Chikungunya in Indonesia: Epidemiology and diagnostic challenges

Abstract

BackgroundChikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and subtropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed. Methodology/Principal findingsAcutely hospitalized febrile patients �1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of PLOS NEGLECTED TROPICAL DISEASES

An investig-ation into the epidemiology of chikungunya virus across neglected regions of Indonesia

“…Overall, our study found that 2.4% (95% CI: 1.3-4.2%) of febrile patients across the three sites had previously been exposed to CHIKV. This is also relatively low in comparison to the results of a recent study of febrile patients in central Indonesia, which reported IgG seroprevalence rates ranging from 25.2-45.9% across 7 cities in Java, Bali and South Sulawesi [43]. High rates have also previously been reported for febrile patients from other countries in Asia, including the Philippines (57.5%), Vietnam (50.0%) and Sri Lanka (38.0%) [44].…”

“…The low seroprevalence observed in Ambon, Batam and Banjarmasin compared to cities in central Indonesia [43] may be due to an absence of recent outbreaks in the study regions. A similar regional difference has been reported from other Southeast Asian countries where the virus is endemic, including Thailand, where IgG seroprevalance was observed to be significantly lower in participants younger than 30 y.o.…”

“…In comparison, similar studies of febrile patients in a non-outbreak setting have reported CHIKV infection rates of 0.6% in Cambodia [39], 1.1% in Thailand [40] and 7.5% in the Philippines [41]. Within Indonesia, a prospective study, conducted at a single site in Bandung, central Java, between 2000-2004 and 2006-2008 reported CHIKV infections in 7.1% of febrile patients outside of any outbreak [42], while another recent multi-site study conducted in Java and Bali between 2013-16 reported a prevalence of 3.7% in febrile, dengue-negative patients [43] suggesting that, at present, CHIKV transmission is more common in these areas.…”

Gambaran Epidemiologi Peningkatan Kasus Chikungunya di Desa Kajongan Kecamatan Bojongsari Kabupaten Purbalingga

“…7 Ko-infeksi dan ko-sirkulasi antara virus Chikungunya dan Dengue juga terkadang dijumpai karena kesamaan dari vektornya. 6,8 Menurut penelitian Heath et al dan Chompoosri et al, virus Chikungunya juga dapat ditularkan dari nyamuk Ae. aegypti maupun Ae.…”

“…1,5 Berbeda dengan Demam Berdarah Dengue (DBD) yang sudah dikenal luas, underdiagnosis chikungunya masih sering terjadi di Indonesia. 8 Hal tersebut disebabkan presentasi/gejala klinis chikungunya sulit dibedakan/tumpang tindih dengan demam berdarah dan infeksi penyakit endemik lainnya serta kurangnya kapasitas pengujian diagnostik. 3,8 Jumlah kasus chikungunya di Indonesia sebanyak 5.042 kasus pada tahun 2019.…”