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Réunion

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Prospective Study of Chikungunya Virus Acute Infection in the Island of La Réunion during the 2005–2006 Outbreak|

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Severe clinical forms with neurological , and cardiac involvements , have also been reported in the literature. In 1973, Obeyesekere described the first cases of acute pericarditis and myocardiopathy associated with CHIKV, based on serology. Thus, CHIKV may, as other viruses, trigger pericarditis and myocarditis. Lemant . , in a retrospective survey of CHIKV-infected patients admitted to intensive care, reported a case of fatal fulminant myocarditis for which analysis of post-mortem myocardial tissue samples pathological examination demonstrated the presence of cytoplasmic viral inclusions in myocytes. Cardiac complications and myocarditis have also been described in infected newborns on the Island of La Réunion , .|

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Reunion is a French overseas territory located in the Indian Ocean, east of the island of Madagascar. The Portuguese discovered the uninhabited island in 1513. From the 17th to the 19th centuries, French immigration supplemented by influxes of Africans, Chinese, Malays and Malabar Indians gave the island its ethnic mix. The opening of the Suez Canal in 1869 cost the island its importance as a stopover on the East Indies trade route. Although remote from mainland France (France métropolitaine), Réunion nonetheless officially forms an integral part of the Republic, representing its own département.|

The prospective study was conducted in the ED of the Groupe Hospitalier Sud Réunion (GHSR) Regional Hospital. This hospital's standards are similar to those found in mainland France. It receives people living in the Southern part of the Island of La Réunion (350,000 inhabitants). The hospital has 1,154 beds and 316 physicians. The ED receives 41,000 patients annually; with adults being treated for medical and surgical conditions, and children for surgical conditions only.|

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We carried out a prospective study of the clinical and biological features characterizing the acute viremic and post-viremic phases of human Chikungunnya infection in patients referred to the ED for febrile athralgia. The patients without Chikungunya entering the ED with fever and arthralgia during the study were used as a control group. The monthly numbers of newly admitted patients with CHIKV viremia in our study were consistent with the estimated incidence in La Réunion (March 2006 32,500, April 11,800, May 5,300). The percentages of viremic patients were stable along the study and represented 0.5% of the total estimated new cases in the Island in March, 0.45% in April and 0.45% in May. Consequently, the newly admitted viremic patients at the ED are representative of the epidemic. Yet, this study does not take into account asymptomatic infections, but they are thought to represent an extremely low proportion (5%) when compared to other arbovirosis such as dengue (80%) , .|

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Chikungunya virus (CHIKV) is a positive strand RNA enveloped alphavirus belonging to the family. CHIKV was first isolated by R.W. Ross in the Newala district of Tanzania and is responsible for acute febrile arthralgia in human. Since 1952, several outbreaks of Chikungunya fever have been reported in Sub-Saharan Africa, Asia (India, Pakistan, South-East Asia, Philippines), and the islands of the Pacific Ocean . CHIKV has emerged in the South-Western Indian Ocean region in the beginning of 2005. Between March 2005 and September 2006, 38.2% of the 785,000 inhabitants of La Réunion Island , were infected. This is the first outbreak recorded on this territory.|

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