title: Chikungunya infection in India: results of a prospective hospital based multi-centric study.
abstract: BACKGROUND
  Chikungunya (CHIKV) has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India.
  
  
  RESULTS
  A total of 540 patients with fever of up to 7 days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS), Karnataka (South); Sawai Man Singh Medical College (SMS) Rajasthan (West), and All India Institute of Medical Sciences (AIIMS) New Delhi (North) from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM). Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36%) followed by west (16.28%) and north (0.56%) India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (p<0.05). Rashes, joint pain/swelling, abdominal pain and vomiting was frequently observed among chikungunya confirmed cases (p<0.05). Adults were affected more than children. Anti-CHIK antibodies (IgM) were detected for more than 60 days of fever onset. Phylogenetic analysis based on E1 gene from KIMS patients (n = 15) revealed ∼99% homology clustering with Central/East African genotype. An amino acid change from lysine to glutamine at position 132 of E1 gene was frequently observed among strains infecting children.
  
  
  CONCLUSIONS
  The study documented re-emergence of chikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. pratimaray.aiims@gmail.com
authors.forename: Pratima
authors.initials: P
authors.lastname: Ray
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Ratagiri
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Kabra
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lodha
authors.forename: Sumit
authors.initials: S
authors.lastname: Sharma
authors.forename: B S
authors.initials: BS
authors.lastname: Sharma
authors.forename: Mani
authors.initials: M
authors.lastname: Kalaivani
authors.forename: Naveet
authors.initials: N
authors.lastname: Wig
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D018354:Alphavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D000914:Antibodies, Viral / Q000276:immunology; D065632:Chikungunya Fever; D002646:Chikungunya virus / Q000235:genetics / Q000276:immunology; D002648:Child; D019411:Clinical Laboratory Techniques; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016679:Genome, Viral / Q000235:genetics; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D007194:India / Q000453:epidemiology; D007700:Kinetics; D008297:Male; D010802:Phylogeny; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D012367:RNA, Viral