Endemic chikungunya fever in Kenyan children: a prospective cohort study

Doris K Nyamwaya,Rosemary Sang,Everlyn Kamau,George Githinji,Stanley Cheruiyot,Charles N Agoti,George M Warimwe,Philip Bejon,Mark Otiende,Henry K Karanja,John N Gitonga,James R Otieno,Donwilliams O Omuoyo,Edward Otieno,Zaydah R De Laurent,Samuel M Thumbi

doi:10.1186/s12879-021-05875-5

Abstract

BackgroundChikungunya fever (CHIKF) was first described in Tanzania in 1952. Several epidemics including East Africa have occurred, but there are no descriptions of longitudinal surveillance of endemic disease. Here, we estimate the incidence of CHIKF in coastal Kenya and describe the associated viral phylogeny.MethodsWe monitored acute febrile illnesses among 3500 children visiting two primary healthcare facilities in coastal Kenya over a 5-year period (2014–2018). Episodes were linked to a demographic surveillance system and blood samples obtained. Cross-sectional sampling in a community survey of a different group of 435 asymptomatic children in the same study location was done in 2016. Reverse-transcriptase PCR was used for chikungunya virus (CHIKV) screening, and viral genomes sequenced for phylogenetic analyses.ResultsWe found CHIKF to be endemic in this setting, associated with 12.7% (95% CI 11.60, 13.80) of all febrile presentations to primary healthcare. The prevalence of CHIKV infections among asymptomatic children in the community survey was 0.7% (95% CI 0.22, 2.12). CHIKF incidence among children < 1 year of age was 1190 cases/100,000-person years and 63 cases/100,000-person years among children aged ≥10 years. Recurrent CHIKF episodes, associated with fever and viraemia, were observed among 19 of 170 children with multiple febrile episodes during the study period. All sequenced viral genomes mapped to the ECSA genotype albeit distinct from CHIKV strains associated with the 2004 East African epidemic.ConclusionsCHIKF may be a substantial public health burden in primary healthcare on the East African coast outside epidemic years, and recurrent infections are common.

Highlights

Chikungunya fever (CHIKF) was first described in Tanzania in 1952
In 2004, chikungunya virus (CHIKV) re-emerged in coastal Kenya causing one of the largest epidemics on record, affecting millions of people as it spread along the Indian Ocean islands, India, southeast Asia and Europe [8, 13, 14]
This epidemic was associated with emergence of the Indian Ocean Lineage (IOL), which mapped within the ECSA genotype and included viruses with adaptive mutations in the E1 protein that increased their transmissibility by Aedes albopictus mosquitoes [15, 16]

Summary

Introduction

Chikungunya fever (CHIKF) was first described in Tanzania in 1952. Several epidemics including East Africa have occurred, but there are no descriptions of longitudinal surveillance of endemic disease. In 2004, CHIKV re-emerged in coastal Kenya causing one of the largest epidemics on record, affecting millions of people as it spread along the Indian Ocean islands, India, southeast Asia and Europe [8, 13, 14]. This epidemic was associated with emergence of the Indian Ocean Lineage (IOL), which mapped within the ECSA genotype and included viruses with adaptive mutations in the E1 protein that increased their transmissibility by Aedes albopictus mosquitoes [15, 16]

Methods

Results

Discussion

Conclusion