Doris K Nyamwaya1, Mark Otiende1, Donwilliams O Omuoyo1, George Githinji1, Henry K Karanja1, John N Gitonga1, Zaydah R de Laurent1, James R Otieno1, Rosemary Sang2, Everlyn Kamau1, Stanley Cheruiyot1, Edward Otieno1, Charles N Agoti1, Philip Bejon1,3, Samuel M Thumbi4,5,6, George M Warimwe7,8. 1. KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya. 2. KEMRI-Centre for Virus Research, Nairobi, Kenya. 3. Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, NDM Research Building, Oxford, OX3 7FZ, UK. 4. Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164-7090, USA. 5. Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-4100, Kisumu, Kenya. 6. Institute of Tropical and Infectious Diseases, University of Nairobi, P.O Box 19676, Nairobi, 00202, Kenya. 7. KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya. gwarimwe@kemri-wellcome.org. 8. Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, NDM Research Building, Oxford, OX3 7FZ, UK. gwarimwe@kemri-wellcome.org.
Abstract
BACKGROUND: Chikungunya fever (CHIKF) was first described in Tanzania in 1952. Several epidemics including East Africa have occurred, but there are no descriptions of longitudinal surveillance of endemic disease. Here, we estimate the incidence of CHIKF in coastal Kenya and describe the associated viral phylogeny. METHODS: We monitored acute febrile illnesses among 3500 children visiting two primary healthcare facilities in coastal Kenya over a 5-year period (2014-2018). Episodes were linked to a demographic surveillance system and blood samples obtained. Cross-sectional sampling in a community survey of a different group of 435 asymptomatic children in the same study location was done in 2016. Reverse-transcriptase PCR was used for chikungunya virus (CHIKV) screening, and viral genomes sequenced for phylogenetic analyses. RESULTS: We found CHIKF to be endemic in this setting, associated with 12.7% (95% CI 11.60, 13.80) of all febrile presentations to primary healthcare. The prevalence of CHIKV infections among asymptomatic children in the community survey was 0.7% (95% CI 0.22, 2.12). CHIKF incidence among children < 1 year of age was 1190 cases/100,000-person years and 63 cases/100,000-person years among children aged ≥10 years. Recurrent CHIKF episodes, associated with fever and viraemia, were observed among 19 of 170 children with multiple febrile episodes during the study period. All sequenced viral genomes mapped to the ECSA genotype albeit distinct from CHIKV strains associated with the 2004 East African epidemic. CONCLUSIONS: CHIKF may be a substantial public health burden in primary healthcare on the East African coast outside epidemic years, and recurrent infections are common.
BACKGROUND:Chikungunya fever (CHIKF) was first described in Tanzania in 1952. Several epidemics including East Africa have occurred, but there are no descriptions of longitudinal surveillance of endemic disease. Here, we estimate the incidence of CHIKF in coastal Kenya and describe the associated viral phylogeny. METHODS: We monitored acute febrile illnesses among 3500 children visiting two primary healthcare facilities in coastal Kenya over a 5-year period (2014-2018). Episodes were linked to a demographic surveillance system and blood samples obtained. Cross-sectional sampling in a community survey of a different group of 435 asymptomatic children in the same study location was done in 2016. Reverse-transcriptase PCR was used for chikungunya virus (CHIKV) screening, and viral genomes sequenced for phylogenetic analyses. RESULTS: We found CHIKF to be endemic in this setting, associated with 12.7% (95% CI 11.60, 13.80) of all febrile presentations to primary healthcare. The prevalence of CHIKV infections among asymptomatic children in the community survey was 0.7% (95% CI 0.22, 2.12). CHIKF incidence among children < 1 year of age was 1190 cases/100,000-person years and 63 cases/100,000-person years among children aged ≥10 years. Recurrent CHIKF episodes, associated with fever and viraemia, were observed among 19 of 170 children with multiple febrile episodes during the study period. All sequenced viral genomes mapped to the ECSA genotype albeit distinct from CHIKV strains associated with the 2004 East African epidemic. CONCLUSIONS: CHIKF may be a substantial public health burden in primary healthcare on the East African coast outside epidemic years, and recurrent infections are common.
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