Determining the Long Term Outcomes Due to Chikungunya Virus Infection: A Descriptive Systematic Review of the Literature Open Access

Sancken, Christina Louise (2016)

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Background. Chikungunya virus affects people of all ages in tropical areas around the world, and can cause potentially severe long-term outcomes (three or more months) due to viral infection. A systematic review of the literature was conducted to describe the variability of long-term outcomes associated with chikungunya virus infection and to characterize potential risk factors for these outcomes.

Methods. The Cochrane Review method for systematic reviews of the literature was used as a framework to search for appropriate literature in the PubMed, Embase, and Medline databases meeting predefined inclusion and exclusion criteria. Full text was obtained for all studies meeting inclusion criteria, organized in an EndNote X7 file, and references of each included article were reviewed for other related articles. Pertinent information was abstracted from final included articles into a Summary of Findings table.

Results. The literature search identified 294 articles relating to chikungunya virus sequelae. Upon review, 24 articles were selected for inclusion in this review. All 24 studies described long-term outcomes attributed to chikungunya virus infection, but not all studies addressed the same outcomes. Symmetrical arthritis and arthralgia of the hands, fingers, wrists, and knees were most commonly reported, especially in females and people over age 40. Pre-existing conditions, comorbid conditions, and family history are thought to play a role in determining long-term outcomes related to chikungunya virus infection. Only two studies exclusively addressed pediatric patient outcomes. Neurodevelopmental delays and dermatologic outcomes were noted.

Conclusions. Long-term outcomes vary widely and affect people of all ages. Research is required to establish the causal effects of long-term outcomes related to chikungunya virus infection, with the focus on pediatric outcomes and risk factors for long-term outcomes in adults. Directing research in these areas could help researchers, clinicians, and other public health professionals better understand the potential of future outbreaks and better respond to the health needs of affected individuals.

Table of Contents

Chapter 1 - Introduction 1

Introduction and Rationale 1

Problem Statement 5

Purpose Statement 6

Research Questions 6

Significance Statement 7

Definition of Terms 7

Chapter 2 - Methodology 8

Introduction 8

Search Strategy 8

Inclusion and Exclusion Criteria 8

Data Extraction and Synthesis 9

Ethical Considerations 10

Chapter 3 - Results of the Literature Review 11

Introduction 11

3-8 Months Follow-Up Time 11

9-14 Months Follow-Up Time 16

15-20 Months Follow-Up Time 18

21-26 Months Follow-Up Time 21

27-32 Months Follow-Up Time 23

33-38 Months Follow-Up Time 24

39 or More Months Follow-Up Time 27

Chapter 4 - Discussion, Recommendations, and Conclusion 29

Synthesis of Results 29

Limitations and Delimitations 30

Gaps in Knowledge 31

Recommendations 33

Conclusion 34

References 35

Appendix A. Flow Chart of Included Studies i

Appendix B. Summary of Findings Table ii

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