Chikungunya: a decade of burden in the Americas

William M de Souza^{1

2

3

4}, Guilherme S Ribeiro^{5

6}, Shirlene T S de Lima^{7

8}, Ronaldo de Jesus^{9

10}, Filipe R R Moreira¹¹, Charles Whittaker¹², Maria Anice M Sallum¹³, Christine V F Carrington¹⁴, Ester C Sabino^{15

16}, Uriel Kitron¹⁷, Nuno R Faria^{12

15

18}, Scott C Weaver^{2

3

4

19}

Affiliations

¹ Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, College of Medicine, Lexington, KY, USA.
² Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA.
³ World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, TX, USA.
⁴ Global Virus Network, Baltimore, MD, USA.
⁵ Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
⁶ Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
⁷ Laboratório Central de Saúde Pública do Ceará, Fortaleza, Ceará, Brazil.
⁸ Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, São Paulo, Brazil.
⁹ Coordenação Geral dos Laboratórios de Saúde Pública, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
¹⁰ Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
¹¹ Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
¹² MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
¹³ Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, Brazil.
¹⁴ Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Republic of Trinidad and Tobago.
¹⁵ Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁶ Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁷ Department of Environmental Sciences, Emory University, Atlanta, GA, USA.
¹⁸ Department of Biology, University of Oxford, Oxford, UK.
¹⁹ Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA.

PMID: 38283942
PMCID: PMC10820659
DOI: 10.1016/j.lana.2023.100673

Review

Chikungunya: a decade of burden in the Americas

William M de Souza et al. Lancet Reg Health Am. 2024.

. 2024 Jan 8:30:100673.

doi: 10.1016/j.lana.2023.100673. eCollection 2024 Feb.

Authors

Affiliations

¹ Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, College of Medicine, Lexington, KY, USA.
² Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA.
³ World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, TX, USA.
⁴ Global Virus Network, Baltimore, MD, USA.
⁵ Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
⁶ Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
⁷ Laboratório Central de Saúde Pública do Ceará, Fortaleza, Ceará, Brazil.
⁸ Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, São Paulo, Brazil.
⁹ Coordenação Geral dos Laboratórios de Saúde Pública, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
¹⁰ Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
¹¹ Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
¹² MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
¹³ Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, Brazil.
¹⁴ Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Republic of Trinidad and Tobago.
¹⁵ Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁶ Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁷ Department of Environmental Sciences, Emory University, Atlanta, GA, USA.
¹⁸ Department of Biology, University of Oxford, Oxford, UK.
¹⁹ Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA.

PMID: 38283942
PMCID: PMC10820659
DOI: 10.1016/j.lana.2023.100673

Abstract

In the Americas, one decade following its emergence in 2013, chikungunya virus (CHIKV) continues to spread and cause epidemics across the region. To date, 3.7 million suspected and laboratory-confirmed chikungunya cases have been reported in 50 countries or territories in the Americas. Here, we outline the current status and epidemiological aspects of chikungunya in the Americas and discuss prospects for future research and public health strategies to combat CHIKV in the region.

Keywords: Alphavirus; Americas; Arbovirus; Chikungunya virus; Mosquito-borne virus.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Fig. 1**
**Epidemiology of chikungunya in the Americas. (a)** The map shows cumulative chikungunya cases (i.e., suspected and laboratory-confirmed). In the Americas reported to the Pan American Health Organization (PAHO) from December 2013 to June 2023. A larger-scale map of Central America and the Caribbean region is shown at the bottom. **(b)** The map shows cumulative incidence of chikungunya cases (i.e., suspected and laboratory-confirmed) per 100,000 inhabitants per country in the Americas from 2013 to 2023. Incidence was calculated based on population data for 2023, estimated by an International Database from the United States Census Bureau. A larger-scale map of Central America and the Caribbean region is shown at the bottom. **(c)** Annual number of chikungunya cases (i.e., suspected and laboratory-confirmed). In the Americas reported to the PAHO from 2013 to 2023 by subregion (https://www3.paho.org/data/index.php/en/mnu-topics/chikv-en/550-chikv-weekly-en.html). In 2013, 109 chikungunya cases were reported in the Americas. **(d)** Annual number of chikungunya and Zika cases (i.e., suspected and laboratory-confirmed). in the Americas reported to PAHO from 2013 to 2023. The dashed line represents 100,000 cases reported in the Americas per year. The American subregions are presented based on the PAHO definition. Andean region: Bolivia, Colombia, Ecuador, Peru, and Venezuela. Central America region: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama. Latin Caribbean region: Cuba, Dominican Republic, French Guiana, Guadeloupe, Guyana, Haiti, Martinique, Puerto Rico, and Saint Martin. Non-Latin Caribbean region: Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, Bonaire, Saint Eustatius and Saba, Cayman Islands, Curaçao, Dominica, Grenada, Jamaica, Montserrat, Saint Barthelemy, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad and Tobago, Turks and Caicos Islands, British Virgin Islands, and Virgin Islands (USA). North America region: Bermuda, Canada, Mexico, and the United States of America. South Cone region: Argentina, Brazil, Chile, Paraguay, and Uruguay.

**Fig. 2**
**Chikungunya virus lineage and genomic information**. **(a)** The number of chikungunya virus genomes sequenced and deposited into NCBI GenBank per year from 2013 to 2023, based on viral lineage. **(b)** The number of chikungunya virus genomes sequenced and deposited into NCBI GenBank per country based on chikungunya lineage up to 17 August 2023. **(c)** Spatiotemporal distribution of chikungunya virus lineages in countries and territories in the American subregions. The chikungunya lineage circulating was determined based on years with at least one genome sequenced and deposited at NCBI GenBank up to 17 August 2023. ECSA, East-Central-South-African lineage. USA, United States of America.

**Fig. 3**
**Phylogenetic tree based on maximum likelihood method for the complete dataset of publicly available chikungunya virus genomes**. Branch lengths reflect genetic distances in substitutions per site. The chikungunya virus lineages and sub-lineages are indicated on the right side of the figure. The chikungunya virus sequences harboring the substitution of alanine (A) to valine (V) mutation at position 226 in the E1 envelope glycoprotein (E1-A226V) are indicated in purple. IOL, Indian Ocean sub-lineage. ECSA, East-Central-South-African. WA, West African. The Asian and ECSA lineage strains from the Americas are shown as Asian-American and ECSA-American sub-lineages, respectively.

**Fig. 4**
**Epidemiology and genomic information of chikungunya in Brazil. (a)** Map shows cumulative chikungunya cases (i.e., suspected and laboratory-confirmed). In all 26 Brazilian States and the Federal District reported to the Brazilian Ministry of Health from March 2013 to June 2023. **(b)** Spatiotemporal distribution of chikungunya virus lineages in countries and territories in all 26 Brazilian States and the Federal District. The chikungunya lineage circulating was determined based on years with at least one genome sequenced and deposited in GenBank through 17 August 2023. AC = Acre. AL = Alagoas. AM = Amazonas. AP = Amapá. BA = Bahia. CE = Ceará. ES = Espírito Santo. DF = Distrito Federal (Federal District). GO = Goiás. MA = Maranhão. MG = Minas Gerais. MS = Mato Grosso do Sul. MT = Mato Grosso. PA = Pará. PB = Paraíba. PE = Pernambuco. PI = Piauí. PR = Paraná. RJ = Rio de Janeiro. RN = Rio Grande do Norte. RO = Rondônia. RR = Roraima. RS = Rio Grande do Sul. SC = Santa Catarina. SE = Sergipe. SP = São Paulo. TO = Tocantins. Km = kilometers. ECSA-American, East-Central-South-African-American sub-lineage.

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References

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Chikungunya: a decade of burden in the Americas

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Chikungunya: a decade of burden in the Americas

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Conflict of interest statement

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