Field evaluation of clinical features during chikungunya outbreak in Mayotte, 2005-2006.

BACKGROUND: To record and assess the clinical features of chikungunya fever (CHIKF), with a view to enable diagnosis based on clinical criteria rather than costly laboratory procedures in field conditions. METHODS: As part of a cross-sectional serologic survey conducted in Mayotte after a massive chikungunya outbreak in 2006, we collected data on clinical features of chikungunya infection and assessed the performance and accuracy of clinical case definition criteria combining different symptoms. RESULTS: Of 1154 participants included, 440 (38.1%) had chikungunya-specific IgM or IgG antibodies by enzyme-linked immunosorbent assay (ELISA). Of symptomatic participants, 318 (72.3%) had confirmed chikungunya, the dominant symptoms reported were incapacitating polyarthralgia (98.7%), myalgia (93.1%), backache (86%), fever of abrupt onset (85%) and headache (81.4%). There was a strong linear association between symptomatic infection and age (chi(2) for trend = 9.85, P < 0.001). Only 52% of persons with presumptive chikungunya sought medical advice, principally at public primary health care facilities. The association of fever and polyarthralgia had a sensitivity of 84% (95% CI: 79-87) and a specificity of 89% (95% CI: 86-91). This association allowed to classify correctly 87% (95% CI: 85-89) of individuals with serologically confirmed chikungunya. CONCLUSIONS: Our results suggest that the pair fever and incapacitating polyarthralgia is an accurate and reliable tool for identifying presumptive CHIKF cases in the field. These criteria provide a useful evidence base to support operational syndromic surveillance in laboratory-confirmed chikungunya epidemic settings.

Seroepidemiology of Dengue virus in Mayotte, Indian Ocean, 2006.

BACKGROUND: Although Dengue virus (DENV) circulation had been documented in neighbouring South-western Indian Ocean Islands, its presence in Mayotte is poorly characterised. To address this issue, we aimed to assess the seroprevalence of dengue IgG antibodies (DENV-IgG Ab) among the population and to investigate potential associations with individual and household characteristics. METHODS/PRINCIPAL FINDINGS: In November-December 2006 we conducted a cross-sectional serologic survey in Mayotte among 1,154 inhabitants aged≥2 years by using a multistage cluster random sampling method. The overall prevalence of DENV-specific IgG antibodies (ELISA) was 22.73% (95% CI, 18.16-27.31). The age-specific seroprevalence increased with age (χ2 for trend=11.86, P<0.0006), and was linked with previous known outbreaks in this region. In multivariate analysis, older age, being born in the Comoros and living in a household with a low socioeconomic index were positively associated with DENV IgG antibody positivity. CONCLUSIONS: These findings document substantial prior exposure of the population of Mayotte to DENV and highlight the risk of severe illness due to the possibility of sequential DENV infections. Further investigations characterizing current DENV circulation patterns and associated serotypes are needed.

Seroprevalence and risk factors of chikungunya virus infection in Mayotte, Indian Ocean, 2005-2006: a population-based survey.

BACKGROUND: Since 2006, Chikungunya virus (CHIKV) has re-emerged as an important pathogen of global concern. However, individual and household factors associated with the acquisition and the magnitude of clinically silent CHIKV infections remain poorly understood. In this present study, we aimed to investigate the seroprevalence, estimate the proportion of symptomatic illness and identify the risk factors for CHIKV infection in the primo-exposed population of Mayotte. METHODS/ PRINCIPAL FINDINGS: We conducted a household-based cross sectional serosurvey in Mayotte in November and December 2006 using complex multistage cluster sampling. To produce the results representative of the island population aged 2 years or older, sample data were adjusted with sample weights. Explanatory and multiple logistic regression analyses were performed to investigate associations between CHIKV infection seropositivity (presence of IgM and/or IgG to CHIKV by enzyme-linked immunoabsorbent assay) and risk factors. A total of 1154 individuals were analyzed. The overall seroprevalence of CHIKV infection was 37.2% (95% CI = 33.9-40.5), 318 (72.3%) of the seropositive participants reported symptoms consistent with a CHIKV infection during the epidemic period. Risk factors for CHIKV seropositivity among adults (aged 15 years and older) were male gender, low socioeconomic index, schooling < or = 6 years and living in makeshift housing. CONCLUSIONS: Our findings indicate that roughly one out of four CHIKV infections is asymptomatic. Conditions associated with poverty may be considered as critical in CHIKV acquisition. Thus, these conditions should be taken into account in the development of future prevention strategies of CHIKV disease.