de Jesus Pereira Blenda, Brasil Michelle Queiroz Aguiar, Silva Jessica de Jesus, Cristal Juqueline Rocha, Carvalho Isabele de Pádua, Miranda Maria Carolina Prado, Paixão Daniela, Khouri Ricardo, Cerqueira-Silva Thiago, Boulos Fernanda Castro, Barral-Netto Manoel, Kalas Esper Georges, Barral Aldina, Bandeira Antônio, Boaventura Viviane Sampaio
Laboratório de Medicina e Saúde Pública de Precisão, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
Universidade Federal da Bahia, Salvador, Bahia, Brazil.
PLoS Negl Trop Dis. 2025 Jul 16;19(7):e0013254. doi: 10.1371/journal.pntd.0013254. eCollection 2025 Jul.
Chikungunya disease, caused by the chikungunya virus (CHIKV), is an acute febrile syndrome that frequently leads to chronic musculoskeletal manifestations. Little is known about the incidence, asymptomatic rate, seroconversion and chronicity after acute CHIKV infection in children and adolescents. We leveraged a nested cohort study within a phase III clinical trial of the Dengue vaccine by the Butantan Institute (DEN-03-IB), in Simões Filho (Bahia-Brazil) to characterize the dynamics of CHIKV infection in the pediatric population. 348 volunteers were included between 2018-2020 and followed for up to three years. Arbovirus surveillance was conducted during medical visits using 1) routine study visits with periodic blood collection; 2) visits due to adverse events (any symptom or illness); and 3) visits due to febrile episodes, with routine blood samples tested for chikungunya, Dengue, and Zika by viral RNA detection using RT-PCR. For cases with suspected arbovirus infection, symptoms and signs were collected with a structured questionnaire. At baseline, 7% (23/348) were positive for antichikungunya IgG. Among 311 that completed follow up (41 months, IQR 38-43), 17% tested positive for CHIKV, with 25 cases positive by RT-PCR and 28 cases by serology. 9.4% were asymptomatic and 3 (12%) developed chronic arthralgia. By the end of the study, only onefifth have been exposed to CHIKV despite several local outbreaks. Seroconversion rate among RT-PCR positive cases was 84%. Chronic arthralgia, though infrequent, was observed in the pediatric population. Our study demonstrates that, within the pediatric population, most CHIKV infections are symptomatic. We observed a small but significant frequency of negative antibody responses following acute infection and instances of chronic disease. These findings underscore the necessity for continuous surveillance and tailored interventions to tackle the unique challenges chikungunya presents in children and adolescents.
基孔肯雅病由基孔肯雅病毒（CHIKV）引起，是一种急性发热综合征，常导致慢性肌肉骨骼症状。关于儿童和青少年急性CHIKV感染后的发病率、无症状率、血清转化和慢性化情况，人们了解甚少。我们利用布坦坦研究所（DEN-03-IB）在巴西巴伊亚州西芒斯菲柳进行的登革热疫苗III期临床试验中的一项巢式队列研究，来描述儿童人群中CHIKV感染的动态情况。2018年至2020年期间纳入了348名志愿者，并对他们进行了长达三年的随访。在医疗就诊期间进行虫媒病毒监测，方法如下：1）定期进行常规研究访视并采集血液样本；2）因不良事件（任何症状或疾病）进行访视；3）因发热发作进行访视，对常规血液样本采用逆转录聚合酶链反应（RT-PCR）检测基孔肯雅病毒、登革热病毒和寨卡病毒核糖核酸。对于疑似虫媒病毒感染的病例，通过结构化问卷收集症状和体征。基线时，7%（23/348）的抗基孔肯雅病毒IgG呈阳性。在完成随访的311人（41个月，四分位距38 - 43）中，17%的人CHIKV检测呈阳性，其中25例通过RT-PCR检测呈阳性，28例通过血清学检测呈阳性。9.4%的人无症状，3例（12%）出现慢性关节痛。到研究结束时，尽管当地有几次疫情爆发，但只有五分之一 的人接触过CHIKV。RT-PCR阳性病例的血清转化率为84%。在儿童人群中观察到了慢性关节痛，尽管并不常见。我们的研究表明，在儿童人群中，大多数CHIKV感染是有症状的。我们观察到急性感染后抗体反应阴性以及慢性病病例的发生率虽低但有统计学意义。这些发现强调了持续监测和针对性干预措施的必要性, 以应对基孔肯雅病给儿童和青少年带来的独特挑战
