Human and entomologic investigations of chikungunya outbreak in Mandera, Northeastern Kenya, 2016

PLoS One. 2018 Oct 11;13(10):e0205058. doi: 10.1371/journal.pone.0205058. eCollection 2018.

Abstract

Chikungunya is a reemerging vector borne pathogen associated with severe morbidity in affected populations. Lamu, along the Kenyan coast was affected by a major chikungunya outbreak in 2004. Twelve years later, we report on entomologic investigations and laboratory confirmed chikungunya cases in northeastern Kenya. Patient blood samples were received at the Kenya Medical Research Institute (KEMRI) viral hemorrhagic fever laboratory and the immunoglobulin M enzyme linked immunosorbent assay (IgM ELISA) was used to test for the presence of IgM antibodies against chikungunya and dengue. Reverse transcription polymerase chain reaction (RT-PCR) utilizing flavivirus, alphavirus and chikungunya specific primers were used to detect acute infections and representative PCR positive samples sequenced to confirm the circulating strain. Immature mosquitoes were collected from water-holding containers indoors and outdoors in the affected areas in northeastern Kenya. A total of 189 human samples were tested; 126 from Kenya and 63 from Somalia. 52.9% (100/189) tested positive for Chikungunya virus (CHIKV) by either IgM ELISA or RT-PCR. Sequence analysis of selected samples revealed that the virus was closely related to that from China (2010). 29% (55/189) of the samples, almost all from northeastern Kenya or with a history of travel to northern Kenya, tested positive for dengue IgM antibodies. Entomologic risk assessment revealed high house, container and Breteau indices of, 14.5, 41.9 and 17.1% respectively. Underground water storage tanks were the most abundant, 30.1%, of which 77.4% were infested with Aedes aegypti mosquitoes. These findings confirm the presence of active chikungunya infections in the northeastern parts of Kenya. The detection of dengue IgM antibodies concurrently with chikungunya virus circulation emphasizes on the need for improved surveillance systems and diagnostic algorithms with the capacity to capture multiple causes of arbovirus infections as these two viruses share common vectors and eco-systems. In addition sustained entomological surveillance and vector control programs targeting most productive containers are needed to monitor changes in vector densities, for early detection of the viruses and initiate vector control efforts to prevent possible outbreaks.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Viral / blood
  • Biomarkers / blood
  • Chikungunya Fever / blood*
  • Chikungunya Fever / epidemiology*
  • Chikungunya Fever / immunology
  • Chikungunya virus / genetics
  • Chikungunya virus / immunology
  • Dengue / blood
  • Dengue / epidemiology
  • Dengue / immunology
  • Disease Outbreaks
  • Humans
  • Immunoglobulin M / blood
  • Kenya / epidemiology
  • Mosquito Vectors / virology*
  • Phylogeny
  • Risk Factors

Substances

  • Antibodies, Viral
  • Biomarkers
  • Immunoglobulin M

Grants and funding

This work was funded by the World Health Organization Kenya office and the Global Emerging Infections Surveillance (GEIS) program of the United States Army Medical Research Directorate Kenya (USAMRD-K) for the field based entomological investigations. This manuscript is reporting on data generated from samples passively sent to the central laboratory in a public health response activity.