Chikungunya (ChikV) Infection is relatively new to the Western Hemisphere. The recent epidemic in the Caribbean has brought it out of obscurity and engendered worldwide interest. ChikV mortality is low, ≤1% in most studies from endemic areas such as India, West Africa and La Réunion. However, morbidity is high due to the chronic arthralgias described (80-90% after 3 months in La Reunion). Even in the acute phase there is a significant impact on morbidity and economic productivity. The Aedes mosquito vector is endemic in the region. The first case was confirmed in St. Martin in November 2013. Due to frequent inter-island travel in a highly tourism dependent area, cases were identified in 7 countries 1 month later. The first case was identified in Jamaica in July 2014. By October, a national state of emergency was declared, during the peak of the outbreak. Few studies have explored the morbidity of this disease in the Caribbean. In this study we looked at the clinical features and outcomes of acute infection with ChikV in a non-immune population.
A retrospective sample of all adult emergency room (ER) visits to an urban hospital in Kingston Jamaica for ChikV infection in September 2014 was identified using patient logs of acute viral illness and ChikV. A docket review was then conducted of all cases identified. Data were analysed using STATA 12.1.
208 cases met the inclusion criteria, 85 male and 128 female, with a median of 8 cases seen per day. Joint pain (90%), self-reported fever (74%) and headache (45%) were the most common symptoms. Other reported symptoms included malaise (39%), rash (39%), pruritus (18%) and eye pain (13%). Temperatures taken on arrival in the ER ranged from 92.4F to 104.3F with a median of 99.3F. Only 1 person required in-patient care. Of the 29 cases for whom PCR testing was requested, only 25 tests were done, with 12 positives (48%); whereas, only 2 out of 75 (132 requests) IgM ELISAs were positive.
Fever, join pain, headache and skin rash were the most common symptoms among patients with ChikV in this study. PCR testing appears to be much more sensitive than IgM ELISA for laboratory diagnosis of ChikV. Further study into the chronic sequelae in this setting is needed.
K. A. Pate-Robinson,
T. Clarke, None
T. Ferguson, None