Emerging Pathogens Institute, College of Public Health and Health Professions and College of Medicine.
Department of Epidemiology, College of Public Health and Health Professions and College of Medicine.
Clin Infect Dis. 2019 Mar 5;68(6):919-926. doi: 10.1093/cid/ciy582.
Beginning in December 2013, an epidemic of chikungunya virus (CHIKV) infection spread across the Caribbean and into virtually all countries in the Western hemisphere, with >2.4 million cases reported through the end of 2017.
We monitored a cohort of school children in rural Haiti from May 2014, through February 2015, for occurrence of acute undifferentiated febrile illness, with clinical and laboratory data available for 252 illness episodes.
Our findings document passage of the major CHIKV epidemic between May and July 2014, with 82 laboratory-confirmed cases. Subsequent peaks of febrile illness were found to incorporate smaller outbreaks of dengue virus serotypes 1 and 4 and Zika virus, with identification of additional infections with Mayaro virus, enterovirus D68, and coronavirus NL63. CHIKV and dengue virus serotype 1 infections were more common in older children, with a complaint of arthralgia serving as a significant predictor for infection with CHIKV (odds ratio, 16.2; 95% confidence interval, 8.0-34.4; positive predictive value, 66%; negative predictive value, 80%).
Viral/arboviral infections were characterized by a pattern of recurrent outbreaks and case clusters, with the CHIKV epidemic representing just one of several arboviral agents moving through the population. Although clinical presentations of these agents are similar, arthralgias are highly suggestive of CHIKV infection.
自 2013 年 12 月以来，基孔肯雅病毒（CHIKV）疫情在加勒比地区蔓延，并传播到西半球几乎所有国家，截至 2017 年底报告了超过 240 万例病例。
我们从 2014 年 5 月到 2015 年 2 月监测了海地农村的一个学童队列，以监测急性未分化发热疾病的发生情况，为 252 个疾病发作提供了临床和实验室数据。
我们的研究结果记录了 2014 年 5 月至 7 月间主要的 CHIKV 疫情，有 82 例实验室确诊病例。随后发现发热病的高峰包含了较小的登革热病毒 1 型和 4 型和寨卡病毒爆发，还发现了其他 Mayaro 病毒、肠道病毒 D68 和冠状病毒 NL63 的感染。CHIKV 和登革热病毒 1 型感染在年龄较大的儿童中更为常见，关节痛是 CHIKV 感染的重要预测因素（优势比，16.2；95%置信区间，8.0-34.4；阳性预测值，66%；阴性预测值，80%）。
病毒/虫媒病毒感染的特点是反复爆发和病例群集，CHIKV 疫情只是通过人群传播的几种虫媒病毒之一。尽管这些病原体的临床表现相似，但关节痛高度提示 CHIKV 感染。
