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. 2017 Aug 21:41:e60.
doi: 10.26633/RPSP.2017.60.

Chikungunya: important lessons from the Jamaican experience

Jacqueline Duncan  1 , Kelly Ann Gordon-Johnson  2 , Marshall K Tulloch-Reid  3 , Colette Cunningham-Myrie  4 , Kacey Ernst  5 , Nathlee McMorris  6 , Andriene Grant  2 , Marcia Graham  7 , Daisylyn Chin  2 , Karen Webster-Kerr  2
Affiliations

Chikungunya: important lessons from the Jamaican experience

Jacqueline Duncan et al. Rev Panam Salud Publica. .

Abstract
in English, Spanish

Objectives: To describe the clinical presentation of chikungunya virus (CHIKV) illness in adults during the 2014 outbreak in Jamaica and to determine the predictive value of the case definition.

Methods: A cross-sectional study was conducted using clinical data from suspected cases of CHIKV that were reported to the Ministry of Health in April - December 2014. In addition, charts were reviewed of all individuals over 15 years of age with suspected CHIKV based on a diagnosis of CHIKV or "acute viral illness" that presented to four major health centers in Jamaica during the week prior to and the peak week of the epidemic. Data abstracted from these charts using a modified CHIKV Case Investigation Form included demographics, clinical findings, and laboratory tests.

Results: In 2014, the Ministry of Health of Jamaica received 4 447 notifications of CHIKV infection. PCR testing was conducted on 137 suspected CHIKV cases (56 men and 81 women; median age 28 years) and was positive for 89 (65%) persons. In all, 205 health charts were identified that met the selection criteria (51 men and 154 women, median age 43 years). The most commonly reported symptoms were arthralgia (86%) and fever (76%). Of those who met the epidemiologic case definition for CHIKV as defined by the Pan American Health Organization, only 34% had this diagnosis recorded. Acute viral illness was the most frequently recorded diagnosis (n = 79; 58%).

Conclusions: Broader case definitions for acute CHIKV illness may be needed to identify suspected cases during an outbreak. Standardized data collection forms and validation of case definitions may be useful for future outbreaks.

Objetivo.: Describir el cuadro clínico de la infección por el virus del chikungunya (CHIKV) en los adultos durante el brote del 2014 en Jamaica y determinar el valor predictivo de la definición de caso.

Métodos.: Se realizó un estudio transversal con los datos clínicos de los presuntos casos de CHIKV que se notificaron al Ministerio de Salud entre abril y diciembre del 2014. Además, se examinaron las historias clínicas de todos los mayores de 15 años con presunto cuadro de CHIKV, es decir con diagnóstico de CHIKV o de “virosis aguda”, que acudieron a cuatro grandes centros de salud de Jamaica durante la semana de máxima incidencia de la epidemia y la semana anterior. De las historias se extrajo, mediante un formulario modificado para el estudio de casos de CHIKV, la siguiente información: datos demográficos, resultados clínicos y análisis de laboratorio.

Resultados.: En el 2014, el Ministerio de Salud de Jamaica recibió 4 447 notificaciones de infección por el CHIKV. Se realizó la RCP de 137 presuntos casos de CHIKV (56 varones y 81 mujeres; mediana de edad de 28 años), que dio positivo en 89 personas (el 65%). En total, se encontraron 205 historias clínicas que reunían los criterios de selección (51 varones y 154 mujeres; mediana de edad de 43 años). Los síntomas comunicados con mayor frecuencia fueron las artralgias (86%) y la fiebre (76%). De los que se ajustaron a la definición epidemiológica de caso de CHIKV de la Organización Panamericana de la Salud, solo en el 34% se había registrado ese diagnóstico. La virosis aguda fue el diagnóstico registrado con mayor frecuencia (n = 79; 58%).

Conclusiones.: Es posible que se necesiten definiciones de caso más amplias para la infección aguda por CHIKV a fin de identificar los casos sospechosos durante un brote. Los formularios estandarizados para la recopilación de datos y la validación de las definiciones quizá resulten útiles para otros brotes en el futuro.

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Conflict of interest statement

Conflict of interests:

None declared.

Figures

FIGURE 1.
FIGURE 1.. Physician diagnosis process flow according to chikungunya status based on epidemiologic diagnostic criteria defined by the Pan American Health Organization, during either the week prior to or the peak week of the chikungunya outbreak, Jamaica, 2014
See this image and copyright information in PMC

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