Chikungunya-attributable deaths: A neglected outcome of a neglected disease

Chikungunya is caused by an arbovirus RNA of the genus alphavirus (CHIKV) of Togaviridae family Symptomatic acute CHIKV infection is mainly characterized by high fever and severe joint pain (arthralgia) that can compromise daily life activities Acute symptoms (such as fever, myalgia, and exanthema) usually resolve or decrease in intensity (arthralgias) in 1 or 2 weeks, although the acute phase may last up to 21 days Clinical features of postacute phase, which begins after 3 weeks of onset of symptoms and may extend for 90 days, include polyarthralgia, polyarthritis, exacerbation of comorbidities, chronic fatigue, and worsening of preexisting degenerative or traumatic arthropathies The persistence of arthralgia for more than 3 months indicates the transition to the chronic stage of chikungunya. In addition to joint pain, exacerbation of comorbidities, tenosynovitis, tendinitis, and neuritis have been reported in patients in the chronic phase of the disease Before the epidemic in the Indian Ocean islands (the Comoros, Mauritius, the Seychelles, Madagascar, Mayotte, and Reunion) and in India between 2005 and 2006, there were no consistent reports of severe cases or chikungunya-related deaths Particularly, the chikungunya outbreak in Reunion Island revealed unknown characteristics of the disease, such as arthralgia persisting for more than 15 months (with critical implications in quality of life) and high lethality among elderly patients with preexisting conditions, such as hypertension and diabetes Corroborating these findings, more than 4,500 excess deaths were estimated to have occurred in Ahmedabad, India [8], and Mauritius [9] during the 2005-2006 chikungunya epidemics.