Paediatric chikungunya infection: lessons from the la reunion 2005–6 epidemic

Chikungunya virus, a mosquito-borne arbovirus (alphavirus), was responsible for a massive epidemic in La Reunion Island (French overseas territory in the Indian ocean) during 2005–6 (256 000 cases, ie, a third of the population). This emerging virus has since become a major public health concern with widespread outbreaks in India and other islands of the Indian ocean. The classic clinical picture is abrupt febrile illness, maculopapular rash with articular pains. Chikungunya was believed to be a benign self-limiting disease before the La Reunion epidemic. Objective To share our experience of chikungunya virus infection from a paediatric perspective. Results We review clinical manifestations and risk factors for hospitalisation including forgotten forms of the disease such as neurological, cardiac or haemorrhagic manifestations. We describe previously unknown forms of the disease (mother-to-child infection (48 cases), extensive cutaneous blistering (13 cases)) and discuss physiopathological mechanisms. Three deaths occurred in the paediatric population. We highlight difficulties concerning the management of small infants (anaelgesics, breastfeeding, use of insect repellents, fetal exposure during pregnancy) due to limited knowledge of this virus and in the absence of specific antiviral therapy. Conclusion The experience acquired in Reunion may be useful in other latitudes, as the Aedes albopictus mosquito is present in many regions of Europe and north America. The recent epidemic in Ravenna, Italy, confirmed that chikungunya is no longer a tropical disease.