title: Clinical Attack Rate of Chikungunya in a Cohort of Nicaraguan Children.
abstract: Chikungunya virus (CHIKV) was recently introduced into the Americas. In Nicaragua, the first endogenous transmission of CHIKV was recognized in September 2014. We used an ongoing dengue cohort study of children aged 2-14 years in Managua, Nicaragua, to document the attack rate of symptomatic chikungunya in a presumably naive population. From September 2014 through March 2015, the overall clinical attack rate of laboratory-confirmed CHIKV infection was 2.9% (95% confidence interval [CI]: 2.3%, 3.4%). The attack rate was greater in children ≥ 8 years of age (4.1%; 95% CI: 3.2%, 5.1%) than in those < 8 years of age (1.5%; 95% CI: 0.9%, 2.1%). The mean age of CHIKV cases presenting with typical chikungunya symptoms was 9.8 years, compared with 7.8 years for cases presenting with undifferentiated fever (P = 0.04). Our data suggest that the clinical attack rate in children may underestimate the true burden of disease as some children, especially young children, may experience more atypical symptoms (e.g., undifferentiated fever).
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Angel
authors.initials: A
authors.lastname: Balmaseda
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California gordonal@umich.edu eharris@berkeley.edu.
authors.forename: Aubree
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Lionel
authors.initials: L
authors.lastname: Gresh
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Sergio
authors.initials: S
authors.lastname: Ojeda
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Saira
authors.initials: S
authors.lastname: Saborio
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Tellez
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Nery
authors.initials: N
authors.lastname: Sanchez
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Guillermina
authors.initials: G
authors.lastname: Kuan
authors.affiliation: Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Sustainable Sciences Institute, Managua, Nicaragua; Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California gordonal@umich.edu eharris@berkeley.edu.
authors.forename: Eva
authors.initials: E
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D065632:Chikungunya Fever / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006798:Housing; D006801:Humans; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors