Chikungunya Case Classification after the Experience with Dengue Classification: How Much Time Will We Lose?
In 2013, cases of chikungunya virus (CHIKV) infection were first detected in the Caribbean. Chikungunya virus rapidly spread through Central and South America, causing explosive outbreaks in naive populations. Since its emergence in 2004, the number of case and series reports describing severe, atyp...
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Published in | The American journal of tropical medicine and hygiene Vol. 102; no. 2; pp. 257 - 259 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Institute of Tropical Medicine
01.02.2020
The American Society of Tropical Medicine and Hygiene |
Subjects | |
Online Access | Get full text |
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Summary: | In 2013, cases of chikungunya virus (CHIKV) infection were first detected in the Caribbean. Chikungunya virus rapidly spread through Central and South America, causing explosive outbreaks in naive populations. Since its emergence in 2004, the number of case and series reports describing severe, atypical manifestations seen in chikungunya patients has increased substantially, calling into question whether clinicians and health services are failing to diagnose these atypical cases because of not only insufficient knowledge but also limitations in the case classification. Although this classification based on the duration of the musculoskeletal (acute, subacute, and chronic forms) complaints helped guide therapeutic approaches directed to these manifestations, patients presenting severe or complicated forms, which are less frequent but produce most of the fatal outcomes, were not properly addressed. In Brazil and the Caribbean, a clear temporal and spatial association between excess overall mortality and the occurrence of chikungunya epidemics has been shown, supporting the hypothesis that many of these excess deaths were a consequence of CHIKV infections. Thus, accumulated experience has highlighted that the current chikungunya case classification does not encompass the actual needs presented by certain cases with atypical features nor does it contribute to early detection and management of potentially severe cases. With continued CHIKV circulation in three continents and recent reemergence in Asia and Europe, we need a classification that is prospective and informed both by initial clinical presentation and by progression of signs and symptoms. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Disclosures: S. C. W. reports grants from National Institutes of Health, Emergent Biotechnologies, Valneva, and Themis Biosciences during the conduct of the study. In addition, S. C. W. has two patents for alphavirus vaccine development issued. Authors’ addresses: Luciano Pamplona de Góes Cavalcanti, Luís Arthur Brasil Gadelha Farias, and Francisca Kalline de Almeida Barreto, Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil, E-mails: pamplona.luciano@gmail.com, luisarthurbrasilk@gmail.com, and kallineabarreto@gmail.com. André Machado Siqueira, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, E-mail: amsiqueira@gmail.com. Guilherme Sousa Ribeiro, Centro de Pesquisas Goncalo Moniz, Ministério da Saúde, Salvador, Brazil, and Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Brazil, E-mail: gsribeiro@gmail.com. André Ricardo Ribas Freitas, Faculdade São Leopoldo Mandic Curso de Medicina, Epidemiologia, Campinas, Brazil, E-mail: arrfreitas2010@gmail.com. Scott C. Weaver, University of Texas Medical Branch, Galveston, TX, E-mail: sweaver@utmb.edu. Uriel Kitron, Emory University, Atlanta, GA, E-mail: ukitron@emory.edu. Carlos Alexandre Antunes Brito, Medicina Clínica, Universidade Federal de Pernambuco, Recife, Brazil, E-mail: cbritoc@gmail.com. Financial support: This work was partially supported by the Network of Clinical and Applied Research into Chikungunya (REPLICK) through funds from the Department of Science and Technology (DECIT), Brazilian Ministry of Health, the National Council for Scientific and Technological Development, and FUNCAP. G. S. R. and L. P. G. C. are recipients of the fellowship for research productivity granted by the Brazilian National Council for Scientific and Technological Development (CNPq/Brazil). |
ISSN: | 0002-9637 1476-1645 1476-1645 |
DOI: | 10.4269/ajtmh.19-0608 |