Sir,
Since it was first isolated in Tanzania in 1952, the chikungunya virus (CHIKV) has caused a devastating spread of a rheumatic disease known as chronic chikungunya arthritis (CCA). CCA is considered a sequel to chikungunya fever (CHIKF), a disease caused by CHIKV infection, transmitted through the bite of mosquitoes of the genus Aedes and characterized by abrupt high fever, symmetrical polyarthralgia/polyarthritis, maculopapular skin rash, fatigue, nausea, vomiting, diarrhea, and headache.[1] It is estimated that 40% of CHIKV-infected patients have some form of inflammatory rheumatism (arthritis, musculoskeletal pain, or nonspecific arthralgia lasting >2 months and no history of previous rheumatologic disease) at 18-month follow-up. The estimate for CCA (rheumatoid arthritis-like, unspecific or postviral arthritis-like, and seronegative spondylitis-like) is 14%.[2] There is no existing consensus as to how CCA should be treated, and there are no vaccines available against CHIKV infection.[1,2]
CHIKV caused sporadic outbreaks and epidemics in several countries on the African continent, including Uganda, Nigeria, Angola, the Democratic Republic of the Congo, and Kenya between 1960 and 1990.[3] Beginning in 2004, CHIKV spread to several islands in the Indian Ocean, Southeast Asia, and India after a large outbreak in Kenya that infected nearly half a million people.[3,4] Outbreaks in the French island of La Réunion (2005–2006) stand out with 47,000 cases, in Mauritius (2006) with 13,500 cases, and in India (2005–2006) with 1.3 million cases.[5] In 2013, CHIKV was reintroduced in the Americas with the first confirmed cases on the island of San Martin, overseas territory of France, and the Netherlands.[3]
Since the reemergence of CHIKV in the Americas, Brazil has become the major center of outbreaks and epidemics worldwide. According to the Pan American Health Organization (PAHO), between 2013 and 2022, almost 1.5 million CHIKF cases were reported in Brazil. This represents 45% of all reported cases in the American continent in the past 10 years.[6] In the same period, cases reported in all other continents, Asia (660,000), Africa (124,000), Europe (1800), and Oceania and the Pacific (70,000) add up to just over 850,000 [Table 1].[7,8,9] In 2022, while countries as populous as the United States, China, and India did not report major CHIKF outbreaks, Brazil reported 98.8% of all chikungunya cases in the Americas.[6] PAHO, the European Center for Disease Prevention and Control and World Health Organization keep their websites updated on the number of reported CHIKF cases; however, there is incomplete information for some countries.[10]
Table 1.
Number of chikungunya cases reported between 2013 and 2022 worldwide
| Region/Country | Number of cases reported | Total | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||||
| 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | ||
| America | 3,195,974 | ||||||||||
| Brazil | 0 | 2095 | 16,411 | 558,542 | 195,962 | 87,687 | 178,147 | 98,117 | 132,587 | 265,289 | 1,436,720 |
| Dominican Republic | 0 | 524,381 | 14,869 | 112 | * | * | * | * | * | * | 539,362 |
| Colombia | 0 | 0 | 275,907 | 17,779 | 1145 | 663 | 535 | 160 | 70 | 94 | 296,353 |
| Costa Rica | 0 | 74,566 | 102,644 | 3989 | 458 | 146 | 145 | 51 | 34 | 25 | 181,928 |
| Guadeloupe | 3 | 135,383 | 7946 | 34 | 56 | * | * | * | * | 49 | 143,471 |
| Honduras | 0 | 76 | 76,791 | 17,692 | * | 185 | 219 | 55 | 31 | 44 | 95,093 |
| Asia | 661,932 | ||||||||||
| Africa | 124,125 | ||||||||||
| Oceania and the pacific | 70,849 | ||||||||||
| Europe | 1790 | ||||||||||
| World | 4,054,670 | ||||||||||
*Data not available
As CCA often causes severe pain and associated disability, and its mosquito vector is present in virtually all continents, CHIKV has become a major arboviral public health threat. Brazil should take advantage of the fact that it concentrates on the largest number of CHIKF cases around the world and study this debilitating disease in-depth.[1,5] Meanwhile, global surveillance with early recognition in combination with appropriate vector control measures is needed to decrease the overall disease burden.
Research quality and ethics statement
The authors followed applicable EQUATOR Network (https://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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