Abstract
BACKGROUND: Chikungunya, an arboviral disease, caused massive epidemics in Central and South America in 2014-2016. In a prospective pediatric cohort study, we examined the introduction of chikungunya in a naive population and investigated transmission and clinical characteristics. METHODS: Children presenting to the study health center with a chikungunya-like illness or undifferentiated fever were tested for chikungunya virus (CHIKV) infection by reverse transcriptase-polymerase chain reaction (RT-PCR) and serological assays. Inapparent CHIKV infections in the intervening year were determined by seroconversion in healthy blood samples collected annually. RESULTS: A total of 4353 children participated in the cohort study from March 2014 to February 2016 during the 2 epidemic waves of chikungunya. A total of 539 cases of chikungunya were documented, for an incidence rate of 80.2 cases per 1000 person-years (95% confidence interval [CI]: 73.7, 87.2); and a total of 893 CHIKV infections were documented, for an incidence rate of 137.1 infections per 1000 person-years (95% CI: 128.4, 146.4). The seroprevalence of anti-CHIKV antibodies increased linearly with age, with seroprevalence of >45% in 14-year-old children at the end of Epidemic 2. Symptom presentation varied between the epidemics, with Epidemic 2 exhibiting both a higher symptomatic-to-inapparent ratio (1:1.20 in Epidemic 1 vs. 1:0.65 in Epidemic 2) and more severe clinical presentation among cases. The mean reproduction number was also greater in Epidemic 2 than in Epidemic 1. CONCLUSIONS: The intensity of transmission and severity of clinical presentation varied between the 2 epidemics, with higher transmission intensity associated with greater disease severity.