London School of Hygiene and Tropical Medicine, London, UK; Seoul National University College of Medicine School, Seoul, South Korea.
London School of Hygiene and Tropical Medicine, London, UK.
Lancet Infect Dis. 2024 May;24(5):488-503. doi: 10.1016/S1473-3099(23)00810-1. Epub 2024 Feb 8.
Chikungunya is an arboviral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes with a growing global burden linked to climate change and globalisation. We aimed to estimate chikungunya seroprevalence, force of infection (FOI), and prevalence of related chronic disability and hospital admissions in endemic and epidemic settings.
In this systematic review, meta-analysis, and modelling study, we searched PubMed, Ovid, and Web of Science for articles published from database inception until Sept 26, 2022, for prospective and retrospective cross-sectional studies that addressed serological chikungunya virus infection in any geographical region, age group, and population subgroup and for longitudinal prospective and retrospective cohort studies with data on chronic chikungunya or hospital admissions in people with chikungunya. We did a systematic review of studies on chikungunya seroprevalence and fitted catalytic models to each survey to estimate location-specific FOI (ie, the rate at which susceptible individuals acquire chikungunya infection). We performed a meta-analysis to estimate the proportion of symptomatic patients with laboratory-confirmed chikungunya who had chronic chikungunya or were admitted to hospital following infection. We used a random-effects model to assess the relationship between chronic sequelae and follow-up length using linear regression. The systematic review protocol is registered online on PROSPERO, CRD42022363102.
We identified 60 studies with data on seroprevalence and chronic chikungunya symptoms done across 76 locations in 38 countries, and classified 17 (22%) of 76 locations as endemic settings and 59 (78%) as epidemic settings. The global long-term median annual FOI was 0·007 (95% uncertainty interval [UI] 0·003-0·010) and varied from 0·0001 (0·00004-0·0002) to 0·113 (0·07-0·20). The highest estimated median seroprevalence at age 10 years was in south Asia (8·0% [95% UI 6·5-9·6]), followed by Latin America and the Caribbean (7·8% [4·9-14·6]), whereas median seroprevalence was lowest in the Middle East (1·0% [0·5-1·9]). We estimated that 51% (95% CI 45-58) of people with laboratory-confirmed symptomatic chikungunya had chronic disability after infection and 4% (3-5) were admitted to hospital following infection.
We inferred subnational heterogeneity in long-term average annual FOI and transmission dynamics and identified both endemic and epidemic settings across different countries. Brazil, Ethiopia, Malaysia, and India included both endemic and epidemic settings. Long-term average annual FOI was higher in epidemic settings than endemic settings. However, long-term cumulative incidence of chikungunya can be similar between large outbreaks in epidemic settings with a high FOI and endemic settings with a relatively low FOI.
International Vaccine Institute.
基孔肯雅热是一种由埃及伊蚊和白纹伊蚊传播的虫媒病毒病，随着气候变化和全球化的影响，其在全球的负担日益加重。我们旨在评估在地方性和流行地区基孔肯雅热的血清流行率、感染力（FOI）以及相关慢性残疾和住院的患病率。
在这项系统评价、荟萃分析和模型研究中，我们检索了 PubMed、Ovid 和 Web of Science，以获取截至 2022 年 9 月 26 日发表的关于任何地理区域、年龄组和人群亚组中基孔肯雅病毒血清感染的前瞻性和回顾性横断面研究，以及关于慢性基孔肯雅热或基孔肯雅热患者住院的纵向前瞻性和回顾性队列研究的数据。我们对基孔肯雅热血清流行率的研究进行了系统评价，并为每个调查拟合了催化模型，以估计特定地点的 FOI（即易感个体获得基孔肯雅热感染的速率）。我们进行了荟萃分析，以估计经实验室确诊的基孔肯雅热患者中出现慢性基孔肯雅热或感染后住院的有症状患者的比例。我们使用随机效应模型，通过线性回归评估慢性后遗症与随访时间之间的关系。系统评价方案已在 PROSPERO 上注册，注册号为 CRD42022363102。
我们确定了 60 项有关血清流行率和慢性基孔肯雅热症状的研究，这些研究在 38 个国家的 76 个地点进行，并将 17 个（22%）76 个地点分类为地方性流行地区，59 个（78%）为流行地区。全球长期平均年度 FOI 为 0.007（95%置信区间 0.003-0.010），从 0.0001（0.00004-0.0002）到 0.113（0.07-0.20）不等。10 岁时估计的最高中位血清流行率在南亚（8.0%[95%置信区间 6.5-9.6]），其次是拉丁美洲和加勒比地区（7.8%[4.9-14.6]），而中东的中位血清流行率最低（1.0%[0.5-1.9]）。我们估计，经实验室确诊的有症状基孔肯雅热患者中有 51%（95%CI 45-58）出现慢性残疾，4%（3-5）在感染后住院。
我们推断出长期平均年度 FOI 和传播动态的次国家异质性，并在不同国家确定了地方性和流行地区。巴西、埃塞俄比亚、马来西亚和印度都包括地方性和流行地区。流行地区的长期平均年度 FOI 高于地方性流行地区。然而，在流行地区的大型暴发中，长期累积发病率可能与 FOI 较高的地方性流行地区和 FOI 相对较低的地方性流行地区相似。
国际疫苗研究所。
