#Geographical #trends of #chikungunya and #Zika in the #Colombian #Amazonian #gateway department, Caqueta, 2015-2018 – Implications for #publichealth and #travel medicine (Travel Med Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Travel Med Infect Dis. 2019 Sep 12:101481. doi: 10.1016/j.tmaid.2019.101481. [Epub ahead of print]

Geographical trends of chikungunya and Zika in the Colombian Amazonian gateway department, Caqueta, 2015-2018 – Implications for public health and travel medicine.

Bonilla-Aldana DK1, Bonilla-Aldana JL2, García-Bustos JJ3, Lozada CO4, Rodríguez-Morales AJ5.

Author information: 1 School of Veterinary Medicine and Zootechnics, Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira, Risaralda, Colombia; Semillero de Zoonosis, Grupo de Investigación BIOECOS, Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira, Risaralda, Colombia; Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Committee on Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología (ACIN), Bogotá, Colombia. 2 Grupo de Investigación en Ciencias Animales Macagual, Universidad de La Amazonia, Florencia, Caquetá, 180002, Colombia. 3 Grupo de Investigación en Ciencias Animales Macagual, Universidad de La Amazonia, Florencia, Caquetá, 180002, Colombia; Grupo de Investigación en Patología e Inmunología – Doctorado en Medicina Tropical, Universidad del Magdalena, Santa Marta, Magdalena, 470004, Colombia. 4 Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Regional Information System, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia. 5 Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Committee on Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología (ACIN), Bogotá, Colombia; Medical School, Faculty of Health Sciences, UniFranz, Cochabamba, Bolivia. Electronic address: arodriguezm@utp.edu.co.

 

Abstract

BACKGROUND:

Chikungunya (CHIKV) and Zika (ZIKV) significantly affected Latin America in the period 2015-2017. Most studies were reported from urban areas of Brazil and Colombia. In this paper we estimate Incidence rates for CHIKV and ZIKV in Caqueta, the Amazonian gateway area of Colombia, from 2015 to 2018.

METHODS:

Using surveillance data of CHIKV and ZIKV in Caqueta, Colombia, incidence rates were estimated (cases/100,000 population). Sixteen geographical information systems (GIS)-based municipal maps were developed. GIS software used was Kosmo 3.0®.

RESULTS:

From 1st of January 2015 to the 24th of November 2018, 825 cases of CHIK and 1079 of ZIKV were reported, yielding cumulated incidence rates of 169.42 and 221.59 cases/100,000 population respectively. In 2016, 48.7% of the CHIKV cases (402) and 96.6% of the ZIKV cases (1042) were reported. The highest number of both arboviral diseases occurred at Florencia (capital department city), 225 cases for CHIKV (127.17 cases/100,000 pop.) and 611 for ZIKV (345.34 cases/100,000 pop.).

DISCUSSION:

The temporo-spatial distribution of CHIKV and ZIKV infections in Caquetá reflected the pattern of concurrent epidemics, especially in 2016. Studies using GIS-linked maps are necessary to attain accurate epidemiological analyses for public health decisions. That is also useful for an epidemiologically based assessment of traveler risks when visiting specific areas in destination countries.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Arboviruses; Chikungunya virus (CHIKV); Geographical information systems (GIS); Infectious diseases epidemiology; Travelers; Zika virus (ZIKV)

PMID: 31521805 DOI: 10.1016/j.tmaid.2019.101481

Keywords: Zika Virus; Chikungunya fever; Colombia.

——

Advertisements

#Chikungunya-attributable #deaths: A neglected #outcome of a neglected disease (PLoS Negl Trop Dis., summary)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Summary, edited.]

OPEN ACCESS / VIEWPOINTS

Chikungunya-attributable deaths: A neglected outcome of a neglected disease

Antonio S. Lima Neto, Geziel S. Sousa, Osmar J. Nascimento, Marcia C. Castro

Published: September 12, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007575

Citation: Lima Neto AS, Sousa GS, Nascimento OJ, Castro MC (2019) Chikungunya-attributable deaths: A neglected outcome of a neglected disease. PLoS Negl Trop Dis 13(9): e0007575. https://doi.org/10.1371/journal.pntd.0007575

Editor: Brett M. Forshey, DoD – AFHSB, UNITED STATES

Published: September 12, 2019

Copyright: © 2019 Lima Neto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: ASLN was sponsored by the CAPES Foundation, Brazil (Coordenação do Aperfeiçoamento de Pessoal de Nível Superior), PVEX – 88881.172879/2018-01. MCC was supported by Harvard University Lemann Brazil Research Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

___

Chikungunya is caused by an arbovirus RNA of the genus alphavirus (CHIKV) of Togaviridae family [1]. Symptomatic acute CHIKV infection is mainly characterized by high fever and severe joint pain (arthralgia) that can compromise daily life activities [2].

Acute symptoms (such as fever, myalgia, and exanthema) usually resolve or decrease in intensity (arthralgias) in 1 or 2 weeks, although the acute phase may last up to 21 days [1, 3]. Clinical features of post-acute phase, which begins after 3 weeks of onset of symptoms and may extend for 90 days, include polyarthralgia, polyarthritis, exacerbation of comorbidities, chronic fatigue, and worsening of preexisting degenerative or traumatic arthropathies [1, 3].

The persistence of arthralgia for more than 3 months indicates the transition to the chronic stage of chikungunya. In addition to joint pain, exacerbation of comorbidities, tenosynovitis, tendinitis, and neuritis have been reported in patients in the chronic phase of the disease [2–4].

Before the epidemic in the Indian Ocean islands (the Comoros, Mauritius, the Seychelles, Madagascar, Mayotte, and Reunion) and in India between 2005 and 2006, there were no consistent reports of severe cases or chikungunya-related deaths [5, 6].

Particularly, the chikungunya outbreak in Reunion Island revealed unknown characteristics of the disease, such as arthralgia persisting for more than 15 months (with critical implications in quality of life) and high lethality among elderly patients with preexisting conditions, such as hypertension and diabetes [5, 7]. Corroborating these findings, more than 4,500 excess deaths were estimated to have occurred in Ahmedabad, India [8], and Mauritius [9] during the 2005–2006 chikungunya epidemics.

(…)

Keywords: Chikungunya fever.

——

#Dengue and #chikungunya among outpatients with acute undifferentiated #fever in #Kinshasa, #DRC: A cross-sectional study (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study

Sam Proesmans , Freddy Katshongo, John Milambu, Blaise Fungula, Hypolite Muhindo Mavoko, Steve Ahuka-Mundeke, Raquel Inocêncio da Luz, Marjan Van Esbroeck, Kevin K. Ariën, Lieselotte Cnops, Birgit De Smet, Pascal Lutumba, Jean-Pierre Van geertruyden, Veerle Vanlerberghe

Published: September 5, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007047 / This is an uncorrected proof.

 

Abstract

Background

Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis.

Methodology

We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections.

Results

Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue–caused by DENV-1 and/or DENV-2 –and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment.

Discussion

Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will–ultimately and hopefully–improve the clinical care of outpatients in low-resource settings.

Trial registration ClinicalTrials.gov NCT02656862.

 

Author summary

Malaria remains one of the most important causes of fever in sub-Saharan Africa. However, its share is declining, since the diagnosis and treatment of malaria have improved significantly over the years. Hence leading to an increase in the number of patients presenting with non-malarial fever. Often, obvious clinical signs and symptoms like cough or diarrhea are absent, probing the question: “What causes the fever?” Previous studies have shown that the burden of arboviral infections–like dengue and chikungunya–in sub-Saharan Africa is underestimated, which is why we screened for four common arboviral infections in patients presenting with ‘undifferentiated fever’ at an outpatient clinic in suburban Kinshasa, Democratic Republic of Congo. Among the patients tested, we found that one in ten presented with an acute arboviral infection and that almost one in three patients had been infected in the past. These findings suggest that clinicians should think about arboviral infections more often, thereby refraining from the prescription of antibiotics, a practice increasingly problematic given the global rise of antimicrobial resistance.

___

Citation: Proesmans S, Katshongo F, Milambu J, Fungula B, Muhindo Mavoko H, Ahuka-Mundeke S, et al. (2019) Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study. PLoS Negl Trop Dis 13(9): e0007047. https://doi.org/10.1371/journal.pntd.0007047

Editor: Stuart D. Blacksell, Mahidol Univ, Fac Trop Med, THAILAND

Received: November 28, 2018; Accepted: August 6, 2019; Published: September 5, 2019

Copyright: © 2019 Proesmans et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This study was co-funded by the framework agreement between the Institute of Tropical Medicine and the Belgian development cooperation (https://www.itg.be/E/cooperation) to VV and Vlaamse Interuniversitaire Raad – Universitaire Ontwikkelingssamenwerking (https://www.vliruos.be/en) (VLIR-UOS, Grant reference ZRDC2014MP083) to JPVG. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Arbovirus; Dengue fever; Chikungunya fever; Malaria; Serology; Seroprevalence; DRC.

——

Macropinocytosis Dependent #Entry of #Chikungunya Virus into #Human #Muscle Cells (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Macropinocytosis Dependent Entry of Chikungunya Virus into Human Muscle Cells

Ching Hua, Regina Lee, Khairunnisa Mohamed Hussain, Justin Jang Hann Chu

Published: August 26, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007610 / This is an uncorrected proof.

 

Abstract

Chikungunya virus (CHIKV) is a re-emerging arbovirus known to cause chronic myalgia and arthralgia with high morbidity. CHIKV is now considered endemic in many countries across Asia and Africa. In this study, the susceptibility of various human, mammalian and mosquito cell lines to CHIKV infection was evaluated. CHIKV infection was found to be cell-type dependent and virus strain-specific. Furthermore, SJCRH30 (human rhabdomyosarcoma cell line) was showed to be highly permissive to CHIKV infection, with maximum production of infectious virions observed at 12 h.p.i. Pre-infection treatment of SJCRH30 with various inhibitors of endocytosis, including monodansylcadaverine (receptor-mediated endocytic inhibitor), dynasore (clathrin-mediated endocytic inhibitor), as well as filipin (caveolin-mediated endocytosis inhibitor), resulted in minimal inhibition of CHIKV infection. In contrast, dose-dependent inhibition of CHIKV infection was observed with the treatment of macropinocytosis inhibitor, 5-(N-ethyl-N-isopropyl)amiloride (EIPA). Furthermore, siRNA-mediated knockdown of sortin nexin 9 (SNX9) a protein involved in macropinosome formation, also resulted in a significant dose-dependent reduction in viral titre. By performing a virus entry assay, CHIKV particles were also observed to colocalize with FITC-dextran, a macropinosome marker. This study shows for the first time, that the infectious entry of CHIKV into human muscle cells is mediated by macropinocytosis. Together, the data from this study may pave the way for the development of specific inhibitors that target the entry process of CHIKV into cells.

 

Author summary

This study revealed the differences in susceptibility of various human, mammalian and mosquito cell lines to CHIKV infection. CHIKV infection was found to be cell-type dependent and virus-strain specific. Additionally, two human muscle cell lines, SJCRH30 (rhabdomyosarcoma cell line) and HSMM (human skeletal muscle myoblasts), were shown to be highly susceptible to infection by different CHIKV strains. Pre-infection treatment of SJCRH30 and HSMM with a macropinocytosis inhibitor, 5-(N-ethyl-N-isopropyl)amiloride (EIPA) showed a dose-dependent inhibition. Additionally, knockdown of a protein involved in macropinocytosis formation, SNX9, revealed that CHIKV infection of SJCRH30 cells relies on macropinocytosis. Results were confirmed with a FITC-dextran assay, which showed colocalisation between CHIKV particles and macropinosomes during viral entry. Overall, this study may contribute to the development of therapeutic interventions using specific inhibitors that target the entry of CHIKV into muscle cells.

___

Citation: Lee CHR, Mohamed Hussain K, Chu JJH (2019) Macropinocytosis Dependent Entry of Chikungunya Virus into Human Muscle Cells. PLoS Negl Trop Dis 13(8): e0007610. https://doi.org/10.1371/journal.pntd.0007610

Editor: Sujatha Sunil, International Centre for Genetic Engineering and Biotechnology, INDIA

Received: December 13, 2018; Accepted: July 8, 2019; Published: August 26, 2019

Copyright: © 2019 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: JC is funded by the Singapore National Research Foundation (https://www.nrf.gov.sg/) and the Ministry of Education Tier 2 Grants (MOE 2017-T2-1-078 and MOE 2017-T2-2-014) (https://www.olga.moe.gov.sg/T2/default.aspx). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Chikungunya fever; Viral pathogenesis.

——

#Epidemiology of #Dengue, #Chikungunya, and #Zika Virus Disease in the #US States and Territories, 2017 (Am J Trop Med Hyg., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Trop Med Hyg. 2019 Aug 19. doi: 10.4269/ajtmh.19-0309. [Epub ahead of print]

Epidemiology of Dengue, Chikungunya, and Zika Virus Disease in the U.S. States and Territories, 2017.

Adams LE1, Martin SW2, Lindsey NP2, Lehman JA2, Rivera A1, Kolsin J2, Landry K2, Staples JE2, Sharp TM1, Paz-Bailey G1, Fischer M2.

Author information: 1 Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico. 2 Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado.

 

Abstract

Dengue, chikungunya, and Zika viruses, primarily transmitted by Aedes species mosquitoes, have caused large outbreaks in the Americas, leading to travel-associated cases and local mosquito-borne transmission in the United States. We describe the epidemiology of dengue, chikungunya, and noncongenital Zika virus disease cases reported from U.S. states and territories in 2017, including 971 dengue cases, 195 chikungunya cases, and 1,118 Zika virus disease cases. Cases of all three diseases reported from the territories were reported as resulting from local mosquito-borne transmission. Cases reported from the states were primarily among travelers, with only seven locally acquired mosquito-transmitted Zika virus disease cases reported from Texas (n = 5) and Florida (n = 2). In the territories, most dengue cases (n = 508, 98%) were reported from American Samoa, whereas the majority of chikungunya (n = 39, 100%) and Zika virus disease (n = 620, 93%) cases were reported from Puerto Rico. Temporally, the highest number of Zika virus disease cases occurred at the beginning of the year, followed by a sharp decline, mirroring decreasing case numbers across the Americas following large outbreaks in 2015 and 2016. Dengue and chikungunya cases followed a more seasonal pattern, with higher case numbers from July through September. Travelers to the United States and residents of areas with active virus transmission should be informed of both the ongoing risk from dengue, chikungunya, and Zika virus disease and personal protective measures to lower their risk of mosquito bites and to help prevent the spread of these diseases.

PMID: 31436154 DOI: 10.4269/ajtmh.19-0309

Keywords: Zika Virus; Dengue fever; Chikungunya fever; USA.

——

#Epidemiological profile of #Zika, #Dengue and #Chikungunya virus #infections identified by medical and molecular evaluations in #Rondonia, #Brazil (Rev Inst Med Trop Sao Paulo, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Rev Inst Med Trop Sao Paulo. 2019 Aug 19;61:e40. doi: 10.1590/S1678-9946201961040.

Epidemiological profile of Zika, Dengue and Chikungunya virus infections identified by medical and molecular evaluations in Rondonia, Brazil.

Vieira DS1,2,3, Zambenedetti MR4, Requião L4, Borghetti IA4,5, Luna LKS4, Santos AOD1,3, Taborda RLM3, Pereira DB3, Krieger MA4,6, Salcedo JMV1,3, Rampazzo RCP4.

Author information: 1 Fundação Oswaldo Cruz Rondônia, Porto Velho, Rondônia, Brazil. 2 Universidade Federal de Rondônia, Programa de Pós-Graduação em Biologia Experimental, Porto Velho, Rondônia, Brazil. 3 Centro de Pesquisa em Medicina Tropical, Porto Velho, Rondônia, Brazil. 4 Instituto de Biologia Molecular do Paraná, Curitiba, Paraná, Brazil. 5 Universidade Federal do Paraná, Departamento de Engenharia de Bioprocessos e Biotecnologia, Curitiba, Paraná, Brazil. 6 Instituto Carlos Chagas, Curitiba, Paraná, Brazil.

 

Abstract

Several arboviruses have emerged and/or re-emerged in North, Central and South-American countries. Viruses from some regions of Africa and Asia, such as the Zika and Chikungunya virus have been introduced in new continents causing major public health problems. The aim of this study was to investigate the presence of RNA from Zika, Dengue and Chikungunya viruses in symptomatic patients from Rondonia, where the epidemiological profile is still little known, by one-step real-time RT-PCR. The main clinical signs and symtoms were fever (51.2%), headache (78%), chills (6.1%), pruritus (12.2%), exanthema (20.1%), arthralgia (35.3%), myalgia (26.8%) and retro-orbital pain (19.5%). Serum from 164 symptomatic patients were collected and tested for RNA of Zika, Dengue types 1 to 4 and Chikungunya viruses, in addition to antibodies against Dengue NS1 antigen. Direct microscopy for Malaria was also performed. Only ZIKV RNA was detected in 4.3% of the patients, and in the remaining 95.7% of the patients RNA for Zika, Dengue and Chikungunya viruses were not detected. This finding is intriguing as the region has been endemic for Dengue for a long time and more recently for Chikungunya virus as well. The results indicated that medical and molecular parameters obtained were suitable to describe the first report of symptomatic Zika infections in this region. Furthermore, the low rate of detection, compared to clinical signs and symptoms as the solely diagnosis criteria, suggests that molecular assays for detection of viruses or other pathogens that cause similar symptoms should be used and the corresponding diseases could be included in the compulsory notification list.

PMID: 31432989 DOI: 10.1590/S1678-9946201961040

Keywords: Zika Virus; Dengue fever; Chikungunya fever; Seroprevalence; Brazil.

—–

Molecular characterization and #phylogenetic analysis of #Chikungunya virus from #Delhi, #India (Med J Armed Forces India, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Med J Armed Forces India. 2019 Jul;75(3):266-273. doi: 10.1016/j.mjafi.2018.02.004. Epub 2018 May 24.

Molecular characterization and phylogenetic analysis of Chikungunya virus from Delhi, India.

Tandel K1, Kumar M2, Shergill SPS3, Sahai K4, Gupta RM5.

Author information: 1 Assistant Professor (Microbiology), Army Hospital (R&R), Delhi Cantt 110010, India. 2 Professor (Microbiology), Army Hospital (R&R), Delhi Cantt 110010, India. 3 Assistant Professor (Microbiology), Command Hospital (Southern Command), Pune 411040, India. 4 Professor (Pathology) Department of Lab Sciences and Molecular Medicine, Army Hospital (R&R), Delhi 110010, India. 5 Dy Commandant, Command Hospital (Northern Command), Udhampur, India.

 

Abstract

BACKGROUND:

Chikungunya virus is an alpha virus with high similarity to Dengue and Zika viruses, both in transmission cycle and in clinical presentation. Chikungunya is a re-emerging mosquito-borne infection known to cause small to very large outbreaks/epidemics at frequent intervals. In 2016, India witnessed a large outbreak of Chikungunya infection affecting more than 58,000 people. This study was undertaken to look at the genotypic phylogeny to know the relatedness with previously reported strains.

METHODS:

During the 2016 outbreak, samples from all patients clinically suspected to have Chikungunya were collected and subjected to testing for IgM antibody by ELISA and viral RNA detection by RT-PCR. Sequencing of the E1 gene segment was done to create a phylogenetic tree comparison with other strains.

RESULTS:

Serum samples were collected from 142 patients of clinically suspected Chikungunya infection. Majority of the patients were in the age group of 31-50 years accounting for more than 35% of the total cases. Twenty eight samples were positive for IgM antibody. Thirty seven samples were positive for viral RNA by RT-PCR. Only 06 cases were positive by both tests. Mutations in the amino acids K211E, M269V and D284E in the E1 gene segment of the Chikungunya virus were observed in the seven strains that were sequenced. On phylogeny tree, all the strains were found to belong to the ECSA genotype.

CONCLUSION:

Actively searching for the potential epidemic causing mutations and reporting of novel mutations may help in better understanding and probably forecasting of future CHIKV outbreaks and its nature.

KEYWORDS: Chikungunya; Mutations; Outbreak; Phylogeny

PMID: 31388228 PMCID: PMC6676464 [Available on 2020-07-01] DOI: 10.1016/j.mjafi.2018.02.004

Keywords: Chikungunya fever; India.

——-