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BACKGROUND: During 2014, Florida experienced an increase in the number of internationally acquired cases of chikungunya fever and the first confirmed case of local transmission in the continental United States. Given the debilitating symptoms and rapidly growing burden of the disease, we sought to describe the comorbidities, clinical features, and laboratory abnormalities associated with chikungunya.
METHODS: We identified the first 75 confirmed cases of chikungunya on the basis of symptom onset as listed in Florida’s reportable disease system (Merlin). Descriptive data from Merlin were extracted, and each patient’s medical records were requested for reviewing additional information (e.g., laboratory testing results). Probable cases are defined as clinically compatible illness with presumptive laboratory evidence (e.g., virus-specific antibodies). Confirmed cases are defined as clinically compatible illness with confirmatory laboratory evidence (e.g., isolation of virus, or demonstration of specific viral antigen or nucleic acid; or four-fold or greater change in virus-specific quantitative antibody titers in paired sera; or virus-specific IgM antibodies in serum with confirmatory virus-specific neutralizing antibodies in the same or later specimen). Preliminary analysis was conducted with the information available at the time of abstract submission.
RESULTS: Patients were a mean age of 47 years. The majority of patients were female (59%), black (61%), and Florida residents (92%). Ninety-two percent of the infections were acquired in the Caribbean. Dade, Broward, and Palm Beach Counties experienced the highest number of cases. The patients reported an average time abroad of 7.2 days. Other reported risk factors included history of mosquito bites (61%) and spending extended time outdoors (56%). One out of five patients had a known comorbidity. Of those, hypertension was the most commonly reported (53%), followed by diabetes (40%). The majority of illnesses met the confirmed case criteria (71%), by positive polymerase chain reaction (53%) or IgM (39%) testing. The average number of days from symptom onset to laboratory report was 18.2 days. Thirty-nine percent of patients were hospitalized, and 72% of patients were treated in an emergency department. All patients had fever, with myalgia (53%), rash (37%), headache (32%), and polyarthralgia (23%) reported as other symptoms. Analyses of vital signs at presentation, routine laboratory testing (e.g., blood cell counts, liver function tests, blood chemistries, and markers of inflammation), arboviral diagnostic testing, frequency of health care visits and patient diagnoses will be presented at conference.
CONCLUSIONS: Florida is the only state to have locally acquired chikungunya. Understanding patient characteristics is essential to preventing further transmission.