The Chikungunya Epidemic: A look at five cases

Shiferaw, Bethel; Lam, Paul; Tuthill, Summer; Choudhry, Hira; Syed, Sarah; Ahmed, Shadab; Yasmin, Tabassum

doi:10.1016/j.idcr.2015.08.004

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…Chikungunya should be considered as a diagnosis in persons who report fever, rash, or arthralgia, especially those returning from travel to virus-endemic areas (14). Chikungunya cases increased in Karachi and adjoining areas of Pakistan within months after massive outbreaks in India in 2016 (15).…”

Section: Discussionmentioning

confidence: 99%

Emergence of Chikungunya Virus, Pakistan, 2016–2017

Badar¹,

Salman²,

Ansari³

et al. 2020

Emerg. Infect. Dis.

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C hikungunya is a vectorborne viral disease that causes large outbreaks, mainly in tropical and subtropical countries (1). The term chikungunya is derived from a word in the Makonde language (spoken in parts of Tanzania and Mozambique, Africa), kungunyala, meaning "that which bends up," referring to the stooped posture and impaired gait patients exhibit because of severe joint pain (2). Chikungunya virus (CHIKV; family Togaviridae, genus Alphavirus) is an enveloped, single-strand, positive-sense RNA virus transmitted through the bite of infected Aedes mosquitoes, predominantly Ae. aegypti and Ae. albopictus (2). West African, East/Central/South African (ECSA), and Asian CHIKV genotypes are distinguished by envelope 1 (E1) glycoprotein phylogeny. In 2005, a major outbreak in countries around the Indian Ocean was caused by the ECSA genotype (3). Virus mutations facilitated its replication in Ae. albopictus mosquitoes and its rapid spread by Ae. albopictus and Ae. aegypti mosquitoes (3), species prevalent in Pakistan during and after monsoon season, May-September. In Pakistan, CHIKV was reported to be circulating in rodents as early as 1983 (4), but few human cases were reported. During a 2011 dengue outbreak in Lahore, some patients also had CHIKV antibodies. CHIKV emerged in Karachi during 2016, and an outbreak eventually was declared when evidence of local transmission was confirmed (5). We reviewed the epidemiologic and evolutionary links of CHIKV detected during December 2016-May 2017 across Pakistan. The Study We tested serum samples from 584 patients with suspected CHIKV infection, according to the World Health Organization case definition (6). Patients were seen in different hospitals and clinics during December 20, 2016-May 31, 2017. Patients had acute onset fever (temperature >38.5°C), rash, and severe arthralgia or arthritis <7 days after a mosquito bite. Clinical signs and symptoms included fever in 90% (523/584) of persons with suspected cases, headache in 65% (382/584), joint pain in 85% (497/584), and rash in 24% (141/584) (Appendix Table 1, https://wwwnc. cdc.gov/EID/article/26/2/17-1636-App1.pdf). We used a predesigned form to collect patient demographic data, clinical information, and travel histories. We identified 495 (84.7%) suspected cases in Sindh, 52 (8.9%) in Baluchistan, 10 (1.7%) in Federal Capital Territory, 10 (1.7%) in Punjab, and 17 (2.9%) in Khyber Pakhtunkhwa (Figure 1). We used the QIAmp Viral RNA Mini Kit (QIAGEN, https://www.qiagen.com) to extract RNA from serum samples, according to the manufacturer's protocol. We conducted one-step real-time reverse transcription-PCR (rRT-PCR) on the ABI7500 platform (Applied Biosystems, https://www.thermofisher.com) following guidelines from the U.S. Centers for Disease Control and Prevention emergency use authorization for Trioplex Real-Time RT-PCR assay (7). We used CHIKV-specific oligonucleotide primers to detect and sequence the envelope 1 (E1) and nonstructural protein 1 (NSP1) genes (8). We conducted phylogenetic analysis of partial E1 (n...

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Section: Discussionmentioning

confidence: 99%

Emergence of Chikungunya Virus, Pakistan, 2016–2017

Badar¹,

Salman²,

Ansari³

et al. 2020

Emerg. Infect. Dis.

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“…More recent analyses indicate that the recent Indian Ocean and Pakistani strains form a monophyletic group within the ECSA lineage. 16,[19][20][21][22] However, most CHIKV phylogenetic studies 14,20,[22][23][24][25] have utilized only partial sequences from the envelope glycoprotein E1 gene, preventing a robust assessment of some of the relationships among strains and of their evolutionary dynamics. Some strains of the IOL are characterized by sequential adaptive mutations in the E1 and E2 envelope glycoproteins that increase the infectivity for Ae.…”

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confidence: 99%

Epidemiology of Chikungunya virus isolates 2016–2018 in Pakistan

Badar

Ikram

Salman

et al. 2021

Journal of Medical Virology

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The chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus, which has infected millions of people in Africa, Asia, Americas, and Europe since it remerged in India and Indian Ocean regions in 2005-2006. The purpose of this study was to evaluate the genetic diversity and evolutionary changes in CHIKV from 2016 to 2018 in Pakistan. Blood specimens were collected and processed following the Centers for Disease Control and Prevention Trioplex Protocol. Sequencing and phylogenetic analysis of complete coding sequence of representative isolates from the CHIKV outbreak was carried out during December 2016 to July 2018, a total of 1549 samples were received, out of which 50% (n = 774) were found positive for CHIKV RNA. Mean age of chikungunya positive patients was 31.8 ± 15.7 years and most affected were between 21 and 40 years of age. The Pakistan CHIKV strains clustered with the Indian Ocean sublineage of East/Central/South African with cocirculation of some variants In the structural proteins region, two noteworthy changes (A226V and D284E) were observed in the membrane fusion glycoprotein E1. Key substitutions in the neutralizing epitopes site and a few changes indicative of adaptive to other insect cells were also detected in Pakistani strains. This study provides the emerging trend of CHIKV in the country for early identification of potential variants of high virulence and preventive measures for vector borne disease especially in the endemic areas.

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“…CHIKV infections in non-humanized mice indicate that functional neutrophils contribute to clearance of CHIKV but also to the development of arthritis [ 117 , 118 ]. Neutrophil numbers increased during acute CHIKV infection in humans, but their specific role and the timing of the increase during the course of infection is unknown [ 119 ]. Since human neutrophil populations are modulated in hu-NSG mice infected with CHIKV, longer term studies could help clarify the role of these cells in producing arthritis-like signs of disease.…”

Section: Resultsmentioning

confidence: 99%

Mosquito-bite infection of humanized mice with chikungunya virus produces systemic disease with long-term effects

et al. 2021

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Chikungunya virus (CHIKV) is an emerging, mosquito-borne alphavirus responsible for acute to chronic arthralgias and neuropathies. Although it originated in central Africa, recent reports of disease have come from many parts of the world, including the Americas. While limiting human CHIKV cases through mosquito control has been used, it has not been entirely successful. There are currently no licensed vaccines or treatments specific for CHIKV disease, thus more work is needed to develop effective countermeasures. Current animal research on CHIKV is often not representative of human disease. Most models use CHIKV needle inoculation via unnatural routes to create immediate viremia and localized clinical signs; these methods neglect the natural route of transmission (the mosquito vector bite) and the associated human immune response. Since mosquito saliva has been shown to have a profound effect on viral pathogenesis, we evaluated a novel model of infection that included the natural vector, Aedes species mosquitoes, transmitting CHIKV to mice containing components of the human immune system. Humanized mice infected by 3–6 mosquito bites showed signs of systemic infection, with demonstrable viremia (by qRT-PCR and immunofluorescent antibody assay), mild to moderate clinical signs (by observation, histology, and immunohistochemistry), and immune responses consistent with human infection (by flow cytometry and IgM ELISA). This model should give a better understanding of human CHIKV disease and allow for more realistic evaluations of mechanisms of pathogenesis, prophylaxis, and treatments.

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The Chikungunya Epidemic: A look at five cases

Cited by 11 publications

References 10 publications

Emergence of Chikungunya Virus, Pakistan, 2016–2017

Emergence of Chikungunya Virus, Pakistan, 2016–2017

Epidemiology of Chikungunya virus isolates 2016–2018 in Pakistan

Mosquito-bite infection of humanized mice with chikungunya virus produces systemic disease with long-term effects

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