The study on epidemiological characteristics, clinical signs and symptoms, and factors related to chronic joint pain of Chikungunya patients in urban area, Songkhla Province, Thailand, 2019

Abstract

The outbreak of Chikungunya occurred in urban area of Hatyai District, Songkhla Province, from June 2018 to March 2019. The outbreak investigation team from the Office of Disease Prevention and Control Region 12, Songkhla, was dispatched to perform outbreak investigation. This study, which was part of this outbreak investigation, aimed to describe the epidemiological characteristics, clinical signs and symptoms, as well as factors associated with chronic joint pain due to Chikungunya. Using the case definition of the Bureau of Epidemiology, a total of 304 probable cases of Chikungunya were identified and recruited for interview about the signs and symptoms and their duration. Descriptive statistics, which include frequency, percentage, means and median, and inferential statistics, i.e. stepwise multiple regression analysis, were used. The results revealed, among probable cases, a female-to-male ratio of 1.2:1 (p-value=0.06). Most of them were in the working age groups with a mean age of 33.7 years. Seventy-one point one (71.1) percent of probable cases were living with other probable case(s) in the same household. Major signs and symptoms were fever, joint pain and rash. The fever, which was most commonly found in the first three days of illness onset, was sometimes accompanied by headache, peri-orbital pain, conjunctivitis, and nausea. After fever, joint pain occurred and followed by rash lasting for about one week. The cases with pain in multiple joints accounted for 94.4% and those with pain rotating to a different joint at any given time 21.1% of all cases. Most of joint pain events were in the knees (83.6%), ankles (80.6%) and fingers (74%). In addition, it was also found that female and elderly populations were more likely to suffer from chronic joint pain. Findings from this study suggested that detection of clusters of patients with fever, multiple joint pain and rash and more than one case in the same household should be suggestive of chikungunya outbreak, and the incidence should be promptly notified to local public health officials so that disease control measures can be implemented in a timely manner. Female and elderly populations are particularly recommended to prevent mosquito bite, which is the cause of Chikgununya infection, as they are more likely to develop chronic joint pain if infected.