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J Infect. 2012 Aug;65(2):165-72. doi: 10.1016/j.jinf.2012.04.005. Epub 2012 Apr 17.

Long-term chikungunya infection clinical manifestations after an outbreak in Italy: a prognostic cohort study.

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Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regione Emilia-Romagna, Viale Aldo Moro 21, Bologna, Italy.



Following a Chikungunya (CHIKV) outbreak in Italy, a cohort study was conducted to describe the infection long-term clinical course and outcome.


Persons identified through active and passive surveillance as confirmed or possible CHIKV cases during the outbreak were enrolled and interviewed by trained public health nurses, between 4-5 and 12-13 months following the acute stage. Patients reporting persistent clinical symptoms were evaluated by rheumatologists. Serum samples were obtained and anti-CHIKV specific IgG and IgM immune responses detected. Only confirmed cases who completed the follow-up were analysed.


Out of 250 patients, 66.5% still reported myalgia, asthenia or arthralgia (most frequent sign) after 12 months. Functional ability, measured by the ROAD index, was more impaired for lower extremities (3.75; Inter Quartile Range - IQR 4.4), and the activities of daily living (average 4.2; IQR 5). Variables independently associated with the presence of joint pain at 12-13 months were increasing age, and history of rheumatologic diseases). Elderly, females, and persons with history of rheumatologic diseases had higher anti-CHIKV IgG titres at 12-13 months.


This study confirms, in an unselected population, that the long-lasting burden of CHIKV infection is significant.

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