The global burden of Chikungunya fever among children: A systematic literature review and meta-analysis

Abstract

Chikungunya fever (CHIKF) is an arboviral illness that was first described in Tanzania (1952). In adults, the disease is characterised by debilitating arthralgia and arthritis that can persist for months, with severe illness including neurological complications observed in the elderly. However, the burden, distribution and clinical features of CHIKF in children are poorly described. We conducted a systematic literature review and meta-analysis to determine the epidemiology of CHIKF in children globally by describing its prevalence, geographical distribution, and clinical manifestations. We searched electronic databases for studies describing the epidemiology of CHIKF in children. We included peer-reviewed primary studies that reported laboratory confirmed CHIKF. We extracted information on study details, sampling approach, study participants, CHIKF positivity, clinical presentation and outcomes of CHIKF in children. The quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tool for case reports and National Institute of Health quality assessment tool for quantitative studies and case series. Random-effects meta-analysis was used to estimate the pooled prevalence of CHIKF among children by geographical location. We summarised clinical manifestations, laboratory findings, administered treatment and disease outcomes associated with CHIKF in children. We identified 2104 studies, of which 142 and 53 articles that met the inclusion criteria were included in the systematic literature review and meta-analysis, respectively. Most of the selected studies were from Asia (54/142 studies) and the fewest from Europe (5/142 studies). Included studies were commonly conducted during an epidemic season (41.5%) than non-epidemic season (5.1%). Thrombocytopenia was common among infected children and CHIKF severity was more prevalent in children <1 year. Children with undifferentiated fever before CHIKF was diagnosed were treated with antibiotics and/or drugs that managed specific symptoms or provided supportive care. CHIKF is a significant under-recognised and underreported health problem among children globally and development of drugs/vaccines should target young children.

Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram illustrating identification and inclusion of studies for a systematic review of Chikungunya disease among children.

Fig 2. A global map depicting the geographical distribution of reviewed articles for CHIKV infection in children.

The map was generated using open-source data in the R statistical package “spData” (https://cran.r-project.org/web/packages/spData/index.html). Despite the absence of data from most parts of the globe, most of the studies were from Asia and South America.

Fig 3. Funnel plot showing the precision of 53 reviewed studies included in the meta-analysis of CHIKV prevalence among children against their effect estimates.

Fig 4. A summary of symptoms/complications of CHIKV infection in children.

The number in brackets represents the number of studies that reported on this symptom/complication.

Fig 5. A summary of the treatments administered to CHIKV infected children and the reported laboratory investigation findings among studies included in this review.