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Chikungunya virus (CHIKV) was recently introduced into the Americas. In Nicaragua, the first endogenous transmission of CHIKV was recognized in September 2014. We used an ongoing dengue cohort study of children aged 2–14 years in Managua, Nicaragua, to document the attack rate of symptomatic chikungunya in a presumably naive population. From September 2014 through March 2015, the overall clinical attack rate of laboratory-confirmed CHIKV infection was 2.9% (95% confidence interval [CI]: 2.3%, 3.4%). The attack rate was greater in children ≥ 8 years of age (4.1%; 95% CI: 3.2%, 5.1%) than in those < 8 years of age (1.5%; 95% CI: 0.9%, 2.1%). The mean age of CHIKV cases presenting with typical chikungunya symptoms was 9.8 years, compared with 7.8 years for cases presenting with undifferentiated fever (P = 0.04). Our data suggest that the clinical attack rate in children may underestimate the true burden of disease as some children, especially young children, may experience more atypical symptoms (e.g., undifferentiated fever).
Financial support: This work was supported by the National Institute of Allergy and Infectious Diseases, National Institutes of Health (grant no. R01AI099631 to Angel Balmaseda and K02TW009483 to Aubree Gordon).
Authors' addresses: Angel Balmaseda, Saira Saborio, and Yolanda Tellez, Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Aubree Gordon, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, E-mail: email@example.com. Lionel Gresh, Sergio Ojeda, and Nery Sanchez, Sustainable Sciences Institute, Managua, Nicaragua, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Guillermina Kuan, Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua, E-mail: email@example.com. Eva Harris, Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, E-mail: firstname.lastname@example.org.