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Indian Pediatr 2009;46: 440-441 |
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Outbreak of Chikungunya Disease in Kerala in
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Manju George Elenjickal
S Sushamabai
Department of Pediatrics, Pushpagiri Institute of Medical
Sciences and Research Centre,
Tiruvalla, Kerala, 689101, India.
E-mail:
[email protected]
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C
hikungunya
disease is an acute arboviral illness characterized by sudden onset of
fever, skin rashes and incapacitating arthralgia(1). Kerala state
had the first outbreak of Chikungunya during June-July 2006 along the
coastal areas of Alleppey, Quilon, and Trivandrum districts and again
during May-August 2007 in Pattanamthitta, Kottayam and Idukki districts.
We report the incidence, clinical presentation and outcome of Chikungunya
disease in children during the epidemic outbreak in 2007 from Kerala.
Chikungunya disease was diagnosed according to the case definition by
Ministry of Health, Malaysia(2). A suspected case was defined as a child
with sudden onset of high fever, polyarthritis, and/or maculopapular
rashes, during an epidemic of Chikungunya disease. A suspected case is
confirmed by either isolation of Chikungunya virus, or a detection of
antichik IgM in serum with a two fold rise in its titres, or by detection
of CHIK nucleic acids in the serum by RT-PCR. Children between 1 month and
15 years, admitted with sudden onset high grade fever(>102ºF) were
included; those <1 month and >15 years of age and those with proven
bacterial Infections or with a definite cause for fever, and other
clinical features like rashes or circulatory failure were excluded.
Antibody assay was done for CHIKV, Dengue and Leptospira in all feasible
cases.
TABLE I
Clinical Features of Confirmed Cases of Chikungunya (n=35)
| Fever |
35 (100%) |
| Skin manifestations |
35 (100%) |
| Circulatory Failure |
6 (17%) |
| Polyarthralgia |
6 (17%) |
| Encephalitis |
1 (2.8%) |
A total of 392 children aged between 35 days and
15 years were suspected of Chikungunya disease, and they were classified
into 4 age groups as less than 6 months [57(14.5%)], 6 months to 1 year
[83(21%)], 1 to 5 years [133 (34%)] and above 5 years [119(30%)]. There
was no sex predilection in any age group. Admissions steadily rose from
May (37) to June (147) to July (185) and had a sharp decline in August
(23). In infants <6 months, circulatory failure was the major symptom
(57%) and its association with a suspected case of Chikungunya was highly
significant (P<0.001). Between 6 to 12 months and 1 to 5 years,
febrile seizure was the major symptom (80%) and its association with a
suspected case of Chikungunya was very high (P<0.0001).
Maculo-papular rashes, vesiculobullous lesions, pigmentary changes and
erythema were more commonly seen in <5 years (84.3%), which was also
highly significant (P<0.001). In above 5 years category,
encephalitis (81%) (P<0.0001) and polyarthralgia (59%) (P<0.001)
were the major manifestations. One hundred and fifty suspected cases were
subjected to antibody studies and 35 were confirmed as Chikungunya
infection. Their clinical features are shown in Table I. Two
boys died due to profound shock and cardiorespiratory failure. Residual
symptoms were seen only for skin manifestations (up to 4 weeks) and for
arthralgia (up to 12 weeks).
As on October 28 2006, 13,92,027 cases suspected of
chikungungya fever have been reported from several parts of the country of
which only 1985 are confirmed. From Kerala there are 70,731 suspected and
only 43 confirmed cases(3). There are no reports regarding specific
clinical features in different pediatric age groups. Our study had few
limitations. Only admitted cases were included in the study and this may
represent only one-third of the cases detected in the out patient clinic.
All cases suspected could not be submitted to antibody testing due to time
and financial constraints. Few initial cases of vesiculobullous lesions in
infants were diagnosed and treated as staphylococcal scalded skin
syndrome, which retrospectively can be considered as due to Chikungunya
disease.
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