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research letters

Indian Pediatr 2009;46: 440-441

Outbreak of Chikungunya Disease in Kerala in 2007


Manju George Elenjickal
S Sushamabai

Department of Pediatrics, Pushpagiri Institute of Medical Sciences and Research Centre,
Tiruvalla, Kerala, 689101, India.
E-mail: [email protected]


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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