A Cross-Sectional Study of the Physical and Mental Well-Being of Long COVID Patients in Aruba.

Objective: To investigate the pattern and prevalence of persistent symptoms of Post-COVID-19 Syndrome (PCS) at 3, 6, 9, and 18 months after discharge. Associated risk factors were further examined to potentially explain the persistence of these symptoms.Design and Setting: A cross-sectional cohort study was conducted at the primary health care facility of Aruba, Dr. Horacio E. Oduber Hospital (HOH).Participants: Inclusion criteria were adults hospitalized at HOH for at least one night between March and July 2021 and laboratory-confirmed COVID-19 diagnosis. Exclusion criteria were deceased before the follow-up, not able to mobilize before or after discharge, living outside of Aruba or in nursing homes, and patients with psychosis, dementia, or hospitalized due to unrelated diseases.Methods: Eligible and willing participants completed a 20-question survey: a self-reported symptoms questionnaire about symptoms during and after COVID-19 infection, level of dyspnea measurement (mMRC-scale), quality of life measurement (EQ-5D-5E with EuroQoL VAS), and mental well-being (WHO-5). Hospitalization related data were gathered via retrospective analysis of patient records. Chi-square test, logistic regression, and ANOVA analyses were conducted; P<0.05 was chosen as level of statistical significance for all analyses.Results: In total, 222 (34.5%) patients were eligible, consenting, and completed the survey. Most participants were interviewed a year or more after their initial COVID-19 infection. Fatigue (37.8%), new-onset dyspnea (38.7%), hair loss (20.3%), and muscle pain (18.0%) were the most frequently reported symptoms at any time post COVID-19 infection. Female participants were found more likely to experience fatigue (P<0.05, OR 2.135, 95% CI 1.154-3.949) and new-onset dyspnea (P<0.05, OR 2.026 95% CI 1.093-3.756) after initial infection. Participants with one or more respiratory comorbidity were more likely to experience new-onset dyspnea (P<0.05, OR 2.681, 95% CI 1.223-5.873). None of the predictor variables was associated with cognitive impairment.Conclusion: This study identified female sex and respiratory comorbidity as crucial risk factors for PCS. Females were also found to have significantly lower health scores. Female participants were more likely to experience fatigue and dyspnea after COVID-19 infection.

Prevalence of congenital anomalies in the Dutch Caribbean islands of Aruba, Bonaire, and Curaçao.

BACKGROUND: Congenital anomalies represent an important global health issue. Data on the prevalence and pattern of congenital anomalies in the Caribbean region are scarce and lacking altogether in Aruba, Bonaire and Curaçao (ABC islands). METHODS: We performed a population-based surveillance study to determine the prevalence of structural congenital anomalies in the ABC islands, including all live births and stillbirths between January 1, 2008 and December 31, 2017 with major congenital anomalies according to EUROCAT guide 1.5. Terminations of pregnancy for fetal anomaly were included as well. Cases were identified by active case ascertainment, using multiple sources including pediatric patient files and discharge letters, delivery records, and clinical genetic patient files. Total and subgroup prevalence rates were compared between the three islands and to the French West Indies and Northern Netherlands. RESULTS: Total prevalence of congenital anomalies on the ABC islands was 242.97 per 10,000 births. Total prevalence of congenital anomalies in Bonaire (325.15 per 10,000 births) was higher compared to Aruba (233.29 per 10,000 births) and Curaçao (238.58 per 10,000 births), which was mainly attributable to a higher prevalence of limb anomalies, in particular polydactyly, in Bonaire. Total prevalence of congenital anomalies on the ABC islands was comparable to the French West Indies (248.69 per 10,000 births) but significantly lower compared to the Northern Netherlands (298.98 per 10,000 births). In the subgroup prevalence analysis, the prevalence of polydactyly and atrial septal defect on the ABC islands was significantly higher compared with the French West Indies and the Northern Netherlands, while the prevalence of congenital anomalies of the kidney and urinary tract and genetic disorders was significantly lower. CONCLUSIONS: This is the first study to establish the prevalence and pattern of congenital anomalies on the ABC islands, which is important to inform healthcare managers and policymakers and to provide a basis for continuous surveillance of congenital anomalies.

Annual Report 2021. Aruba, Curaçao, Sint Maarten, and Bonaire, Sint Eustatius and Saba: Responding to COVID-19 and Preparing for the Future

In 2022 the Pan American Health Organization (PAHO) is celebrating its 120th anniversary. Operating as the independent specialized health agency of the inter-American system, PAHO provides technical cooperation to its Member States to address communicable and noncommunicable diseases and their causes, strengthen health systems, and respond to emergencies and disasters throughout the Americas. In addition, in its capacity as the World Health Organization’s Regional Office for the Americas, PAHO participates in the United Nations Country Team, collaborating with other United Nations agencies, funds, and programs to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. At the subregional level, PAHO works with integration mechanisms to position health and its determinants on the political agenda. The 2021 Country Annual Reports reflect PAHO’s technical cooperation in countries and territories in implementing the Country Cooperation Strategies, responding to their needs and priorities, and operating within the framework of PAHO’s regional and global mandates and the SDGs. Under the overarching theme of Responding to COVID-19 and Preparing for the Future, they highlight PAHO’s actions on the COVID-19 pandemic and its continuing efforts in priority areas such as health emergencies, health systems and services, communicable diseases, noncommunicable diseases and mental health, health throughout the life course, and health equity. They also provide a financial summary for the biennium 2020-2021.

Belief in Brua among psychiatric patients from Aruba, Bonaire, and Curaçao: Results from an explorative study in the Netherlands.

Brua is an Afro-Caribbean religion and healing tradition predominantly practised on the ABC islands of the former Netherlands Antilles. It is grounded in oral tradition and shrouded in strict social taboos. Existing literature suggests that the majority of people on and from the islands are familiar with Brua and that it plays a substantial role in shaping their illness conception and idioms of distress. A lack of knowledge of Brua may therefore lead biomedically trained health professionals to misdiagnose these patients. This article discusses how religious beliefs related to Brua influence the illness concepts and idioms of distress of psychiatric patients originating from the ABC Islands, based on semi-structured interviews with former islanders receiving treatment at a psychiatric institute in the Netherlands. We found that of the 29 interviewees, 93.1% knew what Brua involved, 72.4% believed in it, 48.2% had first-hand experience with Brua practices, and 34.5% attributed their mental illness to Brua with greater or lesser certainty. However, only one patient had previously discussed her belief in Brua with her psychiatrist and only when asked to do so. The role of psychoactive substances in the context of Brua practices was negligible. Thus, the present study indicates that the majority of psychiatric patients from the ABC islands are familiar with Brua, but feel reluctant to discuss their concerns in this area with mental health professionals. Recommendations for clinical practice and further research are provided, including the need for a culture-sensitive approach and integrative care.

Annual Report 2020. Universal Health and the Pandemic. Resilient Health Systems. Aruba, Curaçao, Sint Maarten, Bonaire, Sint Eustatius, and Saba

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the territories for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.

Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands

[ABSTRACT]. Objective. To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods. Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988–2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005–2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga’s method. Results. During the period 1988–2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005–2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). Conclusions. Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.

[RESUMEN]. Objetivo. Determinar las áreas específicas de atención de salud cuya optimización podría mejorar la salud de la población en las islas del Caribe holandés de Aruba y Curaçao. Métodos. Estudio de observación comparativo en el que se utilizaron datos demográficos y de mortalidad de las islas del Caribe holandés y de los Países Bajos. Se calcularon las tendencias de mortalidad y luego se analizaron con programas de computación Jointpoint de regresión lineal segmentada, para el período 1988–2014. La esperanza de vida se calculó utilizando tablas de mortalidad abreviadas con los datos más recientes disponibles de todos los territorios (2005–2007). Las diferencias de esperanza de vida entre el Caribe holandés y los Países Bajos se desglosaron, usando el método de Arriaga, en contribuciones por causas específicas. Resultados. En el período 1988–2014, los niveles de mortalidad por causas evitables mediante la atención de salud han sido sistemáticamente mayores en Aruba y Curaçao que en los Países Bajos. En el caso de Aruba, la brecha en la mortalidad por causas evitables mediante la atención de salud con respecto a los Países Bajos no varió significativamente durante el período de estudio; en el caso de Curaçao, la brecha fue mayor. Si la mortalidad por causas evitables mediante la atención de salud se redujese a un nivel similar al de los Países Bajos, los hombres y las mujeres en Aruba habrían sumado, respectivamente, 1,19 años y 0,72 años a su esperanza de vida en el período 2005–2007. En Curaçao, el aumento hubiese sido de 2,06 años y de 2,33 años. Según el estudio, las causas específicas que más contribuyen a esta diferencia son las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis (estas últimas dos causas solamente en Curaçao). Conclusiones. Una mejora en los servicios de salud en relación con las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis en el Caribe holandés podría contribuir sustancialmente a la reducción de la brecha en la esperanza de vida con respecto a los Países Bajos. Por tanto, con base en nuestro estudio, recomendamos que se realicen más estudios exhaustivos a fin de determinar las intervenciones específicas y los recursos que se necesitan para optimizar las áreas de atención de salud involucradas.

[RESUMO]. Objetivo. Identificar áreas específicas da atenção à saúde cuja otimização poderia melhorar a saúde da população nas ilhas de Aruba e Curaçao, no Caribe holandês. Métodos. Estudo observacional comparativo baseado em dados de mortalidade e populacionais das ilhas do Caribe holandês e dos Países Baixos. As tendências de mortalidade foram calculadas e então analisadas com o software Joinpoint, no período de 1988 a 2014. As expectativas de vida foram computadas usando tábuas de mortalidade resumidas com os dados disponíveis mais recentes de todos os territórios (2005-2007). As diferenças na expectativa de vida entre o Caribe holandês e os Países Baixos foram desagregadas segundo as contribuições específicas por causa usando o método de Arriaga. Resultados. No período de 1988 a 2014, os níveis de mortalidade evitável foram consistentemente mais elevados em Aruba e Curaçao do que nos Países Baixos. Em Aruba, a diferença na mortalidade evitável em comparação com os Países Baixos não mudou significativamente durante o período do estudo, enquanto que em Curaçao a diferença aumentou. Se a mortalidade por causas evitáveis fosse reduzida a níveis semelhantes aos dos Países Baixos, os homens e mulheres de Aruba teriam aumentos respectivos de 1,19 e 0,72 anos nas suas expectativas de vida durante o período 2005-2007. Em Curaçao, o aumento seria de 2,06 e 2,33 anos. As maiores contribuições de causas específicas foram as de doenças circulatórias, câncer de mama, causas perinatais e nefrite/nefrose (estas duas últimas causas somente em Curaçao). Conclusões. Melhorias nos serviços de saúde relacionados com doenças circulatórias, câncer de mama, mortes perinatais e nefrite/nefrose no Caribe holandês poderiam contribuir substancialmente para reduzir as disparidades na expectativa de vida em comparação com os Países Baixos. Com base neste trabalho, recomendamos estudos mais aprofundados para identificar as intervenções e recursos específicos necessários para otimizar estas áreas da atenção à saúde.

Two distinct lineages of chikungunya virus cocirculated in Aruba during the 2014-2015 epidemic.

Chikungunya virus (CHIKV), a positive-sense, single-stranded RNA virus in the family Togaviridae, is transmitted by Aedes mosquitoes. Of three known CHIKV genotypes, the Asian genotype was introduced into the Caribbean islands and rapidly spread throughout Central and South Americas. We previously found patients with symptoms compatible with chikungunya fever in 2014-2015 in Aruba, a Caribbean island of 180 km2. We here describe the full genome sequences of eight CHIKV strains isolated from patient sera of the Aruban outbreak. Phylogenetic analysis revealed that two closely related but distinct lineages of Asian-genotype CHIKV circulated simultaneously during the epidemic in 2014-2015. These results suggested that CHIKV was introduced into Aruba more than once in a short period, reflecting the importance of Aruba as a travel hub within the region.

Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands / Contribución de la mortalidad por causas evitables mediante la atención de salud a la diferencia de la esperanza de vida entre las islas del Caribe holandés de Aruba y Curaçao y los Países Bajos / Contribuição da mortalidade evitável para as diferenças na expectativa de vida entre as ilhas de Aruba e Curaçao, no Caribe holandês, e os Países Baixos

ABSTRACT Objective. To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods. Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988-2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005-2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga's method. Results. During the period 1988-2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005-2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). Conclusions. Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.(AU)

RESUMEN Objetivo. Determinar las áreas específicas de atención de salud cuya optimización podría mejorar la salud de la población en las islas del Caribe holandés de Aruba y Curaçao. Métodos. Estudio de observación comparativo en el que se utilizaron datos demográficos y de mortalidad de las islas del Caribe holandés y de los Países Bajos. Se calcularon las tendencias de mortalidad y luego se analizaron con programas de computación Jointpoint de regresión lineal segmentada, para el período 1988-2014. La esperanza de vida se calculó utilizando tablas de mortalidad abreviadas con los datos más recientes disponibles de todos los territorios (2005-2007). Las diferencias de esperanza de vida entre el Caribe holandés y los Países Bajos se desglosaron, usando el método de Arriaga, en contribuciones por causas específicas. Resultados. En el período 1988-2014, los niveles de mortalidad por causas evitables mediante la atención de salud han sido sistemáticamente mayores en Aruba y Curaçao que en los Países Bajos. En el caso de Aruba, la brecha en la mortalidad por causas evitables mediante la atención de salud con respecto a los Países Bajos no varió significativamente durante el período de estudio; en el caso de Curaçao, la brecha fue mayor. Si la mortalidad por causas evitables mediante la atención de salud se redujese a un nivel similar al de los Países Bajos, los hombres y las mujeres en Aruba habrían sumado, respectivamente, 1,19 años y 0,72 años a su esperanza de vida en el período 2005-2007. En Curaçao, el aumento hubiese sido de 2,06 años y de 2,33 años. Según el estudio, las causas específicas que más contribuyen a esta diferencia son las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis (estas últimas dos causas solamente en Curaçao). Conclusiones. Una mejora en los servicios de salud en relación con las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis en el Caribe holandés podría contribuir sustancialmente a la reducción de la brecha en la esperanza de vida con respecto a los Países Bajos. Por tanto, con base en nuestro estudio, recomendamos que se realicen más estudios exhaustivos a fin de determinar las intervenciones específicas y los recursos que se necesitan para optimizar las áreas de atención de salud involucradas.(AU)

RESUMO Objetivo. Identificar áreas específicas da atenção à saúde cuja otimização poderia melhorar a saúde da população nas ilhas de Aruba e Curaçao, no Caribe holandês. Métodos. Estudo observacional comparativo baseado em dados de mortalidade e populacionais das ilhas do Caribe holandês e dos Países Baixos. As tendências de mortalidade foram calculadas e então analisadas com o software Joinpoint, no período de 1988 a 2014. As expectativas de vida foram computadas usando tábuas de mortalidade resumidas com os dados disponíveis mais recentes de todos os territórios (2005-2007). As diferenças na expectativa de vida entre o Caribe holandês e os Países Baixos foram desagregadas segundo as contribuições específicas por causa usando o método de Arriaga. Resultados. No período de 1988 a 2014, os níveis de mortalidade evitável foram consistentemente mais elevados em Aruba e Curaçao do que nos Países Baixos. Em Aruba, a diferença na mortalidade evitável em comparação com os Países Baixos não mudou significativamente durante o período do estudo, enquanto que em Curaçao a diferença aumentou. Se a mortalidade por causas evitáveis fosse reduzida a níveis semelhantes aos dos Países Baixos, os homens e mulheres de Aruba teriam aumentos respectivos de 1,19 e 0,72 anos nas suas expectativas de vida durante o período 2005-2007. Em Curaçao, o aumento seria de 2,06 e 2,33 anos. As maiores contribuições de causas específicas foram as de doenças circulatórias, câncer de mama, causas perinatais e nefrite/nefrose (estas duas últimas causas somente em Curaçao). Conclusões. Melhorias nos serviços de saúde relacionados com doenças circulatórias, câncer de mama, mortes perinatais e nefrite/nefrose no Caribe holandês poderiam contribuir substancialmente para reduzir as disparidades na expectativa de vida em comparação com os Países Baixos. Com base neste trabalho, recomendamos estudos mais aprofundados para identificar as intervenções e recursos específicos necessários para otimizar estas áreas da atenção à saúde.(AU)

Health systems strengthening for noncommunicable disease control and healthy aging: integrated actions in Aruba and Curaçao

[ABSTRACT]. Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)—now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual’s capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.

[RESUMEN]. Los países del Caribe están experimentando transiciones sociales, epidemiológicas y demográficas como resultado del envejecimiento de la población y el aumento de la prevalencia de las enfermedades no transmisibles (ENT), que en la actualidad causan el 78% de todas las defunciones. Estas circunstancias exigen replantear el modelo de atención para mejorar los resultados de salud y establecer sistemas de salud más sostenibles mediante nuevos enfoques en políticas, prestación de servicios, organización, capacitación, tecnología y financiamiento. Las políticas deben tener como propósito procurar una vida saludable, aprovechando las intervenciones que garanticen el envejecimiento saludable. El sistema de salud debe ser proactivo, estructurando las intervenciones para reducir la incidencia de nuevos casos de ENT y para prevenir las complicaciones relacionadas. Las intervenciones deben centrarse en optimizar la capacidad funcional, la autonomía y el desenvolvimiento general de la persona dentro de un entorno adaptado y con el apoyo necesario del sistema de salud en materia de atención preventiva, cuidados a largo plazo, de autocuidado y de atención en la comunidad.

[RESUMO]. Os países do Caribe estão passando por transições sociais, epidemiológicas e demográficas configuradas pela população de idosos cada vez maior e a ascensão das doenças não transmissíveis (DNTs), já responsáveis por 78% de todas as mortes. Essas circunstâncias exigem repensar o modelo de atenção para melhorar os desfechos de saúde e construir sistemas de saúde mais sustentáveis, com novas orientações de política, prestação de serviços, organização, treinamento, tecnologia e financiamento. As políticas devem ser orientadas para a vida saudável, alavancando intervenções que asseguram o envelhecimento saudável. O sistema de saúde deve estruturar proativamente intervenções para reduzir a incidência de novos casos de DNT e a prevenir as complicações relacionadas. As intervenções devem se concentrar na otimização da capacidade do indivíduo, das habilidades funcionais e da autonomia dentro de ambientes adaptados, e também nas ações preventivas a para assistência de longa duração, no autocuidado, na atenção na comunidade e no apoio pelos sistemas de saúde.

Program 1 Report: Quality of Life & Well-being

The World Health Organization (WHO) Quality of Life Group developed a description of 'quality of life,' and it conceptualizes that quality of life is an individual's perception of his or her position in life in the context of the culture and value systems. It also depends on his or her goals, expectations, standards, and concerns. This is an inclusive and broad description of well-being encompassing social indicators, happiness, and health status. It also captures positive aspects of coping, resilience, satisfaction, and autonomy, among other issues. A United Nations resolution in 2011 stated: '..the pursuit of happiness is a fundamental human goal'. It also stresses that 'the gross domestic product indicator by its nature was not designed to and did not adequately reflect the happiness and well-being of people in a country.' With all the economic development and the growth of the tourism industry, Aruba's social context has changed over time. The exponential growth of migrants and visitors to Aruba, resulted in significant changes in the society, bringing with it tremendous stress on the community. This growth in our population, because of the influx of people with different cultural customs and values, required rapid and more development of infrastructure, buildings, and consequently the destructive impact hereof on our nature and environment. In recent years, the government concluded that Aruba is experiencing a social crisis. There seems to be a decrease in mortality and responsibility at all levels of society, an increase of inhabitants living under marginalized conditions due to unemployment and cheap labor. It was also determined that there is a weakening of the social network of family that parents traditionally relied on to serve as a united front to instill good norms and values in their children. The reinforcement of this network should be one of the crucial elements in combatting the social crisis.

Chikungunya virus infection in Aruba: Diagnosis, clinical features and predictors of post-chikungunya chronic polyarthralgia.

BACKGROUND: Chikungunya virus (CHIKV) emerged in Aruba for the first time in 2014. We studied the clinical presentation of acute CHIKV infection and the contribution of serologic and molecular assays to its diagnosis. In a cohort of confirmed CHIKV cases, we analysed the frequency, duration and predictors of post-chikungunya chronic polyarthralgia (pCHIK-CPA), defined as joint pains lasting longer than 6 weeks or longer than 1 year. METHODOLOGY: Patient sera obtained within 10 days of symptom onset were tested for CHIKV, using an indirect immunofluorescence test for the detection of CHIKV-specific Immunoglobulin M (IgM) and post-hoc, by reverse-transcription polymerase chain reaction (RT-PCR). CHIKV was isolated from selected samples and genotyped. For confirmed CHIKV cases, clinical data from chart review were complemented by a Telephone survey, conducted 18-24 months after diagnosis. When joint pain was reported, the duration, presence of inflammatory signs, type and number of joints affected, were recorded. Joint involvement was scored according to the 2010 'American College of Rheumatology/ European League Against Rheumatism' criteria for seronegative rheumatoid arthritis (ACR-score). Risk factors for pCHIK-CPA were identified by logistic regression. PRINCIPAL FINDINGS: Acute CHIKV infection was diagnosed in 269 of 498 sera, by detection of IgM (n = 105), by RT-PCR (n = 59), or by both methods (n = 105). Asian genotype was confirmed in 7 samples. Clinical data were complete for 171 of 248 (69.0%) patients, aged 15 years or older (median 49.4 [35.0-59.6]). The female-to-male ratio was 2.2. The main acute symptoms were arthralgia (94%), fever (85%), myalgia (85%), headache (73%) and rash (63%). In patients with arthralgia (n = 160), pCHIK-CPA longer than 6 weeks was reported by 44% and longer than 1 year by 26% of cases. Inflammatory signs, stiffness, edema and redness were frequent (71%, 39% and 21%, respectively). Joints involved were knees (66%), ankles (50%), fingers (52%), feet (46%), shoulders (36%), elbows (34%), wrists (35%), hips (31%), toes (28.1%) and spine (28.1%). Independent predictors of pCHIK-CPA longer than 1 year were female gender (OR 5.9, 95%-CI [2.1-19.6]); high ACR-score (7.4, [2.7-23.3]), and detection of CHIKV-RNA in serum beyond 7 days of symptom onset (6.4, [1.4-34.1]. CONCLUSIONS: We identified 269 CHIKV patients after the first outbreak of Asian genotype CHIKV in Aruba in 2014-2015. RT-PCR yielded 59 (28%) additional CHIKV diagnoses compared to IgM antibody detection alone. Arthralgia, fever and skin rash were the dominant acute phase symptoms. pCHIK-CPA longer than 1 year affected 26% of cases and was predicted by female gender, high ACR-score and CHIKV-RNA detection beyond 7 days of symptom onset.

Integrated Management Strategy for Dengue Prevention and Control on Aruba. IMS-Dengue Aruba

[Introduction]. Dengue is the most important mosquito-borne viral disease in the world. Repeated epidemics of dengue and severe dengue affect millions of individuals each year in tropical and subtropical areas of the world, including Central and South America and the Caribbean. Following the end of the Aedes aegypti eradication campaign in the 1960s for the control of Yellow Fever the efforts to control this vector were not maintained. As a result all areas that were formerly free of this vector were re-infested, which permitted the introduction and spread of Dengue when it was reintroduced into the region in the 1970’s (PAHO 1997). Over the last 35 years dengue fever has spread throughout the Caribbean and Latin America with cyclical outbreaks (Figure 1). The last major outbreak occurred in 2010 with 1,662,296 cases reported and 1,193 deaths...