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Meta-Analysis
. 2024 Jun 7;18(6):e0012254.
doi: 10.1371/journal.pntd.0012254. eCollection 2024 Jun.

Clinical outcomes of chikungunya: A systematic literature review and meta-analysis

Kris Rama  1 , Adrianne M de Roo  2   3 , Timon Louwsma  1   3 , Hinko S Hofstra  1 , Gabriel S Gurgel do Amaral  1 , Gerard T Vondeling  2 , Maarten J Postma  3   4   5   6 , Roel D Freriks  1   3   7
Affiliations
Meta-Analysis

Clinical outcomes of chikungunya: A systematic literature review and meta-analysis

Kris Rama et al. PLoS Negl Trop Dis. .

Abstract

Background: Chikungunya is a viral disease caused by a mosquito-borne alphavirus. The acute phase of the disease includes symptoms such as fever and arthralgia and lasts 7-10 days. However, debilitating symptoms can persist for months or years. Despite the substantial impact of this disease, a comprehensive assessment of its clinical picture is currently lacking.

Methods: We conducted a systematic literature review on the clinical manifestations of chikungunya, their prevalence and duration, and related hospitalization. Embase and MEDLINE were searched with no time restrictions. Subsequently, meta-analyses were conducted to quantify pooled estimates on clinical outcomes, the symptomatic rate, the mortality rate, and the hospitalization rate. The pooling of effects was conducted using the inverse-variance weighting methods and generalized linear mixed effects models, with measures of heterogeneity reported.

Results: The systematic literature review identified 316 articles. Out of the 28 outcomes of interest, we were able to conduct 11 meta-analyses. The most prevalent symptoms during the acute phase included arthralgia in 90% of cases (95% CI: 83-94%), and fever in 88% of cases (95% CI: 85-90%). Upon employing broader inclusion criteria, the overall symptomatic rate was 75% (95% CI: 63-84%), the chronicity rate was 44% (95% CI: 31-57%), and the mortality rate was 0.3% (95% CI: 0.1-0.7%). The heterogeneity between subpopulations was more than 92% for most outcomes. We were not able to estimate all predefined outcomes, highlighting the existing data gap.

Conclusion: Chikungunya is an emerging public health concern. Consequently, a thorough understanding of the clinical burden of this disease is necessary. Our study highlighted the substantial clinical burden of chikungunya in the acute phase and a potentially long-lasting chronic phase. Understanding this enables health authorities and healthcare professionals to effectively recognize and address the associated symptoms and raise awareness in society.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: KR, TL, HSH, and GSG are employees of Asc Academics. Asc Academics has received consultancy fees for this project from Valneva Austria GmbH. AMR and GTV are Valneva employees and own stock options of Valneva. MJP reports grants and honoraria from various pharmaceutical companies, including those developing, producing, and marketing vaccines. He holds stocks in Health-Ecore (Zeist, Netherlands) and PAG BV (Groningen, Netherlands), and advises ASC Academics (Groningen, Netherlands). These competing interest will not alter adherence to PLOS policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA diagram of the included studies.
Fig 2
Fig 2. Flowchart of the meta-analysis process and number of estimated endpoints.
Fig 3
Fig 3. Forest plot for chronicity rate.
Fig 4
Fig 4. Forest plot for mortality rate.
Fig 5
Fig 5. Forest plot for symptomatic rate.
See this image and copyright information in PMC

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