title: Long-term chikungunya infection clinical manifestations after an outbreak in Italy: a prognostic cohort study.
abstract: OBJECTIVE
  Following a Chikungunya (CHIKV) outbreak in Italy, a cohort study was conducted to describe the infection long-term clinical course and outcome.
  
  
  METHODS
  Persons identified through active and passive surveillance as confirmed or possible CHIKV cases during the outbreak were enrolled and interviewed by trained public health nurses, between 4-5 and 12-13 months following the acute stage. Patients reporting persistent clinical symptoms were evaluated by rheumatologists. Serum samples were obtained and anti-CHIKV specific IgG and IgM immune responses detected. Only confirmed cases who completed the follow-up were analysed.
  
  
  RESULTS
  Out of 250 patients, 66.5% still reported myalgia, asthenia or arthralgia (most frequent sign) after 12 months. Functional ability, measured by the ROAD index, was more impaired for lower extremities (3.75; Inter Quartile Range - IQR 4.4), and the activities of daily living (average 4.2; IQR 5). Variables independently associated with the presence of joint pain at 12-13 months were increasing age, and history of rheumatologic diseases). Elderly, females, and persons with history of rheumatologic diseases had higher anti-CHIKV IgG titres at 12-13 months.
  
  
  CONCLUSIONS
  This study confirms, in an unselected population, that the long-lasting burden of CHIKV infection is significant.
authors.affiliation: Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regione Emilia-Romagna, Viale Aldo Moro 21, Bologna, Italy. mlmoro@regione.emilia-romagna.it
authors.forename: M L
authors.initials: ML
authors.lastname: Moro
authors.forename: E
authors.initials: E
authors.lastname: Grilli
authors.forename: A
authors.initials: A
authors.lastname: Corvetta
authors.forename: G
authors.initials: G
authors.lastname: Silvi
authors.forename: R
authors.initials: R
authors.lastname: Angelini
authors.forename: F
authors.initials: F
authors.lastname: Mascella
authors.forename: F
authors.initials: F
authors.lastname: Miserocchi
authors.forename: P
authors.initials: P
authors.lastname: Sambo
authors.forename: A C
authors.initials: AC
authors.lastname: Finarelli
authors.forename: V
authors.initials: V
authors.lastname: Sambri
authors.forename: C
authors.initials: C
authors.lastname: Gagliotti
authors.forename: E
authors.initials: E
authors.lastname: Massimiliani
authors.forename: A
authors.initials: A
authors.lastname: Mattivi
authors.forename: A M
authors.initials: AM
authors.lastname: Pierro
authors.forename: P
authors.initials: P
authors.lastname: Macini
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D018354:Alphavirus Infections / Q000453:epidemiology* / Q000473:pathology*; D000914:Antibodies, Viral / Q000097:blood; D018771:Arthralgia / Q000453:epidemiology; D065632:Chikungunya Fever; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M