First Chikungunya Outbreak in Suriname; Clinical and Epidemiological Features

Citation: van Genderen FT, Krishnadath I, Sno R, Grunberg MG, Zijlmans W, Adhin MR (2016) First Chikungunya Outbreak in Suriname; Clinical and Epidemiological Features. PLoS Negl Trop Dis 10(4): e0004625. doi:10.1371/journal.pntd.0004625
Published: April 15, 2016

Background: In June 2014, Suriname faced the first Chikungunya outbreak. Since international reports mostly focus on hospitalized patients, the least affected group, a study was conducted to describe clinical characteristics of mainly outpatients including children. In addition, the cumulative incidence of this first epidemic was investigated.
Methodology: During August and September 2014, clinically suspected Chikungunya cases were included in a prospective follow-up study. Blood specimens were collected and tested for viral RNA presence. Detailed clinical information was gathered through multiple telephone surveys until day 180. In addition, a three stage household-based cluster with a cross-sectional design was conducted in October, December 2014 and March 2015 to assess the cumulative incidence.
Principal Findings: Sixty-eight percent of symptomatic patients tested positive for Chikungunya virus (CHIKV). Arthralgia and pain in the fingers were distinctive for viremic CHIKV infected patients. Viremic CHIKV infected children (≤12 years) characteristically displayed headache and vomiting, while arthralgia was less common at onset. The disease was cleared within seven days by 20% of the patients, while 22% of the viremic CHIKV infected patients, mostly women and elderly reported persistent arthralgia at day 180. The extrapolated cumulative CHIKV incidence in Paramaribo was 249 cases per 1000 persons, based on CHIKV self-reported cases in 53.1% of the households and 90.4% IgG detected in a subset of self-reported CHIKV+ persons. CHIKV peaked in the dry season and a drastic decrease in CHIKV patients coincided with a governmental campaign to reduce mosquito breeding sites.
Conclusions/Significance: This study revealed that persistent arthralgia was a concern, but occurred less frequently in an outpatient setting. The data support a less severe pathological outcome for Caribbean CHIKV infections. This study augments incidence data available for first outbreaks in the region and showed that actions undertaken at the national level to mount responses may have positively impacted containment of this CHIKV outbreak.

Author Summary: Chikungunya virus is transmitted to humans by mosquito bites and causes fever and joint pain. Chikungunya was first detected in Africa, but recently became a worldwide concern with outbreaks in many (sub)-tropical countries. We report the characteristics of the first outbreak in Suriname (2014–2015). Mainly non-hospitalized patients were followed-up to study the clinical manifestations and course of the disease, after presentation in the respective clinics with the standard Chikungunya symptoms (fever and arthralgia). Twenty percent of follow-up patients could clear the disease within one week and 22% (mostly women and elderly) still had complaints about arthralgia up to 6 months after infection. This is consistent with the assumption that Caribbean Chikungunya viral infection has a less severe pathological outcome. Furthermore, more insight was gained into the symptomatology of children (≤12 years). In addition, house-to-house surveys in Paramaribo were carried out to identify suspected cases to assess the incidence. Almost 25% of the survey participants experienced symptoms consistent with Chikungunya during the nine months spanning the investigation. The launch of a governmental campaign to eliminate mosquito breeding sites coincided with a sharp decline of Chikungunya cases, suggesting that such measures may be important in the containment of future CHIKV outbreaks.


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