Munich sent us an alert of a probable chikungunya case, diagnosed in a German traveler to Bali, Indonesia. The traveler developed high fever (T>39°C) and incapacitating arthralgias of hands, fingers, knees, and ankles on May 12th, 7 days after arriving in Canggu, Bali. On May 10th she had traveled to Ubud. Four days after onset of fever, she developed a maculopapular rash on trunk and extremities. She returned to Germany on May 26th, and presented to our colleagues in MUC on June 1st, because of relapsing arthralgias.
Diagnostic evaluation (21 days after fever onset) yielded:
01.06.: CHIKV: PCR (serum) negative, IgM 1:320, IgG 1:160 [<1:10]
14.06.: IgM 1:160, IgG 1:320 (Norm < 1:10)
Dengue NS1-Ag + DENV PCR neg, anti-DENV antibodies IgM 6, IgG 41 [<9]
Anti-Zika virus antibodies IgG und IgM negative
We would like to alert you to the possible re-emergence of risk of chikungunya virus disease in Bali, where both Asian and ECSA genotypes were circulating in the past.
Although Chikungunya incidence estimates ranged between 0.16-36.2 cases per 100,000 person-year (Harapan et al. 2019), and seroprevalence of anti-CHIKV IgM antibodies among local populations in both outbreak and non-outbreak scenarios was 13.3% (17.7 and 7.3% for outbreak and non-outbreak events, respectively), no large outbreaks of CHIKV have been reported since the outbreaks following the introduction of ECSA genotype into Indonesia in 2009-2010. In a multisite observational cohort study conducted in Indonesia from 2013 to 2016, Arif et al. confirmed high anti-CHIKV seroprevalence rates (9.1% in >5-18-year-olds up to >50% in >65-year-olds) in Denpasar and argue that CHIKV remains an underdiagnosed acute febrile illness in Indonesia (Arif et al. 2020). Entomological surveillance data indicate that in recent years (from 2016), the Asian-Pacific genotype CHIKV that was responsible for the massive Caribbean, South American and Polynesian epidemics is now the dominant genotype in mosquito populations in Indonesia (Anggraeni et al. 2021).
If you have seen any patients recently with confirmed or probable chikungunya infection, please email the GeoSentinel Program Manager at geosentinel@geosentinel.org (Aisha Rizwan) and David Hamer (GeoSentinel Surveillance Lead).
Best wishes,
On behalf of the OPI
Harapan et al. (2019) Chikungunya virus infection in Indonesia: a systematic review and evolutionary analysis. BMC Infectious Diseases 19:243. https://doi.org/10.1186/s12879-019-3857-y
Arif M, et al. (2020) Chikungunya in Indonesia: Epidemiology and diagnostic challenges. PLoS Negl Trop Dis 14(6):e0008355. https://doi.org/10.1371/journal.pntd.0008355
Anggraeni et al. (2021) Fast Expansion of the Asian-Pacific Genotype of the Chikungunya Virus in Indonesia. Front. Cell. Infect. Microbiol. https://doi.org/10.3389/fcimb.2021.631508
Details are available in a ProMed posting: https://promedmail.org/promed-post/?id=8705113
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Munich sent us an alert of a probable chikungunya case, diagnosed in a German traveler to Bali, Indonesia. The traveler developed high fever (T>39°C) and incapacitating arthralgias of hands, fingers, knees, and ankles on May 12th, 7 days after arriving in Canggu, Bali. On May 10th she had traveled to Ubud. Four days after onset of fever, she developed a maculopapular rash on trunk and extremities. She returned to Germany on May 26th, and presented to our colleagues in MUC on June 1st, because of relapsing arthralgias.
Diagnostic evaluation (21 days after fever onset) yielded:
01.06.: CHIKV: PCR (serum) negative, IgM 1:320, IgG 1:160 [<1:10]
14.06.: IgM 1:160, IgG 1:320 (Norm < 1:10)
Dengue NS1-Ag + DENV PCR neg, anti-DENV antibodies IgM 6, IgG 41 [<9]
Anti-Zika virus antibodies IgG und IgM negative
We would like to alert you to the possible re-emergence of risk of chikungunya virus disease in Bali, where both Asian and ECSA genotypes were circulating in the past.
Although Chikungunya incidence estimates ranged between 0.16-36.2 cases per 100,000 person-year (Harapan et al. 2019), and seroprevalence of anti-CHIKV IgM antibodies among local populations in both outbreak and non-outbreak scenarios was 13.3% (17.7 and 7.3% for outbreak and non-outbreak events, respectively), no large outbreaks of CHIKV have been reported since the outbreaks following the introduction of ECSA genotype into Indonesia in 2009-2010. In a multisite observational cohort study conducted in Indonesia from 2013 to 2016, Arif et al. confirmed high anti-CHIKV seroprevalence rates (9.1% in >5-18-year-olds up to >50% in >65-year-olds) in Denpasar and argue that CHIKV remains an underdiagnosed acute febrile illness in Indonesia (Arif et al. 2020). Entomological surveillance data indicate that in recent years (from 2016), the Asian-Pacific genotype CHIKV that was responsible for the massive Caribbean, South American and Polynesian epidemics is now the dominant genotype in mosquito populations in Indonesia (Anggraeni et al. 2021).
If you have seen any patients recently with confirmed or probable chikungunya infection, please email the GeoSentinel Program Manager at geosentinel@geosentinel.org (Aisha Rizwan) and David Hamer (GeoSentinel Surveillance Lead).
Best wishes,
On behalf of the OPI
Harapan et al. (2019) Chikungunya virus infection in Indonesia: a systematic review and evolutionary analysis. BMC Infectious Diseases 19:243. https://doi.org/10.1186/s12879-019-3857-y
Arif M, et al. (2020) Chikungunya in Indonesia: Epidemiology and diagnostic challenges. PLoS Negl Trop Dis 14(6):e0008355. https://doi.org/10.1371/journal.pntd.0008355
Anggraeni et al. (2021) Fast Expansion of the Asian-Pacific Genotype of the Chikungunya Virus in Indonesia. Front. Cell. Infect. Microbiol. https://doi.org/10.3389/fcimb.2021.631508
Details are available in a ProMed posting: https://promedmail.org/promed-post/?id=8705113