A Global Overview of the Chikungunya Virus Problem
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1 A Global Overview of the Chikungunya Virus Problem Ann M. Powers, Ph.D. Division of Vector-Borne Infectious Diseases Centers for Disease Control and Prevention
2 Chikungunya Virus Family Togaviridae,, genus Alphavirus Enveloped, single stranded RNA virus Plus-sense, sense, unsegmented genome of kilobases First isolated from human serum during outbreak in Tanganyika Distinct biological and transmission patterns between African and Asian strains Classical clinical presentation Fever Severe joint pain Rash (maculopapular( maculopapular)
3 Sylvatic CHIK Transmission Cycle Aedes furcifer, Aedes africanus chimpanzees, monkeys, baboons chimpanzees, monkeys, baboons Aedes furcifer, Aedes africanus
4 Urban CHIK Transmission Cycle Aedes aegypti Aedes albopictus Aedes aegypti Aedes albopictus
5 Distribution of CHIKV prior to 1999
6 Recent Outbreaks of CHIKV , ,
7 Re-emergence emergence of CHIKV:
8 April, 2008 Timeline First cases identified in East Africa April, 2004 April, 2005 April, 2006 April, 2007
9 Kenya SUDAN ETHIOPIA UGANDA SOMALIA Nairobi Lamu Island Mombasa Indian ocean
10 Lamu Island Outbreak July 2004, unusual increase of malaria cases Severity of joint pains unusual 91% blood smears negative for Malaria Out of 10 sera, IgM Ab to CHIK detected in 3 sera
11 Early Findings At least 1300 suspected cases counted IgM ELISAs negative for Dengue, Yellow Fever, West Nile, RVF, and Sindbis CHIK infection diagnosis by IgM ELISA (60 cases) Virus isolation (22 cases) CHIK confirmed by genomic sequencing No deaths reported
12 Magnitude of Outbreak The attack rate was 75%. 13,500 persons (95% CI 12, ) 14328) infected. (Lamu population=18,000) 86% of cases hospitalized/ stayed home in bed for a mean of 7 days ( range ).
13 Nature of Virus Central / East African genotype Less than 3% divergent at nucleotide level from closest historical relative substitutions/site 65 IND73- IND63- MH5 IND65- WB1 IND71- AP7 IND65- CH1 IND73-B- IND73-B- MH7 IND63-V IND65-M IND71-M IND01-Y IND65-N IND73-B IND63- MY06- WB2 BP37437 MY06- BP34198 MY06- BP37348MY98- IND06- MALh0198 AP6 IND06- AP4 IND05- KA1 IND06- MH2 IND06- MS1 IND06- MH TA53-ND- ROSS IND73-B- PO IND06- MS2 IND00- MH4 UG82-MD- AG41855 CAR??- CAR256 SA76- SA76- SAH2123 AR18211 TH88-SP IN85-AI- PH85-B- TH78-BK- PHH15483 RSU1TH62-181/ /78 (vaccine 181/25 strain) IND63-C- Gibbs63263 TH75-BK- 1455/75 TH95-BK- C TH96-PP- SV0451/96 IND06- KA3 HK REU06-LR2006 REU06- OPY3 REU06- IMT6382 REU06-LR2006 IMT6466 OPY1 REU05- KEN04- reu223 COM05- KPA15 COM25 COM05- COM05- COMJ COM125 REU06- KEN04- IMTAAI72 LAMU33REU06- REU06-LR2006 CQI187 OPY2 DRC00- DRC CAR96- ChikRCA DRC DRC DRC DRC DRC KARIUKI et al., JOURNAL OF GENERAL VIROLOGY. 89
14 April, 2007 April, 2008 Timeline Virus moves to Comoros April, 2005 April, 2006 First cases identified in East Africa First cases identified in East Africa April, 2004
15 Comoros Island Outbreak
16 Comoros Island Outbreak Suspected Dengue outbreak reported in February Sera analyzed All negative for Dengue 9 positive for IgM CHIK Antibodies 6 positive for CHIK by PCR
17 1-May 8-May 15-May 22-May 29-May 24-Apr Epidemic curve Epidemic curve Investigation started 30-Jan 6-Feb 13-Feb 20-Feb 27-Feb 6-Mar 13-Mar 20-Mar 27-Mar 3-Apr 10-Apr 17-Apr 23-Jan Week ending 16-Jan 9-Jan 2-Jan Number of cases
18 Antibody Testing Results (N=331) IgG IgM IgG or IgM Positive 89 (27%) 198 (60%) 209 (63%) Negative 242 (73%) 133 (40%) 122 (37%)
19 Magnitude of Outbreak Attack rate of infection was 63% 214,830 persons (95% CI 196, ,244 persons) infected on Island. 79% of cases hospitalized/ stayed at home in bed, mean = 6 days (range days)
20 Nature of Virus Central / East African genotype Virtually identical to isolates from Mombasa and Lamu changes REU06 LR2006 OPY1 COM05 - COM125 KEN04 KPA15 COM05 - COM25 COM05 - COMJ IND KEN04 - LAMU33 TA53 - S27 KARIUKI et al., JOURNAL OF GENERAL VIROLOGY. 89
21 Species Method Sex Number pools + Pools MIR A.aegypti Asp Male A. aegypti Asp Female A. aegypti HLC Male A. aegypti HLC Female (1*) 2.1 A. simpsoni HLC Female A. bromeli HLC Female A. vittatus Asp Female A. simpsoni HLC Female Specie Method Sex Number pools + Pools MIR Aedes. sp Asp Female Culex HLC Female Culex Asp Female Culex Asp/ HLC Males
22 Timeline Virus identified in nearby Reunion April, 2005 April, 2006 April, 2007 April, 2008 PLoS Med. 2006, 3: Virus moves to Comoros Virus moves to Comoros First cases identified in East Africa First cases identified in East Africa April, 2004
23 La Reunion Outbreak First cases: March 2005 Major increase in cases during summer rainy season (mid-december April, 2006) Total number of cases estimated at 244,000
24 Timeline Epidemic peaks in La Reunion: 40,000 cases/wk Cases identified in Virus identified in nearby Reunion Virus identified in nearby Reunion Mauritius, Seychelles, Madagascar, Maldives April, 2008 April, 2007 April, 2006 April, 2005 Virus moves to Comoros Virus moves to Comoros First cases identified in East Africa First cases identified in East Africa April, 2004
25 La Reunion changing patterns? New, virulent genotype? Neurological involvement Intrauterine transmission (?) /neonatal disease CHIKV-associated deaths (underlying conditions) Transmission by alternate vector (?)
26 Possible increase in virulence? PLoS Med. 2006, 3:
27 Aedes albopictus as a vector of CHIKV
28 Timeline Outbreaks occur in India, Malaysia, Sri Lanka, Indonesia Institute Pasteur CHIKV research Science reports Several Indian Ocean islands Epidemic peaks in La Reunion April, 2008 April, 2007 April, 2006 Virus identified in nearby Reunion Virus identified in nearby Reunion April, 2005 Virus moves to Comoros Virus moves to Comoros First cases identified in East Africa First cases identified in East Africa April, 2004
29 Movement to Asia
30 India outbreaks 13 states affected in after 32 year interepidemic period Estimated 1.3 million cases Introduction of the Central/East African genotype into Asia
31 Imported Cases of CHIKV Canada Hong Kong UK Belgium Czech Republic Germany Norway Switzerland Australia France Italy Corsica Sri Lanka Singapore USA Spain Japan Taiwan
32 CHIKV in Italy Outbreak resurges in India A V: albopictus April, 2008 April, 2007 Outbreak explodes in India Outbreak explodes in India Timeline Imported cases documented Outbreaks occur in India, Malaysia, Sri Lanka, Indonesia Institute Pasteur CHIKV research Science reports Several Indian Ocean islands Epidemic peaks in La Reunion April, 2006 Virus identified in nearby Reunion Virus identified in nearby Reunion April, 2005 Virus moves to Comoros Virus moves to Comoros First cases identified in East Africa First cases identified in East Africa April, 2004
33 Confirmed cases of CHIKV in Italy
34 Movement to Italy
35 Italian Outbreaks
36 Outbreaks continue in SE Asia, India Outbreaks continue in SE Asia, India CHIKV in Italy CHIKV in Italy Outbreak resurges in India A V: albopictus April, 2008 April, 2007 Outbreak explodes in India Outbreak explodes in India Timeline Imported cases documented Outbreaks occur in India, Malaysia, Sri Lanka, Indonesia Institute Pasteur CHIKV research Science reports Several Indian Ocean islands Epidemic peaks in La Reunion April, 2006 Virus identified in nearby Reunion Virus identified in nearby Reunion April, 2005 Virus moves to Comoros Virus moves to Comoros First cases identified in East Africa First cases identified in East Africa April, 2004
37 Timeline Continued & renewed activity in Thailand, India, Malaysia, La Reunion. Outbreaks continue in SE Asia, India Outbreaks continue in SE Asia, India????? April, 2011 April, 2010 April, 2009 Outbreaks continue in SE Asia, India Outbreaks continue in SE Asia, India April, 2008
38 Factors Affecting Emergence/Outbreaks???
39 Factors Affecting Emergence/Outbreaks Environmental/ecological conditions Abundance of mosquito egg laying habitats Completely naïve pop Alternate vector(s), new ecological niches involved Viral genetics / mutations
40
41 Gracias!
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