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National Center for Emerging and Zoonotic Infectious Diseases
UPDATE AND OBSERVATIONS ON A LARGE
CHIKUNGUNYA OUTBREAK IN PARAGUAY
Susan Hills, MBBS, MTH
CDC Lead , Chikungunya Vaccines Work Group
Arboviral Diseases Branch
Division of Vector -Borne Diseases
Fort Collins, Colorado
ACIP meeting, June 22, 2023
Chikungunya notifications*
October 1, 2022 –June 3, 2023
167,239 cases
Source: Ministry of Public Health and Social Welfare, Paraguay
Epidemiologic weekNo. notifications
*Confirmed and probable cases and suspected arboviral infection 11
Chikungunya notifications*
by district
January 1 –June 3, 2023
Source: Ministry of Public Health and Social Welfare, Paraguay
No cases
<200 cases200– 1,000 cases
1,001– 4,000 cases
4,001– 8,000 cases
19,324 cases
*Confirmed and probable cases and suspected arboviral infection12
Morbidity and mortality among persons with probable or
confirmed chikungunya (N=90,709)
~8,600 (9%) hospitalizations *
*As of June 3, 2023263 (<1%) deaths *
13
Chikungunya virus transmission in 2023
in new areas of South America
Uruguay
–First autochthonous transmission
r
eported April 2023
Argentina and southern Brazil
–Transmission in new locations
U.S traveler cases reported with
t
ravel to this regionUruguayArgentinaParaguayBrazil
14
Observations on the outbreak of relevance to vaccine recommendations:
Explosive nature of outbreaks
<10,000
notifications* by
end of 2022
>50, 000
n
otifications* by
week 6, 2023
Source: Ministry of Public Health and Social Welfare, Paraguay *Confirmed and probable cases and suspected arboviral infection15
Observations on the outbreak of relevance to vaccine recommendations:
Impact on young infants and older persons
Torales M, et al. MMWR Weekly Rep 2023Number of hospitalizations (N=4,604) and case fatality rate among probable and
confirmed chikungunya cases by age group, October 1, 2022 –March 11, 2023
16
Observations on the outbreak of relevance to vaccine recommendations:
Impact on young infants and older persons
Torales M, et al. MMWR Weekly Rep 2023About three
quarters of all
patients who
died had
comorbiditiesNumber of hospitalizations (N=4,604) and case fatality rate among probable and
confirmed chikungunya cases by age group, October 1, 2022 –March 11, 2023
17
Observations on the outbreak of relevance to vaccine recommendations:
Impact on neonates
Observations on the outbreak of relevance to vaccine recommendations:
Impact on health services
Patient loadHealthcare
staff
absenteeism
Summary of observations from outbreak in Paraguay
Outbreak has been explosive and extensive
Groups at risk for severe disease include infants, older adults,
a
nd persons with comorbidities
Case fatality rate highest among neonates
Impact on health services from patient load and sick staff
20
Acknowledgements
Staff of the M inistry
of Public Health
and Social Welfare, Paraguay
Amy Beeson, CDC