First Chikungunya Outbreak in Suriname; Clinical and Epidemiological Features.

BACKGROUND:In June 2014, Suriname faced the first Chikungunya outbreak. Since international reports mostly focus on hospitalized patients, the least affected group, a study was conducted to describe clinical characteristics of mainly outpatients including children. In addition, the cumulative incidence of this first epidemic was investigated. METHODOLOGY:During August and September 2014, clinically suspected Chikungunya cases were included in a prospective follow-up study. Blood specimens were collected and tested for viral RNA presence. Detailed clinical information was gathered through multiple telephone surveys until day 180. In addition, a three stage household-based cluster with a cross-sectional design was conducted in October, December 2014 and March 2015 to assess the cumulative incidence. PRINCIPAL FINDINGS:Sixty-eight percent of symptomatic patients tested positive for Chikungunya virus (CHIKV). Arthralgia and pain in the fingers were distinctive for viremic CHIKV infected patients. Viremic CHIKV infected children (≤12 years) characteristically displayed headache and vomiting, while arthralgia was less common at onset. The disease was cleared within seven days by 20% of the patients, while 22% of the viremic CHIKV infected patients, mostly women and elderly reported persistent arthralgia at day 180. The extrapolated cumulative CHIKV incidence in Paramaribo was 249 cases per 1000 persons, based on CHIKV self-reported cases in 53.1% of the households and 90.4% IgG detected in a subset of self-reported CHIKV+ persons. CHIKV peaked in the dry season and a drastic decrease in CHIKV patients coincided with a governmental campaign to reduce mosquito breeding sites. CONCLUSIONS/SIGNIFICANCE:This study revealed that persistent arthralgia was a concern, but occurred less frequently in an outpatient setting. The data support a less severe pathological outcome for Caribbean CHIKV infections. This study augments incidence data available for first outbreaks in the region and showed that actions undertaken at the national level to mount responses may have positively impacted containment of this CHIKV outbreak

Number of reported CHIKV cases reported (July 2014-March 2015).

<p>Monthly rainfall (mm, obtained from the Meterological Center in Suriname) is also depicted; for weeks containing overlapping days from two months (<i>i</i>.<i>e</i>. week 31, 36, 40, 44 and 49), rainfall is depicted for the month with the most days in that week.</p

Differences in clinical manifestations of viremic CHIKV infected children and adults^a.

<p>Differences in clinical manifestations of viremic CHIKV infected children and adults<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004625#t003fn001" target="_blank">^a</a>.</p

Study participation profile of the Chikungunya cohort for the prospective study.

<p>Study participation profile of the Chikungunya cohort for the prospective study.</p

Clinical trend of arthralgia, skin rash, itching, nausea and myalgia from D0 to D7 of viremic CHIKV infected patients^a.

<p>Clinical trend of arthralgia, skin rash, itching, nausea and myalgia from D0 to D7 of viremic CHIKV infected patients<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004625#t002fn001" target="_blank">^a</a>.</p

Clinical symptoms of viremic CHIKV infected patients at onset, day 7, 14, 30 and 90.

<p>Data collected from the viremic CHIKV infected individuals enrolled in the telephone survey. Actual number of patients at each time point per symptom: 1) D0: fever (n = 98), arthralgia and rash (n = 96), back pain and vomiting (n = 93), myalgia (n = 92), itching (n = 87) and other symptoms (n = 90); 2) D7: arthralgia (n = 83), fever (n = 82), rash (n = 81), myalgia (n = 80), vomiting (n = 78), back pain (n = 77), eye pain (n = 74), itching (n = 73) and other symptoms (n = 75); 3) D14: arthralgia (n = 73), rash (n = 72) and other symptoms (n = 71); 4) D30: arthralgia and rash (n = 86) and other symptoms (n = 84), and 5) D90: rash (n = 86), itching (n = 84), arthralgia (n = 83) and other symptoms (n = 82). Presence of fever was only registered until 7 days after infection.</p

Archival, paleopathological and aDNA-based techniques in leprosy research and the case of Father Petrus Donders at the Leprosarium 'Batavia', Suriname

OBJECTIVE: We assessed whether Petrus Donders (died 1887), a Dutch priest who for 27 years cared for people with leprosy in the leprosarium Batavia, Suriname, had evidence of Mycobacterium (M.) leprae infection. A positive finding of M. leprae ancient (a)DNA would contribute to the origin of leprosy in Suriname. MATERIALS: Skeletal remains of Father Petrus Donders; two additional skeletons excavated from the Batavia cemetery were used as controls. METHODS: Archival research, paleopathological evaluation and aDNA-based testing of skeletal remains. RESULTS: Neither archives nor inspection of Donders skeletal remains revealed evidence of leprosy, and aDNA-based testing for M. leprae was negative. We detected M. leprae aDNA by RLEP PCR in one control skeleton, which also displayed pathological lesions compatible with leprosy. The M. leprae aDNA was genotyped by Sanger sequencing as SNP type 4; the skeleton displayed mitochondrial haplogroup L3. CONCLUSION: We found no evidence that Donders contracted leprosy despite years of intense leprosy contact, but we successfully isolated an archaeological M. leprae aDNA sample from a control skeleton from South America. SIGNIFICANCE: We successfully genotyped recovered aDNA to a M. leprae strain that likely originated in West Africa. The detected human mitochondrial haplogroup L3 is also associated with this geographical region. This suggests that slave trade contributed to leprosy in Suriname. LIMITATIONS: A limited number of skeletons was examined. SUGGESTIONS FOR FURTHER RESEARCH: Broader review of skeletal collections is advised to expand on diversity of the M. leprae aDNA database

Suspected locations where <i>P</i>. <i>falciparum</i> infections were acquired based on patient travel histories in regions with malaria transmission two weeks prior to malaria diagnosis in Guyana (Top; total N = 100), and Suriname (Bottom; total N = 78).

<p>The number of patients who reported travelling to a particular region (Guyana) or district (Suriname) is indicated in parentheses. The travel history of seven Suriname patients is unknown. Country maps reprinted from d-maps.com under a CC BY license, with permission from Daniel Dalet, original copyright 2007(<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126805#pone.0126805.s001" target="_blank">S1 Supporting Information</a>).</p