Rapidly evolving outbreak of a febrile illness in rural Haiti: The importance of a field diagnosis of Chikungunya virus in remote locations

Abstract

Although rarely fatal, Chikungunya virus (CHIKV) infection can lead to chronic

debilitating sequelae. We describe the outbreak of suspected CHIKV in 93

subjects who presented voluntarily over 2 months to a remote rural Haitian

general medical clinic staffed by international healthcare providers. Diagnosis

was made on clinical signs and symptoms, as no serum analysis was available in

this remote rural site. The subjects were 18.0 ± 16.2 (median±standard

deviation) years of age and were of similar gender distribution. The presenting

vital signs included a temperature of 102.3°± 0.6F with fever lasting for 3.0 ± 0.7

days. Symptoms mainly consisted of symmetrical polyarthralgia in 82.8%,

headache in 28.0%, abdominal pain in 17.2%, cough in 8.6%, maculopapular

rash in 30.0%, and extremity bullae in 12.9%. In 84.9% of subjects, symptoms

persisted for 7.1 ± 8.3 days with 16.1% having ongoing disability due to

persistent pain (?14 day’s duration). There were no deaths. In Haiti, especially

in remote, rural regions, the risk for CHIKV spread is high given the shortage of detection methods and

treatment in this tropical climate. Preventative efforts are similarly lacking. Implications for a global public

health impact are likely with outbreak extension and spread to neighboring countries.