Chikungunya virus in Asia - Pacific: a systematic review

Abstract

Chikungunya virus (CHIKV) is a mosquito-borne pathogen that causes an acute febrile syndrome and severe, debilitating rheumatic disorders in humans that may persist for months. CHIKV's presence in Asia dates from at least 1954, but its epidemiological profile in the region remains poorly understood. We systematically reviewed CHIKV emergence, epidemiology, clinical features, atypical manifestations and distribution of virus genotypes, in 47 countries from South East Asia (SEA) and the Western Pacific Region (WPR) during the period 1954-2017. Following the Cochrane Collaboration guidelines, Pubmed and Scopus databases, surveillance reports available in the World Health Organisation (WHO) and government websites were systematically reviewed. Of the 3504 records identified, 461 were retained for data extraction. Although CHIKV has been circulating in Asia almost continuously since the 1950s, it has significantly expanded its geographic reach in the region from 2005 onwards. Most reports identified in the review originated from India. Although all ages and both sexes can be affected, younger children and the elderly are more prone to severe and occasionally fatal forms of the disease, with child fatalities recorded since 1963 from India. The most frequent clinical features identified were arthralgia, rash, fever and headache. Both the Asian and East-Central-South African (ECSA) genotypes circulate in SEA and WPR, with ECSA genotype now predominant. Our findings indicate a substantial but poorly documented burden of CHIKV infection in the Asia-Pacific region. An evidence-based consensus on typical clinical features of chikungunya could aid in enhanced diagnosis and improved surveillance of the disease.

Keywords: Arbovirus; alphavirus; emerging virus; mosquito; viral arthritis.

Figure 1.

Flow chart of record selection for inclusion in the systematic review.

Figure 2.

Distribution and number of records according to the type of CHIKV activity. The miscellaneous category includes surveillance/serological surveys/seroprevalence studies, atypical manifestations and other records that cannot be classified into any of the other categories.

Figure 3.

Spatial-temporal expansion of CHIKV in SEA and the WPR regions, including records of both local and imported cases.

Figure 4.

Heat map of CHIKV outbreaks and epidemics in the countries of SEA and the WPR regions, by year (1963-2017).

Figure 5.

Spatial-temporal distribution of CHIKV genotypes. There was no sequencing information reported for the period 2015–2017 over the period considered for the review.