Chikungunya virus in Asia – Pacific: a systematic review

B M C Randika Wimalasiri-Yapa,Liesel Stassen,Xiaodong Huang,Louise M Hafner,Wenbiao Hu,Gregor J Devine,Laith Yakob,Cassie C Jansen,Helen M Faddy,Elvina Viennet,Francesca D Frentiu

doi:10.1080/22221751.2018.1559708

Abstract

ABSTRACT Chikungunya virus (CHIKV) is a mosquito-borne pathogen that causes an acute febrile syndrome and severe, debilitating rheumatic disorders in humans that may persist for months. CHIKV’s presence in Asia dates from at least 1954, but its epidemiological profile in the region remains poorly understood. We systematically reviewed CHIKV emergence, epidemiology, clinical features, atypical manifestations and distribution of virus genotypes, in 47 countries from South East Asia (SEA) and the Western Pacific Region (WPR) during the period 1954–2017. Following the Cochrane Collaboration guidelines, Pubmed and Scopus databases, surveillance reports available in the World Health Organisation (WHO) and government websites were systematically reviewed. Of the 3504 records identified, 461 were retained for data extraction. Although CHIKV has been circulating in Asia almost continuously since the 1950s, it has significantly expanded its geographic reach in the region from 2005 onwards. Most reports identified in the review originated from India. Although all ages and both sexes can be affected, younger children and the elderly are more prone to severe and occasionally fatal forms of the disease, with child fatalities recorded since 1963 from India. The most frequent clinical features identified were arthralgia, rash, fever and headache. Both the Asian and East-Central-South African (ECSA) genotypes circulate in SEA and WPR, with ECSA genotype now predominant. Our findings indicate a substantial but poorly documented burden of CHIKV infection in the Asia-Pacific region. An evidence-based consensus on typical clinical features of chikungunya could aid in enhanced diagnosis and improved surveillance of the disease.

Highlights

Chikungunya, a re-emerging tropical disease with a widespread geographical distribution [1], is caused by chikungunya virus (CHIKV), an alphavirus of the family Togaviridae
Clinical features of CHIKV infection and atypical manifestations including rare complications Among the records reporting clinical features associated with CHIKV infection, we only considered the 64 records where all cases described had been laboratory-confirmed
Our findings show that CHIKV has circulated in the Asia-Pacific region since the 1950s, causing sporadic outbreaks in South East Asia (SEA) almost every decade from the 1960s

Summary

Introduction

Chikungunya, a re-emerging tropical disease with a widespread geographical distribution [1], is caused by chikungunya virus (CHIKV), an alphavirus of the family Togaviridae. Chikungunya is rarely fatal, the virus can be a significant cause of central nervous system disease in the context of a large outbreak, placing younger children and elderly with co-morbidities at risk [5,6]. In 2004, a major epidemic started in eastern Kenya [11], spread to several Indian Ocean Islands, India, and South East Asia (SEA) [12,13] and severely affected La Reunion (2005–2006) [14]. The epidemic saw the development of clinical complications not previously associated with CHIKV [14], and adaptation of an ECSA strain (the Indian Ocean Lineage, or IOL) to Ae. albopictus vectors, resulting in enhanced transmission rates [15,16]. In 2013, CHIKV emerged in the Western Hemisphere, and since 46

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