“Kankasha” in Kassala: A prospective observational cohort study of the clinical characteristics, epidemiology, genetic origin, and chronic impact of the 2018 epidemic of Chikungunya virus infection in Kassala, Sudan

Abstract

Background The public health impact of Chikungunya virus (CHIKV) is often underestimated. Usually considered a mild condition of short duration, recent outbreaks have reported greater incidence of severe illness, fatality, and longer-term disability. In 2018/19, Eastern Sudan experienced the largest epidemic of CHIKV in Africa to date, affecting an estimated 487,600 people. Known locally as Kankasha, this study examines clinical characteristics, risk factors, and phylogenetics of the epidemic in Kassala City. Methodology/Principal findings A prospective cohort of 102 adults and 40 children presenting with chikungunya-like illness were enrolled at Kassala Teaching Hospital in October 2018. Clinical information, socio-demographic data, and sera samples were analysed to confirm diagnosis, characterise illness, and identify viral strain. CHIKV infection was confirmed by real-time reverse transcription-PCR in 84.5% (120/142) of participants. Nine (7.5%) CHIKV-positive participants had concurrent Dengue virus (DENV) infection; 34/118 participants (28.8%) had a positive Rapid Diagnostic Test for Plasmodium falciparum; six (5.0%) had haemorrhagic symptoms including two children with life-threatening bleeding. One CHIKV-positive participant died with acute renal injury. Age was not associated with severity of illness although CHIKV-infected participants were younger (p = 0.003). Two to four months post-illness, 63% of adults available for follow-up (30) were still experiencing arthralgia in one or more joints, and 11% remained moderately disabled on Rapid3 assessment. Phylogenetic analysis showed all CHIKV sequences from this study belonged to a single clade within the Indian Ocean Lineage (IOL) of the East/Central/South African (ECSA) genotype. History of contact with an infected person was the only factor associated with infection (p = 0.01), and likely related to being in the same vector environment. Conclusions/Significance Vulnerability to CHIKV remains in Kassala and elsewhere in Sudan due to widespread Aedes aegypti presence and mosquito-fostering household water storage methods. This study highlights the importance of increasing awareness of the severity and impact of CHIKV outbreaks, and the need for urgent actions to reduce transmission risk in households.

Prevalence of Malaria and Chikungunya Co-Infection in Febrile Patients: A Systematic Review and Meta-Analysis

“…Of these, 119 studies were excluded because they were reviews (29), only reported on chikungunya (25), only reported on malaria or chikungunya mono-infection (21), were in vitro studies (12), performed assays (8), were case reports or case series (7), reported on malaria only (5), were animal studies (5), were systematic reviews (4), involved mathematical models (2), or did not have full text (1). Thus, 9 studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] that met the eligibility criteria were included. Another study [ 23 ], identified from Google Scholar, was included.…”

“…Another study [ 23 ], identified from Google Scholar, was included. Finally, 10 studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] were included for the qualitative and quantitative analyses ( Figure 1 ).…”

“…The studies were published between 2013 and 2021. Most of the included studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] were performed in Africa (9/10, 90%), while only 1 was conducted in Venezuela, in 2018 [ 23 ]. Among studies conducted in Africa, 2 were performed in Nigeria in 2008 and 2014 [ 14 , 15 ], 1 in Sudan in 2018 [ 16 ], 2 in Tanzania in 2013 and 2015 [ 17 , 19 ], 1 in Sierra Leone from 2012–2013 [ 18 ], 1 in Mozambique in 2016 [ 20 ], 1 in Senegal from 2009–2013 [ 21 ], and 1 in Kenya from 2014–2015) [ 22 ].…”

“…Most of the included studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] were performed in Africa (9/10, 90%), while only 1 was conducted in Venezuela, in 2018 [ 23 ]. Among studies conducted in Africa, 2 were performed in Nigeria in 2008 and 2014 [ 14 , 15 ], 1 in Sudan in 2018 [ 16 ], 2 in Tanzania in 2013 and 2015 [ 17 , 19 ], 1 in Sierra Leone from 2012–2013 [ 18 ], 1 in Mozambique in 2016 [ 20 ], 1 in Senegal from 2009–2013 [ 21 ], and 1 in Kenya from 2014–2015) [ 22 ]. Most of the included studies were cross-sectional studies (8/10, 80%) [ 14 , 15 , 17 , 18 , 19 , 20 , 22 , 23 ], while the remaining were prospective observational studies [ 16 , 21 ].…”

“…Among studies conducted in Africa, 2 were performed in Nigeria in 2008 and 2014 [ 14 , 15 ], 1 in Sudan in 2018 [ 16 ], 2 in Tanzania in 2013 and 2015 [ 17 , 19 ], 1 in Sierra Leone from 2012–2013 [ 18 ], 1 in Mozambique in 2016 [ 20 ], 1 in Senegal from 2009–2013 [ 21 ], and 1 in Kenya from 2014–2015) [ 22 ]. Most of the included studies were cross-sectional studies (8/10, 80%) [ 14 , 15 , 17 , 18 , 19 , 20 , 22 , 23 ], while the remaining were prospective observational studies [ 16 , 21 ]. Most of the included studies enrolled febrile patients (8/10, 80%), while the remaining enrolled patients suspected to have chikungunya-like illness [ 16 ] and those who had malaria [ 23 ].…”