Chikungunya case classification after the experience with dengue classification: How much time will we lose?

• Type of Material: Article
• Authors: Luciano Pamplona De Góes Cavalcanti, Universidade Federal do Ceará; Luís Arthur Brasil Gadelha Farias, Universidade Federal do Ceará; Francisca De Almeida Barreto, Universidade Federal do Ceará; André Siqueira, Instituto Nacional de Infectologia Evandro Chagas (INI); Guilherme Ribeiro, Emory University; André Ricardo Ribas Freitas, Faculdade Sao Leopoldo Mandic; Scott C. Weaver, University of Texas Medical Branch at Galveston; Uriel Kitron, Emory University; Carlos Alexandre Artunes Brito, Fundacao Oswaldo Cruz
• Language: English
• Date: 2020-01-01
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The American Journal of Tropical Medicine and Hygiene
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.19-0608
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• Volume: 102
• Issue: 2
• Start Page: 257
• End Page: 259
• Grant/Funding Information: This work was partially supported by the Network of Clinical and Applied Research into Chikungunya (REPLICK) through funds from the Department of Science and Technology (DECIT), Brazilian Ministry of Health, the National Council for Scientific and Technological Development, and FUNCAP.; G. S. R. and L. P. G. C. are recipients of the fellowship for research productivity granted by the Brazilian National Council for Scientific and Technological Development (CNPq/Brazil).
• Keywords: Dengue; Disease Outbreaks; Chikungunya Fever; Humans; Chikungunya virus
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

In 2013, cases of chikungunya virus (CHIKV) infection were first detected in the Caribbean. Chikungunya virus rapidly spread through Central and South America, causing explosive outbreaks in naive populations. Since its emergence in 2004, the number of case and series reports describing severe, atypical manifestations seen in chikungunya patients has increased substantially, calling into question whether clinicians and health services are failing to diagnose these atypical cases because of not only insufficient knowledge but also limitations in the case classification. Although this classification based on the duration of the musculoskeletal (acute, subacute, and chronic forms) complaints helped guide therapeutic approaches directed to these manifestations, patients presenting severe or complicated forms, which are less frequent but produce most of the fatal outcomes, were not properly addressed. In Brazil and the Caribbean, a clear temporal and spatial association between excess overall mortality and the occurrence of chikungunya epidemics has been shown, supporting the hypothesis that many of these excess deaths were a consequence of CHIKV infections. Thus, accumulated experience has highlighted that the current chikungunya case classification does not encompass the actual needs presented by certain cases with atypical features nor does it contribute to early detection and management of potentially severe cases. With continued CHIKV circulation in three continents and recent reemergence in Asia and Europe, we need a classification that is prospective and informed both by initial clinical presentation and by progression of signs and symptoms.