Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease

Background
Chikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries, such as Bangladesh. We reported the acute clinical profile, quality of life and consequent economic burden of the affected individuals in the recent chikungunya outbreak (May to September 2017) in Dhaka city, Bangladesh.
Methods
We conducted a cross-sectional study during the peak of chikungunya outbreak (July 24 to August 5, 2017) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Data related to clinical symptoms, treatment cost, loss of productivity due to missing work days, and quality of life during their first two-weeks of symptom onset were collected via face to face interview using a structured questionnaire. World Health Organization endorsed questionnaire was used to assess the quality of life.
Results
A total of 1,326 chikungunya cases were investigated. Multivariate analysis of major clinical variables showed no statistically significant differences between confirmed and probable cases. All the patients reported joint pain and fever. Other more frequently reported symptoms include headache, loss of appetite, rash, myalgia, and itching. Arthralgia was polyarticular in 56.3% of the patients. Notably, more than 70% patients reported joint pain as the first presenting symptom. About 83% of the patients reported low to very low overall quality of life. Nearly 30% of the patients lost more than 10 days of productivity due to severe arthropathy.
Conclusions
This study represents one of the largest samples studied so far around the world describing the clinical profile of chikungunya infection. Our findings would contribute to establish an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited settings like Bangladesh.

背景
基孔肯雅病毒（Chikungunya virus）可经蚊虫传播引发感染，造成广泛发病，严重损害患者生活质量。诸如孟加拉国这类资源匮乏国家，其与疾病相关的发病情况、生活质量受损及经济损失相关报道极为匮乏。本研究针对2017年5月至9月孟加拉国达卡市暴发的基孔肯雅热疫情，报告了感染者的急性临床特征、生活质量状况及其后续经济负担。

方法
本研究于2017年7月24日至8月5日的基孔肯雅热疫情高峰期开展横断面研究，旨在记录经实验室检测确诊的确诊病例以及经临床医师诊断的疑似病例的临床特征。研究通过结构化问卷开展面对面访谈，收集了症状出现后前两周内的临床症状、治疗费用、因缺勤导致的生产力损失以及生活质量相关数据，并采用世界卫生组织（World Health Organization, WHO）认可的生活质量评估问卷进行相关测评。

结果
本研究共纳入1326例基孔肯雅热病例进行分析。针对主要临床变量的多因素分析结果显示，确诊病例与疑似病例之间无统计学显著性差异。所有患者均报告有关节疼痛与发热症状，其他高发报告症状包括头痛、食欲减退、皮疹、肌痛及瘙痒。56.3%的患者表现为多关节性关节痛。值得注意的是，超过70%的患者以关节疼痛为首发症状。约83%的患者报告总体生活质量处于低至极低水平。近30%的患者因严重关节病变缺勤超过10天，造成生产力损失。

结论
本研究是目前全球范围内纳入样本量最大的基孔肯雅热感染临床特征研究之一。本研究结果可为在孟加拉国这类资源受限地区建立有效的症状监测系统提供依据，以实现未来基孔肯雅热疫情的早期发现与及时公共卫生干预。