title: Chikungunya Fever Cases Identified in the Veterans Health Administration System, 2014.
abstract: During December 2013, the first locally transmitted chikungunya virus (CHIKV) infections in the Americas were reported in the Caribbean. Although CHIKV infection is rarely fatal, risk for severe disease increases with age and medical comorbidities. Herein we describe characteristics of Veterans Health Administration (VHA) patients with CHIKV infection and, among those with infections diagnosed in Puerto Rico, investigated risk factors for hospitalization.
  
  
  
  We queried VHA's national electronic medical records to identify patients with CHIKV testing during 2014. Demographics, clinical history, laboratory results, and outcomes were abstracted. We investigated risk factors for hospitalization among patients with laboratory-confirmed CHIKV infection in Puerto Rico.
  
  
  
  We identified 180 laboratory-confirmed CHIKV infections; 148 (82.2%) were diagnosed in Puerto Rico, and 32 (17.8%) were diagnosed among returning travelers elsewhere in the United States. In Puerto Rico, where more patients were hospitalized (55.4% versus 20.0%) and died (4.1% versus 0%), risk for hospitalization increased with age (relative risk [RR]/each 10-year increase, 1.19; 95% confidence interval [CI], 1.06-1.32) and, adjusted for age, increased among patients with congestive heart failure (RR, 1.58; 95% CI, 1.25-1.99), chronic kidney disease (RR, 1.52; 95% CI, 1.19-1.94), diabetes mellitus (RR, 1.39; 95% CI, 1.06-1.84), or chronic lung disease (RR, 1.37; 95% CI, 1.03-1.82).
  
  
  
  CHIKV infection is an emerging problem among Veterans residing in or visiting areas with CHIKV transmission. Although overall mortality rates are low, clinicians in affected areas should be aware that older patients and patients with comorbidities may be at increased risk for severe disease.
authors.affiliation: Public Health Surveillance & Research, Department of Veterans Affairs, Washington, D.C., United States of America.|Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Tara
authors.initials: T
authors.lastname: Perti
authors.affiliation: Public Health Surveillance & Research, Department of Veterans Affairs, Washington, D.C., United States of America.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Lucero-Obusan
authors.affiliation: Public Health Surveillance & Research, Department of Veterans Affairs, Washington, D.C., United States of America.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Schirmer
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America.|Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California, United States of America.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Winters
authors.affiliation: Public Health Surveillance & Research, Department of Veterans Affairs, Washington, D.C., United States of America.|Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065632:Chikungunya Fever / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011647:Puerto Rico / Q000453:epidemiology; D012307:Risk Factors; D014195:Travel; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs