title: First Chikungunya Outbreak in Suriname; Clinical and Epidemiological Features.
abstract: BACKGROUND
  In June 2014, Suriname faced the first Chikungunya outbreak. Since international reports mostly focus on hospitalized patients, the least affected group, a study was conducted to describe clinical characteristics of mainly outpatients including children. In addition, the cumulative incidence of this first epidemic was investigated.
  
  
  METHODS
  During August and September 2014, clinically suspected Chikungunya cases were included in a prospective follow-up study. Blood specimens were collected and tested for viral RNA presence. Detailed clinical information was gathered through multiple telephone surveys until day 180. In addition, a three stage household-based cluster with a cross-sectional design was conducted in October, December 2014 and March 2015 to assess the cumulative incidence.
  
  
  RESULTS
  Sixty-eight percent of symptomatic patients tested positive for Chikungunya virus (CHIKV). Arthralgia and pain in the fingers were distinctive for viremic CHIKV infected patients. Viremic CHIKV infected children (≤12 years) characteristically displayed headache and vomiting, while arthralgia was less common at onset. The disease was cleared within seven days by 20% of the patients, while 22% of the viremic CHIKV infected patients, mostly women and elderly reported persistent arthralgia at day 180. The extrapolated cumulative CHIKV incidence in Paramaribo was 249 cases per 1000 persons, based on CHIKV self-reported cases in 53.1% of the households and 90.4% IgG detected in a subset of self-reported CHIKV+ persons. CHIKV peaked in the dry season and a drastic decrease in CHIKV patients coincided with a governmental campaign to reduce mosquito breeding sites.
  
  
  CONCLUSIONS
  This study revealed that persistent arthralgia was a concern, but occurred less frequently in an outpatient setting. The data support a less severe pathological outcome for Caribbean CHIKV infections. This study augments incidence data available for first outbreaks in the region and showed that actions undertaken at the national level to mount responses may have positively impacted containment of this CHIKV outbreak.
authors.affiliation: Department of Biochemistry, Faculty of Medical Sciences, Anton de Kom Universiteit van Suriname, Paramaribo, Suriname.
authors.forename: Farah T
authors.initials: FT
authors.lastname: van Genderen
authors.affiliation: Department of Public Health, Faculty of Medical Sciences, Anton de Kom Universiteit van Suriname, Paramaribo, Suriname.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Krishnadath
authors.affiliation: Department of Biochemistry, 'Prof. Dr. Paul C. Flu' Institute for Biomedical Sciences, Paramaribo, Suriname.
authors.forename: Rachel
authors.initials: R
authors.lastname: Sno
authors.affiliation: Department of Biochemistry, 'Prof. Dr. Paul C. Flu' Institute for Biomedical Sciences, Paramaribo, Suriname.
authors.forename: Meritha G
authors.initials: MG
authors.lastname: Grunberg
authors.affiliation: Scientific Research Center, Academic Hospital Paramaribo, Paramaribo, Suriname.
authors.forename: Wilco
authors.initials: W
authors.lastname: Zijlmans
authors.affiliation: Department of Biochemistry, Faculty of Medical Sciences, Anton de Kom Universiteit van Suriname, Paramaribo, Suriname.
authors.forename: Malti R
authors.initials: MR
authors.lastname: Adhin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065632:Chikungunya Fever / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D013532:Suriname / Q000453:epidemiology; D055815:Young Adult
chemical_list: D012367:RNA, Viral