Abstract
BackgroundThe first identified Chikungunya outbreak occurred in Bangladesh in 2008. In late October 2011, a local health official from Dohar Sub-district, Dhaka District, reported an outbreak of undiagnosed fever and joint pain. We investigated the outbreak to confirm the etiology, describe the clinical presentation, and identify associated vectors.MethodologyDuring November 2–21, 2011, we conducted house-to-house surveys to identify suspected cases, defined as any inhabitant of Char Kushai village with fever followed by joint pain in the extremities with onset since August 15, 2011. We collected blood specimens and clinical histories from self-selected suspected cases using a structured questionnaire. Blood samples were tested for IgM antibodies against Chikungunya virus. The village was divided into nine segments and we collected mosquito larvae from water containers in seven randomly selected houses in each segment. We calculated the Breteau index for the village and identified the mosquito species.ResultsThe attack rate was 29% (1105/3840) and 29% of households surveyed had at least one suspected case: 15% had ≥3. The attack rate was 38% (606/1589) in adult women and 25% in adult men (320/1287). Among the 1105 suspected case-patients, 245 self-selected for testing and 80% of those (196/245) had IgM antibodies. In addition to fever and joint pain, 76% (148/196) of confirmed cases had rash and 38%(75/196) had long-lasting joint pain. The village Breteau index was 35 per 100 and 89%(449/504) of hatched mosquitoes were Aedes albopictus.ConclusionThe evidence suggests that this outbreak was due to Chikungunya. The high attack rate suggests that the infection was new to this area, and the increased risk among adult women suggests that risk of transmission may have been higher around households. Chikungunya is an emerging infection in Bangladesh and current surveillance and prevention strategies are insufficient to mount an effective public health response.
Highlights
The high attack rate suggests that the infection was new to this area, and the increased risk among adult women suggests that risk of transmission may have been higher around households
Chikungunya is an arthropod-borne disease caused by Chikungunya virus (Alphavirus family, Togaviridae family) which was initially identified in Tanzania in 1952 [1]
Aedes aegypti mosquitoes are responsible for transmission of both Chikungunya and dengue [5]and in Asia, have been identified as the primary vector in most urban dengue epidemics [6].Aedes albopictus was identified as the vector in the 2006 Chikungunya outbreak in La Reunion
Summary
Chikungunya is an arthropod-borne disease caused by Chikungunya virus (Alphavirus family, Togaviridae family) which was initially identified in Tanzania in 1952 [1]. Aedes aegypti mosquitoes are responsible for transmission of both Chikungunya and dengue [5]and in Asia, have been identified as the primary vector in most urban dengue epidemics [6].Aedes albopictus was identified as the vector in the 2006 Chikungunya outbreak in La Reunion (an island in the Indian Ocean). This newly identified vector caused effective replication and spread the infection beyond previously endemic areas [6].A.albopictus can prosper in both rural and urban environments [7] and breed in artificial water containers [8]. We investigated the outbreak to confirm the etiology, describe the clinical presentation, and identify associated vectors
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