Epidemiology and Economic Burden of Chikungunya: A Systematic Literature Review.

Chikungunya (CHIK) is a re-emerging viral infection endemic in tropical and subtropical areas. While the typical clinical presentation is an acute febrile syndrome, long-term articular complications and even death can occur. This review characterizes the global epidemiological and economic burden of chikungunya. The search included studies published from 2007 to 2022 in MEDLINE, Embase, LILACS, and SciELO for a thorough evaluation of the literature. Rayyan software was used for data analysis, and data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventy-six publications were included. Chikungunya is widely distributed in the tropics, including Africa, Asia, South America, and Oceania/the Pacific Islands, and co-circulates with other simultaneous arboviruses such as DENV, ZIKV, and YFV. Chikungunya infection can lead to chronic articular manifestations with a significant impact on the quality of life in the long term. In addition, it generates absenteeism and economic and social losses and can cause fatal infections in vulnerable populations, mainly in high-risk patients with co-morbidities and at the extremes of age. Reported costs associated with CHIKV diseases are substantial and vary by region, age group, and public/private delivery of healthcare services. The chikungunya disease burden includes chronicity, severe infections, increased hospitalization risks, and associated mortality. The disease can impact the economy in several spheres, significantly affecting the health system and national economies. Understanding and measuring the full impact of this re-emerging disease is essential.

Codetecção de dengue e chikungunya durante a gestação: relato de caso / Dengue and chikungunya codetection during pregnancy: case report

Introdução: A tripla circulação de arboviroses no cenário nacional, traz uma constante preocupação para a saúde pública. Relato de caso: Gestante, 38 anos, primigesta, apresenta infecção aguda com quadro de febre, artralgia e mialgia, alteração de níveis pressóricos, elevação de enzimas hepáticas, plaquetopenia e elevação de LDH que gerou quadro grave, resultando em parto de emergência e hemorragia pós-parto maciça. Após suspeição e realização de exames sorológicos, foi constatado codetecção por dengue e chikungunya. Considerações finais: A codetecção de dengue aguda e chikungunya gerou quadro de pré-eclâmpsia e hemorragia pós-parto. Após conduta oportuna, gestante e RN seguiram bem e em alta. Tal situação serve de alerta para vigilância epidemiológica.

Introduction: The triple circulation of arboviruses on the national scene is a constant concern for public health. Case report: Pregnant woman, 3 years old, primigravidae, presented with an acute infection with fever, arthralgia and myalgia, changes in blood pressure levels, elevated liver enzymes, thrombocytopenia and elevated LDH levels, which generated a severe condition, resulting in emergency delivery and hemorrhage. massive postpartum. After suspicion and serological tests, co-detection by dengue and chikungunya was confirmed. Final considerations: The co-detection of acute dengue and chikungunya generated preeclampsia and postpartum hemorrhage. After timely conduct, the pregnant woman and the NB continued well and were discharged. This situation serves as a warning for epidemiological surveillance.

Seroepidemiological survey on chikungunya in endemic zones for arboviruses in Brazil, 2019.

This study aimed to identify the seroprevalence of chikungunya and its associated factors in the city of Quixadá, Ceará, Brazil. We also aimed to identify the spatial distribution patterns of positive cases. A cross-sectional survey was conducted with a questionnaire about clinical symptoms, socioeconomic and demographic factors, and a 10 ml blood sample was collected and analysed by ELISA. For the bivariate analysis, we use the chi-square test, a prevalence ratio and its 95% confidence interval. A robust Poisson hierarchical regression was used to adjust for confounders. The Kernel density was performed for the spatial analysis. A total of 409 samples were analysed; of them, 70.7% were seropositive for previous exposure to chikungunya virus (CHIKV). High seropositivity for CHIKV was higher in female participants (75.5%; PR = 1.23; 95% CI: 1.06-1.43), those aged 31 years or more (74.3%; PR = 1.62; 95% CI: 1.04-2.52), and those with elementary education level (75.0%; PR = 1.30; 95% CI: 1.06-1.60). There were also high seroprevalence in those with less than a minimum wage per month (89.5%; PR = 1.59; 95% CI: 1.11-2.30), housewives (87.5%; PR = 1.64; 95% CI: 1.24-2.18) and unemployed (80.0%; PR = 1.50; 95% CI: 1.10-2.06). After adjusting for age, morning stiffness was the only chikungunya symptom that remained associated (PR = 1.20; 95% CI: 1.06-1.37; p < .001). There was an area of high density of cases in the downtown and two areas of medium density in nearby regions. Otherwise, the higher seroprevalence rates were in the peripherical neighbourhoods. There is a hyperendemicity of CHIKV in Quixadá, and most cases are spatially contiguous. The main associated clinical sign is morning stiffness, but other factors such as low income and spending a longer time at home were significantly associated with higher seroprevalence.

Seroprevalence, spatial dispersion and factors associated with flavivirus and chikungunha infection in a risk area: a population-based seroprevalence study in Brazil.

BACKGROUND: The State of Ceará, in Northeastern Brazil, suffers from a triple burden of arboviruses (dengue, Zika and chikungunya). We measured the seroprevalence of chikungunya, dengue and Zika and its associated factors in the population of Juazeiro do Norte, Southern Ceará State, Brazil. METHODS: A cross-sectional study of analytical and spatial analysis was performed to estimate the seroprevalence of dengue, Zika and chikungunya, in the year 2018. Participants were tested for IgM and IgG against these three viruses. Those with IgM and/or IgG positive tests results were considered positive. Poisson regression was used to analyze the factors associated with positive cases, in the same way that the spatial analysis of positive cases was performed to verify whether the cases were grouped. RESULTS: Of the 404 participants, 25.0% (103/404) were positive for CHIKV, 92.0% (373/404) for flavivirus (dengue or Zika) and of these, 37.9% (153/404) samples were classified as probable dengue infection. Of those who reported having had an arbovirus in the past, positive CHIKV cases had 58.7% arthralgia (PR = 4.31; 95% CI: 2.06-9.03; p = 0.000) mainly in the hands, ankles and feet. Age over 60 years had a positive association with cases of flavivirus (PR = 1.29; 95% CI: 1.09-1.54; p = 0.000). Fever, muscle pain, joint pain and skin rash were the most reported symptoms (46.1, 41.0, 38.3 and 28.41%, respectively). The positive cases of chikungunya and dengue or Zika were grouped in space and the city center was most affected area. CONCLUSIONS: Four years after the introduction of CHIKV, where DENV has been in circulation for over 30 years, 1/4 of the population has already been exposed, showing the extent of the epidemic. The measured prevalence was much higher than that reported by local epidemiological surveillance.

Antihyperglycemic and antioxidant activities of a lectin from the marine red algae, Bryothamnion seaforthii, in rats with streptozotocin-induced diabetes.

The aim of the study was to assess the antihyperglycemic, antilipidemic, and antioxidant effects of a lectin isolated from Bryothamnion seaforthii (BSL), on rats with streptozotocin (STZ)-induced diabetes. The disease model was induced by low-dose injections of STZ. Diabetic rats were treated with NaCl 150 mM, metformin, and BSL at different concentrations. Blood collection was carried out at 0, 30, 60, 90, and 120 days after hyperglycemia confirmation via the assessment of seric glucose, total cholesterol, and triglycerides, assessment of the enzymatic levels of glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD), and the determination of insulin resistance by a homeostasis model of assessment-insulin resistance (HOMA-IR) as well as a homeostasis model of assessment of ß-cells resistance (HOMA-ß). The BSL-treated animals at all three concentrations showed a significant reduction in levels of glucose, cholesterol, total cholesterol, and triglycerides. Moreover, BSL increased the enzymatic activity of GPx and SOD. Index assessments of HOMA-IR and HOMA-ß confirmed that BSL treatment significantly decreased insulin resistance and ß-cell hypersecretion, respectively. In conclusion, BSL treatment might exert hypoglycemic and hypolipidemic effects, diminish insulin resistance, and ameliorate pancreatic ß-cell function along with enzymatic activities toward oxidative stress caused by diabetes mellitus type 2 (T2DM).

Experience of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017: advances and challenges. / Experiência do Comitê de Investigação de Óbitos por Arboviroses no Ceará em 2017: avanços e desafios.

OBJECTIVE: to describe the experience and preliminary results of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017. METHODS: the Committee investigates and discusses all suspected cases of arbovirus deaths reported by the epidemiological surveillance service. RESULTS: a total of 443 suspected arbovirus deaths were reported, 220 (49.7%) of which were confirmed; of these, 88.2% were from chikungunya and 11.8% from dengue; the median age of chikungunya deaths was higher when compared to dengue (77 versus 56 years) and the time until death was also longer when compared to dengue (38 versus 12 days); median time for case closure was 54.5 days; in 2017, Ceará confirmed 80.4% of Brazilian chikungunya deaths. CONCLUSION: the investigation of deaths showed that CHIK viruses were responsible for the majority of arboviral deaths in the state of Ceará, in 2017.

A major chikungunya epidemic with high mortality in northeastern Brazil.

INTRODUCTION: Chikungunya causes fever and severe and persistent joint pain. METHODS: We reported a chikungunya outbreak that occurred in Ceará State, Brazil between 2016 and 2017 with emphasis on epidemiological characterization of cases, high number of deaths, mortality-associated factors, and spatial and temporal spread of the epidemic among municipalities. RESULTS: In November 2015, the first autochthonous cases of chikungunya were confirmed in Ceará, Brazil. In 2016-2017, 195,993 cases were reported, with an incidence of 2,186.5/100,000 inhabitants and 244 confirmed deaths. CONCLUSIONS: Rapid transmission and high mortality rate are serious problems, especially in regions with co-circulating arboviruses.

A major chikungunya epidemic with high mortality in northeastern Brazil

Abstract INTRODUCTION Chikungunya causes fever and severe and persistent joint pain. METHODS We reported a chikungunya outbreak that occurred in Ceará State, Brazil between 2016 and 2017 with emphasis on epidemiological characterization of cases, high number of deaths, mortality-associated factors, and spatial and temporal spread of the epidemic among municipalities. RESULTS: In November 2015, the first autochthonous cases of chikungunya were confirmed in Ceará, Brazil. In 2016-2017, 195,993 cases were reported, with an incidence of 2,186.5/100,000 inhabitants and 244 confirmed deaths. CONCLUSIONS: Rapid transmission and high mortality rate are serious problems, especially in regions with co-circulating arboviruses.

Maternal and infant death after probable vertical transmission of chikungunya virus in Brazil - case report.

BACKGROUND: Chikungunya virus infection in neonates is relatively rare and can lead to death. CASE PRESENTATION: We report the occurrence of the first death of a mother and child after probable vertical transmission of chikungunya virus in Brazil. A 28-year-old pregnant woman with hypertension presented with symptoms compatible with an arboviral disease at 34 weeks' gestation. She developed preeclampsia with severe respiratory failure which resulted in the emergency cesarean section, and the patient died 12 days after the onset of symptoms. The pre-term newborn weighed 2535 g, with an Apgar score of 4/8. He was referred to the neonatal ICU with neutrophilia and thrombocytopenia, several seizure episodes, and hemorrhagic disorders, which resulted in death. Chikungunya IgM antibody was detected in the cerebrospinal fluid. CONCLUSIONS: We present the first documented maternal and neonatal death in Brazil after probable chikungunya infection during pregnancy.

Is the recent increment in attributable deaths to type-2 diabetes (T2D) associated with the latest chikungunya outbreak in a major epidemic area in Brazil?

INTRODUCTION: Chikungunya virus (CHIKV) can negatively influence outcomes in patients with pre-existing conditions. We investigated the association between the recent CHIKV outbreak and increased type 2 diabetes (T2D)-attributable deaths. METHODS: Monthly averages of T2D-attributable deaths between 2001 and 2016 were determined and compared to the equivalent data for 2017 and the recent CHIKV outbreak. RESULTS: CHKV outbreak peaked in April 2017 with 4,394.4 cases/100,000 inhabitants, while T2D-attributable deaths in the same period increased by 35.2%. CONCLUSIONS: T2D-attributable deaths significantly increased compared to the previous data, which overlapped with CHIKV incidence. The pathophysiology of this association warrants further investigations.

Is the recent increment in attributable deaths to type-2 diabetes (T2D) associated with the latest chikungunya outbreak in a major epidemic area in Brazil?

Abstract INTRODUCTION: Chikungunya virus (CHIKV) can negatively influence outcomes in patients with pre-existing conditions. We investigated the association between the recent CHIKV outbreak and increased type 2 diabetes (T2D)-attributable deaths. METHODS: Monthly averages of T2D-attributable deaths between 2001 and 2016 were determined and compared to the equivalent data for 2017 and the recent CHIKV outbreak. RESULTS: CHKV outbreak peaked in April 2017 with 4,394.4 cases/100,000 inhabitants, while T2D-attributable deaths in the same period increased by 35.2%. CONCLUSIONS: T2D-attributable deaths significantly increased compared to the previous data, which overlapped with CHIKV incidence. The pathophysiology of this association warrants further investigations.

Trinta anos de dengue no Ceará: história, contribuições para ciência e desafios no cenário atual com tripla circulação de arbovírus / Thirty years of dengue in Ceará: history, contributions to science and challenges in the current scenario with triple arbovirus circulation

Introdução: Embora os primeiros casos de dengue no estado do Ceará tenham ocorrido em 1986, há registros da presença do mosquito Aedes aegypti desde os anos de 1851/1852. Mesmo após 30 anos, a dengue permanece como um problema grave de saúde pública com epidemias cada vez mais frequentes. Objetivo: Resgatar, reunir e sintetizar a evidência científica produzida nos primeiros 30 anos de dengue no Ceará, contribuindo para melhorar sua compreensão e as intervenções de vigilância e controle. Métodos: Realizou-se uma revisão de literatura com busca de artigos (inglês, português e espanhol) nas bases de dados Pubmed, Scielo, Clinicalkey, Lilacs, Google Acadêmico e banco virtual de teses e dissertações da CAPES, além de livros. O período de 1986 a 2016 foi usado como limite de busca e a mesma foi realizada entre os meses de agosto a novembro de 2016. Utilizaram-se os descritores controlados: dengue, Ceará, Fortaleza e Aedes; com interposição do operador boleano "AND". Resultados: Foram identificadas 574 publicações potencialmente elegíveis, sendo 461 artigos e 113 dissertações ou teses. Foram retirados 272 artigos duplicados ou que não atenderam aos critérios de inclusão. Foram lidos 114 artigos publicados em 60 revistas diferentes, sendo 72,8% artigos completos, 75,2% em inglês, 42,2% experimentais e 81,5% com abordagem quantitativa. Foi publicado apenas um artigo na década de 1980, já na década seguinte foram sete, número que cresceu bastante nos anos 2000, com 38 artigos. No entanto, já há 69 artigos publicados apenas na primeira metade da década de 2010. No período, o Ceará confirmou quase um milhão de casos de dengue, com a circulação dos quatro sorotipos (DENV1 - 1986, DENV2 - 1994, DENV3 - 2002 e DENV4 - 2011) e registrou pelo menos 14 epidemias. A partir de 2015, o Ceará passou a apresentar um cenário diferenciado de tripla epidemia, com a cocirculação autóctone de dois outros arbovírus: Chikungunya e Zika. Conclusão: Nesse período de 30 anos (1986-2016), o Ceará vivenciou várias epidemias de dengue, e, de certa forma, isto vem impulsionando a busca por respostas para o controle desta doença. Há claramente um crescimento em número de artigos publicados a cada ano, revelando a pujança dos grupos locais, que contribuiu de forma importante para a produção científica em diversos fatores relacionados à compreensão da epidemiologia e controle da dengue. (AU)

Introduction: Although the first cases of dengue in the state of Ceará occurred in 1986, there are records of the presence of the Aedes aegypti mosquito since the years 1851/1852. Even after 30 years, dengue remains a serious public health problem with frequent epidemics. Objective: To rescue, gather and synthesize scientific evidence in the first 30 years of dengue in Ceará, contributing to improve its understanding, surveillance and control interventions. Methods: An integrative review was carried out with the search of articles (English, Portuguese and Spanish) in the databases Pubmed, Scielo, Clinicalkey, Lilacs, Google Scholar and virtual bank of thesis and dissertations of CAPES, as well as books. The period from 1986 to 2016 was used as a search limit and it was carried out between August and November 2016. The following descriptors were used: dengue, Ceará, Fortaleza and Aedes; with interposition of the Boolean operator "AND". Results: 574 potentially eligible publications were identified, 461 articles and 113 dissertations or thesis. 272 duplicate articles were removed or did not meet the inclusion criteria. We have read 114 articles published in 60 different journals, 72.8% were full articles, 75.2% were in English, 42.2% were experimental and 81.5% were quantitative. Only one article was published in the 1980s, and in the next decade there were seven, this number grew up considerably in the 2000s with 38 articles. However, there are already 69 articles published only in the first half of the decade of 2010. In this period, Ceará confirmed almost 1 million cases of dengue with the circulation of the four serotypes (DENV1 - 1986, DENV2 - 1994, DENV3 - 2002 and DENV4 - 2011) and recorded at least 14 epidemics. From 2015 on, Ceará started to present a differentiated scenario of a triple epidemic, with the autochthonous co-circulation of two other arboviruses: chikungunya and Zika. Conclusion: In this period of 30 years (1986-2016), Ceará experienced. (AU)

Atividade antihiperglicêmica e antioxidante da lectina de bryothamnion seaforthii em ratoscom diabetes induzido por estreptozotocina

Diabetes mellitus (DM) é uma doença crônica, caracterizada por uma desordem metabólica de múltiplas etiologias, que ocorre quando o pâncreas não produz insulina suficiente ou quando o organismo não pode usar de maneira eficaz a que é produzida, ocasionando uma hiperglicemia sistêmica. A causa do diabetes está associada a uma combinação de disfunção das células β-pancreáticas einsulino-resistência, pois a insulina produzida não é capaz de promover adequada captação periférica de glicose. Aproximadamente 7% da população mundial vive com essa doença e 90% destescasossão diabetes tipo 2. O diabetes pode ocorreras sociado à hiperlipidemias que podem gerar aumento dos radicais livres produzidos, provocando um estresse oxidativo, que por sua vez provoca uma disfunção endotelial,gerando as complicações conhecidas do diabetes. Visto a complexidade do DM, são necessários mais estudos para fornecer terapias alternativas para seu tratamento.As lectinas possuem a propriedade peculiar de ligação acarboidratos e papel intrínseco na comunicação celular, apresentando uma variedade de efeitos biológicos, tais como antiinflamatórios, pró-cicatrizantes, anticâncer, antivirale atividade antioxidante.O presente estudo teve como objetivo avaliar a atividade antihiperglicêmicae antioxidante da lectina de Bryothamnion seaforthii(BSL) in vivo, assim também, como seu efeito na redução de lipídios. Para esta avaliação, foi induzido diabetes mellitus tipo 2 em ratos Wistar,utilizando estreptozotocinae nicotinamida...

Diabetes mellitus(DM) is a chronic disease characterized by metabolic disorder of multiple etiologies, which occurs when the pancreas does not produce enough insulin or when the organism cannot effectively use the insulinproduced, causing systemic hyperglycemia. The cause of diabetes is associated with a combination of dysfunction of pancreatic β-cells and insulin resistance, because the insulin produced is not capable of providing adequate peripheral glucose uptake. Approximately 7% of the world population lives with thedisease and 90% of the cases are type 2 diabetes. Diabetes associated with hyperlipidemia may occur and generate increased production of free radicals, causing oxidative stress, which in turn causes endothelial dysfunction. Since the complexity of the DM,more studies are needed to provide alternative therapies for their treatment. Lectins have the peculiar property of binding to carbohydrates anddisplayintrinsic role in cell communication, featuring a variety of biological effects, such as anti-inflammatory, pro-healing, anti-cancer, antiviral and antioxidant activities. This study aimed to evaluate the antihyperglycemic, antilipidemic and antioxidantactivities of the lectinisolated from Bryothamnionseaforthii(BSL)thorough an in vivostudy. For this evaluation, diabetes mellitustype 2 was induced in Wistar rats using streptozotocin and nicotinamide...