Abstract
Chikungunya virus (CHIKV) is known to cause sporadic or explosive outbreaks. However, little is known about the endemic transmission of CHIKV. To ascertain the endemic occurrence of CHIKV transmission, we tested blood samples from patients with a non-dengue febrile illness who participated in a prospective cohort study of factory workers in Bandung, Indonesia. From August 2000 to June 2004, and September 2006 to April 2008, 1901 febrile episodes occurred and 231 (12.2%) dengue cases were identified. The remaining febrile cases were evaluated for possible CHIKV infection by measuring anti-CHIKV IgM and IgG antibodies in acute and convalescent samples. Acute samples of serologically positive cases were subsequently tested for the presence of CHIKV RNA by RT-PCR and/or virus isolation. A total of 135 (7.1%) CHIKV infections were identified, providing an incidence rate of 10.1/1,000 person years. CHIKV infections were identified all year round and tended to increase during the rainy season (January to March). Severe illness was not found and severe arthralgia was not a prominently reported symptom. Serial post-illness samples from nine cases were tested to obtain a kinetic picture of IgM and IgG anti-CHIKV antibodies. Anti-CHIKV IgM antibodies were persistently detected in high titers for approximately one year. Three patients demonstrated evidence of possible sequential CHIKV infections. The high incidence rate and continuous chikungunya cases in this adult cohort suggests that CHIKV is endemically transmitted in Bandung. Further characterization of the circulating strains and surveillance in larger areas are needed to better understand CHIKV epidemiology in Indonesia.
Highlights
Chikungunya virus (CHIKV) is an arthropod-borne virus belonging to the genus Alphavirus in the family Togaviridae [1]
Our study, conducted between 2000 and 2008 in Bandung, West Java, Indonesia, yielded several important findings: 1. Chikungunya is an important cause of fever among adults in Bandung, Indonesia
Study design This study was a part of ‘‘An epidemiology study of dengue and dengue hemorrhagic fever in adults’’, approved by the Institutional Review Board of NAMRU#2, Jakarta (IRB#30855 and N2.2006.0001) and the National Institute of Health Research and Development (NIHRD), Ministry of Health, Indonesia (KS 02.02.2.1.2181, KS 02.01.2.1732 and KS.02.01.2.1.2776) in compliance with all U.S Federal Regulations governing the protection of human subjects
Summary
Chikungunya virus (CHIKV) is an arthropod-borne virus belonging to the genus Alphavirus in the family Togaviridae [1]. It remained a relatively rare disease causing mostly small outbreaks in both Africa and Asia [2]. This changed dramatically after a mutation in the CHIKV E1 glycoprotein gene (A226V) occurred. This mutation enhanced the infectivity of the virus and its transmission by Aedes albopictus [5]. In 2005, the mutated CHIKV spread from the Indian Ocean where it produced large epidemics in India, Southeast Asia and Italy [6,7,8,9]
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