Imported cases of Chikungunya virus in Iran.

Mohammad Hassan Pouriayevali, Farshid Rezaei, Tahmineh Jalali, Vahid Baniasadi, Mehdi Fazlalipour, Ehsan Mostafavi, Sahar Khakifirouz, Tahereh Mohammadi, Zahra Fereydooni, Mahsa Tavakoli, Sanam Azad-Manjiri, Motahareh Hosseini, Mahsa Ghalejoogh, Mohammad Mehdi Gouya, Anna-Bella Failloux, Mostafa Salehi-Vaziri
Author Information
  1. Mohammad Hassan Pouriayevali: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  2. Farshid Rezaei: Centre for Diseases Control and Prevention, Ministry of Health, Tehran, Iran.
  3. Tahmineh Jalali: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  4. Vahid Baniasadi: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  5. Mehdi Fazlalipour: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  6. Ehsan Mostafavi: Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.
  7. Sahar Khakifirouz: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  8. Tahereh Mohammadi: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  9. Zahra Fereydooni: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  10. Mahsa Tavakoli: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  11. Sanam Azad-Manjiri: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  12. Motahareh Hosseini: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  13. Mahsa Ghalejoogh: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran.
  14. Mohammad Mehdi Gouya: Centre for Diseases Control and Prevention, Ministry of Health, Tehran, Iran.
  15. Anna-Bella Failloux: Department of Virology, Institut Pasteur, Arboviruses and Insect Vectors, Paris, France.
  16. Mostafa Salehi-Vaziri: Department of Arboviruses and Viral Hemorrhagic Fevers (National Ref Lab), Pasteur Institute of Iran, Tehran, Iran. mostafavaziri1985@gmail.com. ORCID

Abstract

BACKGROUND: Chikungunya virus (CHIKV) is a widespread mosquito-borne virus representing a serious challenge to public health. The largest outbreak in the Middle-East was recorded in 2016-2017 in Pakistan. Sistan and Baluchistan Province of Iran shares a wide border with Pakistan; accordingly, introduction of CHIKV from Pakistan to Iran seems to be probable. The current study is aimed at investigating CHIKV infection in Sistan and Baluchistan Province.
METHODS: Between April 2017 and June 2018, a total of 159 serum samples of CHIK suspected cases from 10 cities of Sistan and Baluchistan Province were tested by molecular and serological assays. Samples obtained up to 4 days after onset of illness were tested by real time PCR (n = 8). Samples collected 5-10 days after disease onset were subjected to ELISA, as well as real time PCR tests (n = 72). Samples obtained after the 10th day of disease onset were tested by only ELISA (n = 79). Phylogenetic analysis of real time PCR positive samples was carried out by sequencing of a 1014-bp region of Envelope 1 gene (E1 gene). Chi-square and independent t tests were used to evaluate the association between variables and CHIKV infection.
RESULTS: In total, 40 (25.1%) out of 159 samples tested positive either by real time PCR or ELISA tests.Out of 151 samples serologically analyzed, 19 (12.6%) and 28 (18.6%) cases were positive for anti-CHIKV IgM and anti-CHIKV IgG antibodies, respectively. Of 80 samples tested by real time PCR, CHIKV RNA was detected in 11 (13.7%) sera, all of them had recent travel history to Pakistan. Additionally, phylogenetic analysis of 5 samples indicated their similarity with recent isolates of Pakistan outbreak 2016-2017 belonging to Indian Ocean sub-lineage of ECSA genotype. A significant correlation between abroad travel history and CHIKV infection was observed (P < 0.001). The most common clinical symptoms included fever, arthralgia/arthritis, myalgia, headache, and chill.
CONCLUSIONS: These results present substantial evidence of CHIKV introduction to Iran from Pakistan and emphasize the need for the enhancement of surveillance system and preventive measures.

Keywords

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MeSH Term

Adolescent
Adult
Animals
Antibodies, Viral
Arthralgia
Chikungunya Fever
Chikungunya virus
Communicable Diseases, Imported
Cross-Sectional Studies
Disease Outbreaks
Enzyme-Linked Immunosorbent Assay
Female
Fever
Genotype
Humans
Iran
Male
Middle Aged
Mosquito Vectors
Pakistan
Phylogeny
Real-Time Polymerase Chain Reaction
Retrospective Studies
Travel
Viral Envelope Proteins
Young Adult

Chemicals

Antibodies, Viral
E1 envelope protein, Chikungunya virus
Viral Envelope Proteins

Word Cloud

Created with Highcharts 10.0.0CHIKVPakistansamplesIrantestedrealtimePCRChikungunyavirusSistanBaluchistanProvinceinfectioncasesSamplesonsetELISAtestspositiveoutbreak2016-2017introductiontotal159obtaineddiseaseanalysisgene6%anti-CHIKVrecenttravelhistoryImportedBACKGROUND:widespreadmosquito-bornerepresentingseriouschallengepublichealthlargestMiddle-EastrecordedshareswideborderaccordinglyseemsprobablecurrentstudyaimedinvestigatingMETHODS:April2017June2018serumCHIKsuspected10citiesmolecularserologicalassays4daysillnessn = 8collected5-10 dayssubjectedwelln = 7210thdayn = 79Phylogeneticcarriedsequencing1014-bpregionEnvelope1E1Chi-squareindependenttusedevaluateassociationvariablesRESULTS:40251%eitherOut151serologicallyanalyzed19122818IgMIgGantibodiesrespectively80RNAdetected11137%seraAdditionallyphylogenetic5indicatedsimilarityisolatesbelongingIndianOceansub-lineageECSAgenotypesignificantcorrelationabroadobservedP < 0001commonclinicalsymptomsincludedfeverarthralgia/arthritismyalgiaheadachechillCONCLUSIONS:resultspresentsubstantialevidenceemphasizeneedenhancementsurveillancesystempreventivemeasurescase

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