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Arthralgia, age suggestive of chikungunya virus infection in kids

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September 12, 2018

John Glenn Morris
J. Glenn Morris, Jr.

Older children and those with arthralgia were more likely to be infected with chikungunya virus during an epidemic in Haiti, according to study results published in Clinical Infectious Diseases.

“The paper focuses on the [chikungunya virus (CHIKV)] epidemic, which hit Haiti in 2014, highlighting the importance diagnostically of joint pain as a marker for infection,” Infectious Disease News Editorial Board member J. Glenn Morris, Jr., MD, MPH&TM, professor of medicine and director of the Emerging Pathogens Institute at the University of Florida, said. “However, in terms of deeper take-home messages, the paper underscores the fluidity of arboviral infections across time, with multiple smaller outbreaks of different [dengue virus (DENV)] serotypes, [Zika virus (ZIKV)], [Mayaro virus (MAYV)], and other viruses within this population. We tend to focus on a single infection, such as ZIKV, when in reality these infections are part of recurrent waves of disease moving through the population.”

Morris and colleagues monitored a cohort of approximately 1,250 children attending schools in a semirural region of Haiti between May 2014 and February 2015. All children who presented with acute fibril illness (AFI) were included in the study.

Laboratory data were available for 252 children, or approximately 95% of all children who met criteria for AFI. It included 82 children who had a laboratory-confirmed diagnosis CHIKV.

“Subsequent peaks of febrile illness were found to incorporate smaller outbreaks of DENV serotypes 1 and 4 and ZIKV, with identification of additional infections with MAYV, enterovirus D68 and coronavirus NL63,” the researchers wrote.

They reported that older children aged 10 to 14 years had significantly greater odds of CHIKV infection than children aged 3 to 4 years. Patients with AFI and arthralgia had a 16.2-fold increased odds of being infected with CHIKV when compared with patients with AFI who did not have arthralgia (95% CI, 8.0-34.4).

“In Haiti, in contrast to other studies that relied on serologic assays, we performed actual viral cultures on a majority of case patients; findings further underscored the extent of coinfections and resulted in identification of ‘unexpected’ viruses, such as ZIKV and MAYV,” Morris and colleagues wrote. “It remains to be seen what impact this mix of infections has on host susceptibility and disease occurrence and severity.” – by Bruce Thiel

Disclosures: The researchers report no relevant financial disclosures.

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