Abstract
BackgroundChikungunya (CHIKV) has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India.Methods and FindingsA total of 540 patients with fever of up to 7days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS), Karnataka (South); Sawai Man Singh Medical College (SMS) Rajasthan (West), and All India Institute of Medical Sciences (AIIMS) New Delhi (North) from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM). Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36%) followed by west (16.28%) and north (0.56%) India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (p<0.05). Rashes, joint pain/swelling, abdominal pain and vomiting was frequently observed among chikungunya confirmed cases (p<0.05). Adults were affected more than children. Anti-CHIK antibodies (IgM) were detected for more than 60days of fever onset. Phylogenetic analysis based on E1 gene from KIMS patients (n = 15) revealed ∼99% homology clustering with Central/East African genotype. An amino acid change from lysine to glutamine at position 132 of E1 gene was frequently observed among strains infecting children.ConclusionsThe study documented re-emergence of chikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus.
Highlights
Chikungunya virus (CHIKV) is an enveloped positive-strand RNA virus belonging to genus Alphavirus of the family Togaviridae [1,2]
The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus
Symptoms commonly caused by CHIKV i.e. joint pain, joint swelling, abdominal pain and conjuctival congestions were more common among patients at Karnataka Institute of Medical Sciences (KIMS) as compared to Sawai Man Singh Medical College (SMS) and All India Institute of Medical Sciences (AIIMS)
Summary
Chikungunya virus (CHIKV) is an enveloped positive-strand RNA virus belonging to genus Alphavirus of the family Togaviridae [1,2] It is an epidemic viral disease responsible for significant global public health problem mainly in Asian and African continents [3,4,5,6,7,8,9]. In India, where both Aedes aegypti and Aedes albopictus are known to exist and are widely prevalent during the post monsoon season, CHIKV was first detected in 1963 in West Bengal [18]. It was followed by several epidemics in Chennai, Pondicherry, Vellore, Visakhapatnam, Rajmundry, Kakinada, Nagpur and Barsi between 1964 and 1973 [21]. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India
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