective response to Chikungunya,
enabling early detection, diagnosis, and treatment of
cases23.
In conclusion, the control of Chikungunya in Latin America
presents multifaceted challenges that require a
comprehensive and coordinated response from
governments, healthcare systems, and communities7.
Addressing environmental, social, and healthcare factors
is essential for mitigating the disease's impact and
preventing future outbreaks. By investing in vector
surveillance and control, strengthening healthcare
infrastructure, and addressing health inequities, Latin
American countries can enhance their resilience to
Chikungunya and improve the health and well-being of
their populations24.
Conflictos de interés: No se declaran conflictos de
intereses.
Financiación: Ninguna.
Contribuciones: AJRM: concepción, redacción y
aprobación final del manuscrito.
Declaración: Las opiniones expresadas en este
manuscrito son responsabilidad del autor y no reflejan
necesariamente los criterios ni la política de la RSPP y/o
del INS.
REFERENCES
1. Alfaro-Toloza P, Clouet-Huerta DE, Rodríguez-Morales
AJ. Chikungunya, the emerging migratory rheumatism.
Lancet Infect Dis. 2015;15(5):510-2.
2. Clouet-Huerta D, Alfaro-Toloza P, Rodríguez-Morales
AJ. [Chikungunya in the Americas: preparedness,
surveillance and alert in Chile]. Rev Chilena Infectol.
2014;31(6):761-2.
3. Mourad O, Makhani L, Chen LH. Chikungunya: An
Emerging Public Health Concern. Curr Infect Dis Rep.
2022;24(12):217-28.
4. Cohnstaedt LW, Alfonso-Para C, Fernandez-Salas I.
Mosquito Vector Biology and Control In Latin America-
A 26th Symposium. J Am Mosq Control Assoc.
2016;32(4):315-22.
5. Allan R, Budge S, Sauskojus H. What sounds like
Aedes, acts like Aedes, but is not Aedes? Lessons from
dengue virus control for the management of invasive
Anopheles. Lancet Glob Health. 2023;11(1):e165-e9.
6. Musso D, Rodriguez-Morales AJ, Levi JE, Cao-
Lormeau VM, Gubler DJ. Unexpected outbreaks of
arbovirus infections: lessons learned from the Pacific
and tropical America. Lancet Infect Dis.
2018;18(11):e355-e61.
7. Fernández-Salas I, Danis-Lozano R, Casas-Martínez
M, Ulloa A, Bond JG, Marina CF, et al. Historical inability
to control Aedes aegypti as a main contributor of fast
dispersal of chikungunya outbreaks in Latin America.
Antiviral Res. 2015;124:30-42.
8. Ribeiro GS, Hamer GL, Diallo M, Kitron U, Ko AI,
Weaver SC. Influence of herd immunity in the cyclical
nature of arboviruses. Curr Opin Virol. 2020;40:1-10.
9. Tsiodras S, Pervanidou D, Papadopoulou E, Kavatha
D, Baka A, Koliopoulos G, et al. Imported Chikungunya
fever case in Greece in June 2014 and public health
response. Pathog Glob Health. 2016;110(2):68-73.
10. Jourdain F, de Valk H, Noël H, Paty MC, L'Ambert G,
Franke F, et al. Estimating chikungunya virus
transmission parameters and vector control
effectiveness highlights key factors to mitigate arboviral
disease outbreaks. PLoS Negl Trop Dis.
2022;16(3):e0010244.
11. Rodriguez-Morales AJ, Villamil-Gómez WE, Franco-
Paredes C. The arboviral burden of disease caused by
co-circulation and co-infection of dengue, chikungunya
and Zika in the Americas. Travel Med Infect Dis.
2016;14(3):177-9.
12. Cardona-Ospina JA, Villamil-Gómez WE, Jimenez-
Canizales CE, Castañeda-Hernández DM, Rodríguez-
Morales AJ. Estimating the burden of disease and the
economic cost attributable to chikungunya, Colombia,
2014. Trans R Soc Trop Med Hyg. 2015;109(12):793-
802.
13. Cardona-Ospina JA, Diaz-Quijano FA, Rodríguez-
Morales AJ. Burden of chikungunya in Latin American
countries: estimates of disability-adjusted life-years
8 Rev. salud publica Parag. 2024; 14(1):6-9
Rev. salud publica Parag. | Vol. 14 N° 1 | Ene - Abr 2024
Battling the Rising Tide: Challenges in Controlling Chikungunya in
Latin America
(DALY) lost in the 2014 epidemic. Int J Infect Dis.
2015;38:60-1.
14. Cardona-Ospina JA, Rodriguez-Morales AJ, Villamil-
Gómez WE. The burden of Chikungunya in one coastal
department of Colombia (Sucre): Estimates of the
disability adjusted life years (DALY) lost in the 2014
epidemic. J Infect Public Health. 2015;8(6):644-6.
15. Rodriguez-Morales AJ, Cardona-Ospina JA, Fernanda
Urbano-Garzon S, Sebastian Hurtado-Zapata J.
Prevalence of Post-Chikungunya Infection Chronic
Inflammatory Arthritis: A Systematic Review and Meta-
Analysis. Arthritis Care Res (Hoboken).
2016;68(12):1849-58.
16. Rodriguez-Morales AJ, Villamil-Gomez W, Merlano-
Espinosa M, Simone-Kleber L. Post-chikungunya
chronic arthralgia: a first retrospective follow-up study
of 39 cases in Colombia. Clin Rheumatol.
2016;35(3):831-2.
17. Rodriguez-Morales AJ, Gil-Restrepo AF, Ramirez-
Jaramillo V, Montoya-Arias CP, Acevedo-Mendoza WF,
Bedoya-Arias JE, et al. Post-chikungunya chronic
inflammatory rheumatism: results from a retrospective
follow-up study of 283 adult and child cases in La
Virginia, Risaralda, Colombia. F1000Res. 2016;5:360.
18. Rodriguez-Morales AJ, Simon F. Chronic chikungunya,
still to be fully understood. Int J Infect Dis. 2019;86:133-
4.
19. Rodriguez-Morales AJ, Cardona-Ospina JA, Villamil-
Gomez W, Paniz-Mondolfi AE. How many patients with
post-chikungunya chronic inflammatory rheumatism
can we expect in the new endemic areas of Latin
America? Rheumatol Int. 2015;35(12):2091-4.
20. Rodriguez-Morales AJ, Restrepo-Posada VM,
Acevedo-Escalante N, Rodriguez-Munoz ED, Valencia-
Marin M, Castrillon-Spitia JD, et al. Impaired quality of
life after chikungunya virus infection: a 12-month follow-
up study of its chronic inflammatory rheumatism in La
Virginia, Risaralda, Colombia. Rheumatol Int.
2017;37(10):1757-8.
21. Consuegra-Rodriguez MP, Hidalgo-Zambrano DM,
Vasquez-Serna H, Jimenez-Canizales CE, Parra-
Valencia E, Rodriguez-Morales AJ. Post-chikungunya
chronic inflammatory rheumatism: Follow-up of cases
after 1 year of infection in Tolima, Colombia. Travel Med
Infect Dis. 2018;21:62-8.
22. Rodriguez-Morales AJ, Mejia-Bernal YV, Meneses-
Quintero OM, Gutierrez-Segura JC. Chronic
depression and post-chikungunya rheumatological
diseases: Is the IL-8/CXCL8 another associated
mediator? Travel Med Infect Dis. 2017;18:77-8.
23. Guaraldo L, Wakimoto MD, Ferreira H, Bressan C,
Calvet GA, Pinheiro GC, et al. Treatment of
chikungunya musculoskeletal disorders: a systematic
review. Expert Rev Anti Infect Ther. 2018;16(4):333-44.
24. Pineda C, Muñoz-Louis R, Caballero-Uribe CV, Viasus
D. Chikungunya in the region of the Americas. A
challenge for rheumatologists and health care systems.
Clin Rheumatol. 2016;35(10):2381-5.
ResearchGate has not been able to resolve any citations for this publication.
Chikungunya: An Emerging Public Health Concern
Article
Full-text available
  • Nov 2022
  • Curr Infect Dis Rep
Purpose of Review The worldwide spread of chikungunya over the past two decades calls for greater knowledge and awareness of the virus, its route of transmission, methods of diagnosis, and the use of available treatment and prevention measures. Recent Findings Chikungunya virus infection, an Aedes mosquito-borne febrile disease, has spread from Africa and Asia to Europe and the Americas and from the tropics and subtropics to temperate regions. International travel is a pivotal influence in the emergence of chikungunya as a global public health threat, as evidenced by a growing number of published reports on travel-related chikungunya infections. The striking features of chikungunya are arthralgia and arthritis, and the disease is often mistaken for dengue. Although mortality is low, morbidity can be profound and persistent. Current treatment for chikungunya is supportive; chikungunya vaccines and therapeutics are in development. Travelers planning to visit areas where the mosquito vectors are present should be advised on preventive measures. Summary Chikungunya is an emerging disease in the Americas. Frequent travel, the presence of at least two competent mosquito species, and a largely naïve human population in the Western Hemisphere create a setting conducive to future outbreaks. Awareness of the disease and its manifestations is critical to effectively and safely manage and limit its impact. Vaccines in late-stage clinical trials offer a new pathway to prevention.
View
Estimating chikungunya virus transmission parameters and vector control effectiveness highlights key factors to mitigate arboviral disease outbreaks
Article
Full-text available
Background Viruses transmitted by Aedes mosquitoes have greatly expanded their geographic range in recent decades. They are considered emerging public health threats throughout the world, including Europe. Therefore, public health authorities must be prepared by quantifying the potential magnitude of virus transmission and the effectiveness of interventions. Methodology We developed a mathematical model with a vector-host structure for chikungunya virus transmission and estimated model parameters from epidemiological data of the two main autochthonous chikungunya virus transmission events that occurred in Southern France, in Montpellier (2014) and in Le Cannet-des-Maures (2017). We then performed simulations of the model using these estimates to forecast the magnitude of the foci of transmission as a function of the response delay and the moment of virus introduction. Conclusions The results of the different simulations underline the relative importance of each variable and can be useful to stakeholders when designing context-based intervention strategies. The findings emphasize the importance of, and advocate for early detection of imported cases and timely biological confirmation of autochthonous cases to ensure timely vector control measures, supporting the implementation and the maintenance of sustainable surveillance systems.
View
What sounds like Aedes, acts like Aedes, but is not Aedes? Lessons from dengue virus control for the management of invasive Anopheles
Article
  • Nov 2022
Aedes mosquitoes are responsible for transmission of dengue, chikungunya, Zika, and yellow fever viruses. Aedes mosquitoes are the pathfinders of invasive urban-living mosquitoes, and have spread into 129 countries over the past five decades. In the past 10 years Anopheles stephensi has been identified within densely populated cities in Yemen and across the Horn of Africa and as far west as Nigeria. A stephensi's aggressive spread is closely linked to increases in population movement due to migration, conflict, and climate change; rapid unplanned urbanisation; and resulting poor water quality, sanitation, waste container removal, and hygiene systems. As a highly invasive vector that is adept at transmitting malarial pathogens (eg, Plasmodium vivax and Plasmodium falciparum), A stephensi's spread holds huge implications for increasing malaria morbidity and mortality. Both vectors (ie, Aedes species and A stephensi) thrive in the same urban environments, and urgent action is needed to seize the opportunity to integrate disease control resources and generate innovative vector-control tools for urban populations, to protect the many millions at risk.
View
Influence of herd immunity in the cyclical nature of arboviruses
Article
  • Feb 2020
We review and contrast the evidence for an effect of amplifying host herd immunity on circulation and human exposure to arboviruses. Herd immunity of short-lived West Nile virus avian amplifying hosts appears to play a limited role in levels of enzootic circulation and spillover infections of humans, which are not amplifiers. In contrast, herd immunity of nonhuman primate hosts for enzootic Zika, dengue, and chikungunya viruses is much stronger and appears to regulate to a large extent the periodicity of sylvatic amplification in Africa. Following the recent Zika and chikungunya pandemics, human herd immunity in the Americas quickly rose to ∼50% in many regions, although seroprevalence remains patchy. Modeling from decades of chikungunya circulation in Asia suggests that this level of herd immunity will suppress for many years major chikungunya and Zika epidemics in the Americas, followed by smaller outbreaks as herd immunity cycles with a periodicity of up to several decades.
View
Chronic Chikungunya, still to be fully understood
Article
  • Sep 2019
  • INT J INFECT DIS
“Doctor, I will never normally work and live again; joint pain prevents me that.” This was expressed by a patient in La Virginia, Colombia, three years after having been infected with chikungunya virus (CHIKV). After more than five decades of obscurity, probably due to lack of studies, many clinical consequences of CHIKV began to be reported, particularly rheumatic ones, after the outbreaks in Réunion Island and India (Javelle et al., 2015) during the epidemic wave that crossed over the Indian Ocean in 2005–2010, and later with the emergence in the Americas since 2014. Through the first three weeks of disease, CHIKV can manifest intensely with fever, myalgia, rash and particularly polyarthralgia, polyarthritis or both. However, miscellaneous rheumatic manifestations can persist for months or even years (Javelle et al., 2015) for a variable and non-negligible part of the CHIKV-infected adults (Bouquillard et al., 2018; Dupuis-Maguiraga et al., 2012). Over the recent era of CHIKV clinical research, studies have reported that after three months of infection - the current time criteria to define chronic disease due to CHIKV infection- the prevalence of patients with such clinical persistence is ranging from less than 15% up to more than 90% (Dupuis-Maguiraga et al., 2012; Rodriguez-Morales et al., 2015). Nevertheless, most of those studies only have followed-up patients until 32 months after infection (Bouquillard et al., 2018; Rodriguez-Morales et al., 2016). In a study having compared CHIKV-infected and uninfected adults 6 years after disease onset in Reunion island, the infected group reported higher rheumatic morbidity (joint pain, stiffness, swelling) and surprisingly, a higher prevalence of headache, fatigue, depressive mood and social disabilities, a significant impairment of the quality of life and greater health care consumption (Marimoutou et al., 2015). While the majority of the patients with post-CHIK status suffer from cumulative mechanical musculoskeletal disorders, a low percentage of people develop a de novo chronic inflammatory rheumatism such as rheumatoid arthritis that should be treated according to the appropriate guidelines (Javelle et al., 2015). Most studies converge to conclude that the long-term clinical impact of CHIKV occurs in not less than 14% of the initially infected patients (Dupuis-Maguiraga et al., 2012; Rodriguez-Morales et al., 2015). However, the mechanisms and predicting factors for the development of post-CHIKV chronic disorders remain to be better identified. Studies like the one published by Murillo-Zamora et al. in the current issue of IJID should be stimulated. Such clinical scores or index that could early predict the outcome toward post-CHIKV chronic disorders (Murillo-Zamora et al., 2019) would be useful to sort out the patients and identify those who should benefit from a specific clinical management to mitigate an unfavorable evolution and its long-term burden in daily life. The score proposed by Murillo-Zamora et al. (CCAS-4) showed high sensitivity and specificity to predict the persistence of chronic chikungunya arthralgia at 12 months after acute disease. Nevertheless, retrospective validation of such scores on different cohorts and on uninfected populations are necessary to improve these tools. Unfortunately, numerous questions remain unanswered for patients, physicians, and researchers to date. What processes induce the lasting consequences: host autoimmunity, the possible presence of the virus or its antigens at the synovial cavity promoting local inflammation, cytokines disorders? How to detect early the patients who are developing a chronic and potentially destructive inflammatory rheumatism? For how long will the post-CHIKV chronic clinical disorders persist? Would any early or very early treatment significantly benefit patients, and even avoid the progression to chronic disease? Which should be the most appropriate treatment to manage these patients specifically? How much is CHIKV emergence weighing the global burden of rheumatic diseases? Such points are still to be answered (McHugh, 2018), necessary to fully understand basic and clinical aspects of the viral pathogenesis and the chronic consequences of CHIKV. There is a real need to standardize the nosological frame of the cases and the clinical endpoints in the studies to improve the treatment strategy of these long-lasting persisting symptoms. To date, there is no magic bullet and the treatment must be personalized and based upon good clinical assessment, control of the pain and inflammation, physiotherapy and self-rehabilitation, and identification of the rare cases that should be treated specifically by disease-modifying antirheumatic drugs (Simon and Demoux, 2018). There is still a long way until all patients with a post-CHIK disorder benefit from optimal, efficient and not deleterious, evidence-based treatment. Given the current trends of international human flows, the general practitioners, rheumatologists and specialists on infectious diseases should all be aware of the worldwide multifocal emergence of CHIKV and its related challenges in individual and public health. Still more, it is not unlikely to expect in a non-distant future, new epidemics of CHIKV in tropical and subtropical areas of the world, which again lead to acute but also chronic consequences for significant proportions of affected populations.
View
Unexpected outbreaks of arbovirus infections: Lessons Learned from the Pacific and Tropical America
Article
  • Nov 2018
  • LANCET INFECT DIS
Pandemic arboviruses have emerged as a major global health problem in the past four decades. Predicting where and when the next arbovirus epidemic will occur is a challenge, but history suggests that arboviral black swan events (epidemics that are difficult to predict and that have an extreme effect) will continue to occur as urban growth and globalisation expand. We briefly review unexpected arbovirus epidemics that have occurred in the past 50 years, with emphasis on the American and Pacific regions, to illustrate their unpredictability, and to highlight the need for improved global preparedness, including laboratory-based surveillance, prevention, and control programmes.
View
Treatment of chikungunya musculoskeletal disorders: a systematic review
Article
  • Mar 2018
Introduction: Chikungunya virus is amongst the fastest expanding vector transmissible diseases in recent years and has been causing massive epidemics in Africa, Asia, Latin America and the Caribbean. Despite human infection by this virus being first described in the 1950s, there is a lack of adequate therapeutic evaluations to guide evidence-based recommendations. The current guidelines rely heavily in specialists’ opinion and experience instead of using higher rated evidence. Areas covered: A systematic review of the literature was performed- not restricted to clinical trials - reporting the therapeutic response against this infection with the intent to gather the best evidence of the treatment options against musculoskeletal disorders following chikungunya fever. The 15 studies included in the analysis were categorized considering the initiation of treatment during the acute, subacute and chronic phase. Expert Commentary: This review demonstrates the complexity of chikungunya fever and difficulty of therapeutic management. This review found no current evidence-based treatment recommendations for the musculoskeletal disorders following chikungunya fever. To provide an optimal treatment that prevents perpetuation or progression of chikungunya infection to a potentially destructive and permanent condition without causing more harm is an aim that must be pursued by researchers and health professionals working with this disease.
View
Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia
Article
  • Dec 2017
  • Trav Med Infect Dis
Introduction: Chronic Inflammatory Rheumatism (CIR) is one of the recognized and increasingly reported consequence post-chikungunya infection (pCHIK) in Colombia and Latin America. Methods: Retrospective cohort study of 128 patients with CHIK that persisted with pCHIK-CIR after 59-68 weeks (1.13-1.31 years). This information was evaluated by means of a telephone survey and according to validated criteria (WHO 2015) previously (patients with >12 weeks post-CHIK with ≥1 manifestations [continuous/recurrent]: chronic polyarthralgia [pCHIK-CPA], stiffness and/or joint edema). Results: Of the total CHIK-infected subjects finally included (n = 65), 28 (43.1%) reported pCHIK-CPA; and 38 patients (58.5%) at least one persistent rheumatological symptoms over the last year (pCHIK-CIR); 38.5% of them, morning stiffness, 18.5% joint edema, and 3.1% joint redness. No significant sex differences were found; 60% of patients with pCHIK-CPA aged> 40 years (RR = 3.75; 95%CI 1.47-9.53). The 29.2% of patients required medical attention because of symptoms. Conclusions: Nearly half of patients with CHIK had at least one rheumatologic symptom persistent over a year, and the third of them, pCHIK-CPA. These results are comparable with previous estimates obtained in other cohorts in the country (Risaralda and Sucre) and are consistent with results from other studies in France and India.
View
Impaired quality of life after chikungunya virus infection: a 12-month follow-up study of its chronic inflammatory rheumatism in La Virginia, Risaralda, Colombia
Article
  • Aug 2017
  • RHEUMATOL INT
As has been previously described, chikungunya (CHIK) virus infection has impacted significantly not only with its acute disease [1], but also with the progression to its chronic phase, particularly as the post-CHIK chronic inflammatory rheumatism (pCHIK-CIR) [2]. Different studies estimated and measured its frequency around 50% after 3 months [2-6]. Then, chronic disease has been associated with high costs and disability [7], but also with impairment in the quality of life of patients with pCHIK-CIR [8]. Although, epidemics of CHIK in Latin America occurred since 2014, with more than 2 million cases, there is a lack of studies about quality of life in patients with pCHIK-CIR. This has been reported just in France and India [8, 9]. For these reasons, we measured the frequency of post-chikungunya (CHIK) chronic inflammatory rheumatism (pCHIK-CIR) and assess its impact on quality of life in a cohort of Colombia after one year of infection. In a cohort study among 111 cases diagnosed in Colombia, demographic and clinical characteristics were collected at baseline, and quality of life status by the 36-item short-form health survey (SF-36) was assessed. Cases (pCHIK-CIR) were identified according to validated criteria by WHO (2015) [10]. Those with other arboviral infections during follow-up were excluded.
View
Chronic depression and post-chikungunya rheumatological diseases: Is the IL-8/CXCL8 another associated mediator?
Article
  • Aug 2017
We have read with interest the systematic review of van Aalst [1], about the long-term sequelae of chikungunya (CHIK) virus disease. In that regard, considering the significant number of cases that have been reported in the region of the Americas during the last 3 years (over 2 million) [2], especially in Colombia and Brazil, their findings are of concern. We agree on the fact that the quality of life is significantly affected in chronic chikungunya, not only as consequence of rheumatological sequelae, e.g. post-CHIK chronic inflammatory rheumatism (pCHIK-CIR), but also as the compromise of mental health [1], which can be affected by the occurrence of depression, anxiety, memory problems, ideational slowdown [3], and even sleep disorders [4]. Chikungunya immune response is a complex scenario in which, during acute as well chronic disease, multiple immunopathological mechanisms and mediators are involved [5]. Among them, multiple cytokines, such as IL-6 and TNF-α, which are also related to the development of depression and other mental disorders [1]; [4] ; [5].
View