Jaime A. Cardona-Ospina

Prevalence of Post‐Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta‐Analysis

To determine the percentage of patients who would develop chronic inflammatory rheumatism (CIR) following chikungunya (CHIK) virus disease.

Prevalence of post-Chikungunya Chronic Inflammatory Rheumatism: A Systematic Review and Meta-Analysis.

To determine the percentage of patients who would develop chronic inflammatory rheumatism (CIR) following chikungunya (CHIK) virus disease.

Estimating the burden of disease and the economic cost attributable to chikungunya, Colombia, 2014

BACKGROUND Chikungunya (CHIK) virus disease is expected to be a considerable cause of disability and economic burden in Latin America given its chronic sequelae, particularly its chronic inflammatory rheumatism. There have been no previous studies assessing CHIK costs and disability in Latin America. METHODS We calculated incidence rates for CHIK during the 2014 outbreak in Colombia using epidemiological data provided by the Colombian National Institute of Health, using demographic data from the National Administrative Department of Statistics. The burden of disease was estimated through disability adjusted life years (DALYs) lost and the costs were estimated based on the national recommendations for CHIK acute and chronic phase attention. RESULTS There were a total of 106 592 cases, with incidence rates ranging from 0 to 1837.3 cases/100 000 population in different departments. An estimate was made of total DALYs lost of 40.44 to 45.14 lost/100 000 population. The 2014 outbreak estimated costs were at least US

Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia

73.6 million. CONCLUSIONS Our estimates raise concerns about the effects of continued CHIK spread in Colombia and other Latin-American countries. The lack of transmission control for this disease and potential for spread means that there will be significant acute and chronic disability and related costs in the short and long term for Latin American health care systems.

Mortality and fatality due to Chikungunya virus infection in Colombia

OBJECTIVE There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. METHODS We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. RESULTS Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). CONCLUSIONS According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).

Burden of chikungunya in Latin American countries: estimates of disability-adjusted life-years (DALY) lost in the 2014 epidemic.

• Epidemics of chikungunya (CHIKV) in the Americas during 2014–2015 affect around 1.5 million individuals.

Impaired quality of life after chikungunya virus infection: a 12-month follow-up study of its chronic inflammatory rheumatism in La Virginia, Risaralda, Colombia

El Salvador 135 383 61 031 67 867 23 890 26 566 376.78 418.99 Puerto Rico 28 619 12 901 14 347 5050 5616 148.23 164.83 Colombia 83 832 37 791 42 025 14 793 16 450 30.61 34.04 Guatemala 22 057 9943 11 057 3892 4328 25.16 27.98 Venezuela 37 015 16 686 18 556 6532 7263 21.48 23.89 Nicaragua 3556 1603 1783 627 698 10.32 11.48 Honduras 4086 1842 2048 721 802 8.90 9.90 Costa Rica 238 107 119 42 47 0.86 0.96 Brazil 305

Chikungunya or not, differential diagnosis and the importance of laboratory confirmation for clinical and epidemiological research: comment on the article by Rosario et al.

by WHO [10]. Those with other arboviral infections (dengue and Zika) during follow-up were excluded (also if rheumatological disease was reported before CHIK infection). Of the total CHIK-infected subjects under follow-up, 108 (63.2%) were women and 63 (36.8%) men, with a median age of 39 years (interquartile range 26–47 years). Of them, 78 (45.6%) presented persistent rheumatological symptoms (pCHIK-CIR). These patients reported joint pain (chronic polyarthralgia, pCHIK-CPA), 43.9% morning stiffness, 38.6% joint edema, and 19.9% joint redness. All dimensions of SF-36 (100% optimal quality of life and 0% the poorest) as well as physical and mental component summaries were impaired in pCHIK-CIR+ compared to pCHIK-CIR− subjects. Differences in median scores between both groups were statistically significant (p < 0.0001), being 81.62% in those without pCHIK-CIR− and 54.16% in patients with pCHIK-CIR+. In addition, there were also specific significant differences in five dimensions (p < 0.05): physical functioning (85.53% in pCHIK-CIR− versus 53.89% in pCHIKCIR+), role physical (85.53 versus 41.20%, respectively), bodily pain (81.62 versus 51.62%, respectively), vitality (76.25 versus 56.42%, respectively) and role emotional (85.96 versus 54.94%, respectively) (Fig. 1). Despite possible cohort attrition bias, the comparability of pCHIK-CIR+/− subjects allows the assumption of a long-term impact of CHIK infection with less chance of returning to a previous health status and significant impairment of quality of life as has been reported in other cohort studies [8, 9]. We observed sharp reductions in quality of life not only during active pCHIK-CIR+ associated illness, but also for several months (>1 year) after clinical recovery compared to healthy normal subjects. Chikungunya leads to long-term sequelae in a considerable proportion of patients, impacting significantly on quality of life. Long-term chikungunya sequelae must be considered when dealing with this Sir,

Ebola virus disease: an emerging zoonosis with importance for travel medicine.

Dear Editor: Along with the spread of Chikungunya virus disease (CHIK) in Latin America and its set in new endemic areas in the western hemisphere [1], a post-Chikungunya chronic rheumatism (pCHIK-CIR) epidemic is anticipated. About 48 % of infected people in Latin America in a median of 20 months is expected to develop it, according to recent estimations [2]. We have read with interest the article of Rosario et al. [3] given the fact that there is a lack of good evidence with respect to the proper management of these sequelae, and that with the increasing disease spreading, an increase of the coexistence with other rheumatologic conditions is also expectable. As evidenced, there is still a lack of research in general in chikungunya in Latin America [4], including that. However, although they showed data of two groups of patients assumed to be exposed to CHIK, the study has important limitations to be commented. The lack of laboratory confirmation poses the possibility of confusion especially in the rheumatoid arthritis (RA) group. Although CHIK diagnosis is fundamentally clinical in endemoepidemic regions [5, 6], patients with RA and suspected CHIK should have laboratory confirmation since they can present such symptoms in different situations, e.g., infectious and non-infectious conditions. Those on diseasemodifying antirheumatic drugs and steroids may not develop a typical clinical picture, and joint pain might be the most significant infection sign even in other situations [7]. Although authors mentioned that their population of patients did not showed thrombocytopenia (uncommon in CHIK), other variables of the studied subjects were important to include to evaluate differential diagnoses. Authors did not sufficiently explained the demographic healthcare setting in which the study was conducted, including unbalanced groups to be compared, which precludes to raise conclusions about clinical differences between both, and impair external validity of data. Hence, although RA patients and patients without previous arthropathy did not show clinical differences (which would be also due to lack of statistical power, beta error), and treatment of RA with CHIK infection remained unchanged, the poor internal and external validity of data exposed limits the possibility to be confident on conclusions. The lack of enough data about pCHIK-CIR course in patients with previous rheumatologic conditions and the absence of studies for proper management of pCHIK-CIR in those populations remain still a concern in the light of the ongoing pCHIK-CIR epidemics.

Mapping the residual incidence of taeniasis and cysticercosis in Colombia, 2009–2013, using geographical information systems: Implications for public health and travel medicine

Ebola virus disease (EVD) outbreak in West Africa has drawn the attention of the international community, particularly for being one of the largest EVD outbreak in the history. This zoonotic disease has revealed the effect of broad global inequalities and has showed the healthcare system and health surveillance importance in order to control the spread of an emerging and reemerging zoonotic disease. The report of two imported confirmed cases who traveled from Africa to Spain and United States of America, the media alarm and the fear that EVD provokes, rise concern about the possibility of a global outbreak [1]. Even more, for Latin America, recently a suspected case in Brazil, a refugee from Guinea, has been reported (October 10, 2014). EVD is a highly contagious anthropozoonotic disease, caused by exposure with infected body fluids. Travelers are usually at low risk of infection, since the contact must be close and even if they get infected and return to their country during 2e22 days of incubation period, the early detection and isolation in a more proficient health system would allow a more expeditious control of the disease [1e3]. However, EVD should be suspected in travelers returning from highly affected countries (Guinea, Liberia and Sierra Leone), alive or dead, who have (or had) sudden onset of high fever and have contact with a suspected, probable or confirmed Ebola case or a dead or sick animal; or any person with sudden onset of high fever and at least three of the following symptoms: headache, vomiting, anorexia/loss of appetite, diarrhea, lethargy, stomach pain, aching muscles or joints, difficulty swallowing,