To the Editors:
We welcome the report of Rodriguez-Nieves et al1 of 10 new putative cases of perinatally acquired chikungunya virus (CHIKV) infection from 3 pediatric centers in Puerto Rico. However, we were surprised to see the authors imply that this was the first report of perinatally acquired chikungunya in the Western Hemisphere. This priority claim, instead of generating interest in a study, tends to trivialize the findings. In addition, such statements may offend authors whose earlier papers on this topic may have appeared elsewhere. We believe that clarification is needed with respect to other published studies on perinatal chikungunya in the Western Hemisphere during 2015–2016.
Since December 2013, Chikungunya epidemics affected the Western Hemisphere, particularly Caribbean and Latin America with approximately 3 million cases reported to the Pan-American/World Health Organizations. Just in Colombia, more than 1 million cases were notified between 2014 and 2016. In its Sucre department (state), 8 babies with a confirmed perinatally acquired chikungunya (either documented with reverse transcription polymerase chain reaction and/or serology) were reported as early as August 2015.2 A few months later, at its Santander department, 1 additional case was observed in a 12-month period with the aim of detecting psychomotor residual sequelae.3 In July 2016, 2 novel cases were documented (with reverse transcription polymerase chain reaction confirmation both in serum and urine) in Salvador, Brazil.4 In these case series, as with others,2–4 attention was paid to life-threatening complications requiring support of vital functions in the neonatal intensive care unit, such as meconium-stained aspiration pneumonia, sepsis, necrotizing enterocolitis, severe respiratory distress, myocardiopathy, encephalopathy or bullous dermatosis.2–4 In September 2016, the first initiative of data sharing was published as a multicenter study conducted in 4 large regional maternity units from 3 different countries in Latin America.5 The report included 169 newborns observed in El Salvador, Colombia and Dominican Republic. The clinical presentations presumably due to the Asian lineage of CHIKV were consistent with those previously reported from Reunion Island6 with a lesser incidence of neurologic disease but a higher case fatality rate than expected with the Indian ocean lineage.5 Finally, adding the 10 cases of Rodriguez-Nieves et al1 summarizes the Western Hemisphere experience with at least 180 published cases gathered from 5 countries.
Chikungunya represents a substantial risk for neonates born to symptomatic parturients during outbreaks in the Americas, with important clinical and public health implications. Despite efforts to better control the disease, CHIKV transmission still occurs, with more than 300,000 new cases in 2016 in the region. More research is needed as several knowledge gaps remain. These include the study of interactions between the circulating arboviral pathogens and the comparison of CHIKV genotype-specific neurovirulence on long-term neurodevelopmental outcomes to learn whether the Asian lineage could be also associated with poor neurocognitive performances, as observed after infection with the Indian Ocean Lineage.6
Alfonso J. Rodríguez-Morales, MD, MSc, DTM&H, FFTM, RCSPG, FACE
Public Health and Infection Research Group
Faculty of Health Sciences
Universidad Tecnológica de Pereira
Colombian Collaborative Network on Zika and other Arboviruses (RECOLZIKA)
Pereira, Risaralda, Colombia
Ana Carvajal, MD
Infectious Diseases Service
Hospital Universitario de Caracas
Universidad Central de Venezuela
Patrick Gérardin, MD, PhD
INSERM CIC 1410
Saint Pierre, Reunion
CNRS 9192, INSERM U1187, IRD 249, CHU Réunion
Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT)
Plateforme Technologique CYROI
Sainte-Clotilde, La Réunion, France
1. Rodríguez-Nieves M, García-García I, García-Fragoso L. Perinatally acquired chikungunya infection: the Puerto Rico experience. Pediatr Infect Dis J. 2016;35:1163.
2. Villamil-Gómez W, Alba-Silvera L, Menco-Ramos A, et al. Congenital chikungunya virus infection in Sincelejo, Colombia: a case series. J Trop Pediatr. 2015;61:386–392.
3. Alvarado-Socarras JL, Ocampo-González M, Vargas-Soler JA, et al. Congenital and neonatal chikungunya in Colombia. J Pediatric Infect Dis Soc. 2016;5:e17–e20.
4. Lyra PP, Campos GS, Bandeira ID, et al. Congenital chikungunya virus infection after an outbreak in Salvador, Bahia, Brazil. AJP Rep. 2016;6:e299–e300.
5. Torres JR, Falleiros-Arlant LH, Dueñas L, et al. Congenital and perinatal complications of chikungunya fever: a Latin American experience. Int J Infect Dis. 2016;51:85–88.
6. Ritz N, Hüfnagel M, Gérardin P. Chikungunya in children. Pediatr Infect Dis J. 2015;34:789–791.