title: Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014.
abstract: Since emerging in Saint Martin in 2013, chikungunya virus (CHIKV), an alphavirus transmitted by the Aedes aegypti mosquito, has infected approximately two million individuals in the Americas, with over 500,000 reported cases in the Dominican Republic (DR). CHIKV-infected patients typically present with a febrile syndrome including polyarthritis/polyarthralgia, and a macropapular rash, similar to those infected with dengue and Zika viruses, and malaria. Nevertheless, many Dominican cases are unconfirmed due to the unavailability and high cost of laboratory testing and the absence of specific treatment for CHIKV infection. To obtain a more accurate representation of chikungunya fever (CHIKF) clinical signs and symptoms, and confirm the viral lineage responsible for the DR CHIKV outbreak, we tested 194 serum samples for CHIKV RNA and IgM antibodies from patients seen in a hospital in La Romana, DR using quantitative RT-PCR and IgM capture ELISA, and performed retrospective chart reviews. RNA and antibodies were detected in 49% and 24.7% of participants, respectively. Sequencing revealed that the CHIKV strain responsible for the La Romana outbreak belonged to the Asian/American lineage and grouped phylogenetically with recent Mexican and Trinidadian isolates. Our study shows that, while CHIKV-infected individuals were infrequently diagnosed with CHIKF, uninfected patients were never falsely diagnosed with CHIKF. Participants testing positive for CHIKV RNA were more likely to present with arthralgia, although it was reported in just 20.0% of CHIKF+ individuals. High percentages of respiratory (19.6%) signs and symptoms, especially among children, were noted, though it was not possible to determine whether individuals infected with CHIKV were co-infected with other pathogens. These results suggest that CHIKV may have been underdiagnosed during this outbreak, and that CHIKF should be included in differential diagnoses of diverse undifferentiated febrile syndromes in the Americas.
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Rose M
authors.identifier: 0000-0001-9008-425X
authors.initials: RM
authors.lastname: Langsjoen
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Center for Global Health Education, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Rubinstein
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Department of Microbiology & Immunology, University of Texas, Galveston, TX, United States of America.
authors.forename: Tiffany F
authors.initials: TF
authors.lastname: Kautz
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Auguste
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Jesse H
authors.initials: JH
authors.lastname: Erasmus
authors.affiliation: Center for Global Health Education, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Liddy
authors.initials: L
authors.lastname: Kiaty-Figueroa
authors.affiliation: Center for Global Health Education, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Renessa
authors.initials: R
authors.lastname: Gerhardt
authors.affiliation: cBio Inc., Fremont, CA, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: cBio Inc., Fremont, CA, United States of America.
authors.forename: Kumar L
authors.initials: KL
authors.lastname: Hari
authors.affiliation: cBio Inc., Fremont, CA, United States of America.
authors.forename: Ravi
authors.initials: R
authors.lastname: Jain
authors.affiliation: Center for Global Health Education, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ruiz
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Department of Microbiology & Immunology, University of Texas, Galveston, TX, United States of America.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Muruato
authors.affiliation: Hospital Dr. Francisco Gonzalvo, La Romana, Dominican Republic.
authors.forename: Jael
authors.initials: J
authors.lastname: Silfa
authors.affiliation: Hospital el Buen Samaritano, La Romana, Dominican Republic.
authors.forename: Franklin
authors.initials: F
authors.lastname: Bido
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Center for Global Health Education, University of Texas Medical Branch, Galveston, TX, United States of America.|Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dacso
authors.affiliation: Institute for Human Infections and Immunity and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States of America.|Department of Microbiology & Immunology, University of Texas, Galveston, TX, United States of America.|Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States of America.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Weaver
mesh_terms: D000293:Adolescent; D000328:Adult; D000330:Aedes / Q000821:virology*; D000368:Aged; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood*; D018771:Arthralgia; D065632:Chikungunya Fever / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D002646:Chikungunya virus / Q000235:genetics / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D057210:Delayed Diagnosis; D004196:Disease Outbreaks; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D012367:RNA, Viral