Chikungunya Fever in Children

Chikungunya fever, a viral disease transmitted by mosquitoes, poses a significant health concern, particularly for children. It has been around in Sri Lanka sporadically, but there are reports of an increasing occurrence of it in more recent times. While often associated with debilitating joint pain in adults, its manifestations in children can present unique challenges.

Understanding the nuances of this disease is crucial for effective management and prevention. Chikungunya fever is caused by the chikungunya virus (CHIKV), an alphavirus transmitted to humans through the bites of infected Aedes aegypti and Aedes albopictus mosquitoes. These are the same mosquitoes that transmit dengue and Zika viruses, highlighting the overlapping risks in many areas of the world.



It is entirely possible for chikungunya and dengue to co-circulate in the same area, leading to co-infections in individuals. When a mosquito bites a person infected with CHIKV, it ingests the virus. After a period of growth and multiplication of the virus within the mosquito, the virus can be transmitted to another person through subsequent bites.

Therefore, the mosquito acts as a vector or an intermediate transmitting agent that spreads the disease, but not as a reservoir of the disease. The spread of chikungunya is influenced by environmental factors that support mosquito breeding, such as stagnant water and warm climates. Urbanization and poor sanitation can exacerbate the problem by creating breeding grounds for these mosquitoes.

The clinical presentation of chikungunya in children can vary, ranging from mild to severe. While some infected children may even be asymptomatic and be normal for all intents and purposes, others can experience a range of symptoms, including a sudden onset of high fever, a common initial symptom. Pain in the joints of the body, while being a hallmark of chikungunya in adults, may be less pronounced in children.

However, they can still experience significant discomfort and this must be kept in mind during processes of diagnosis and treatment. It is also important to remember that joint pains can present in various forms, as well as in different locations of the body. There is no characteristic pattern or sites of involvement of joints.

Muscle aches and pains can accompany the fever and joint pain as well. A headache, too, could occur at any stage of the disease. Other symptoms may include nausea, vomiting, and fatigue as well.

A reddish elevated rash, referred to in medical jargon as a maculopapular rash, is frequently observed in children, sometimes more so than in adults. While chikungunya is known to cause such a rash, there is a specific characteristic related to nasal discoloration that is worth noting. It is called the “Chik sign” or “Brownie nose” and refers to an increased darkening of the skin, particularly on the nose.

This discolouration just appears and is not associated with pain or itching. It can occur during or after the fever, and it can be a helpful clinical sign, especially in areas with limited diagnostic resources. While a generalised rash is a common symptom of chikungunya, a distinctive darkening of the skin on the nose is a particular characteristic that has been observed.

In some rare instances, particularly in infants and very young children, chikungunya can lead to neurological complications, such as involvement of the brain, known as encephalitis. This is associated with a change in the level of alertness, drowsiness, convulsions and weakness of limbs. Equally rarely, some studies indicate that children can experience bleeding tendencies and haemorrhagic manifestations more often than adults.

Diagnosis is typically made through evaluating the patient’s symptoms and medical history, as well as by special blood tests that can detect the presence of CHIKV antibodies (IgM and IgG) or the virus itself through PCR testing. There is no specific antiviral treatment for chikungunya. Treatment focuses on relieving symptoms and allowing the body to recover on its own.

Adequate rest is essential for recovery, and maintaining hydration is crucial, especially in children with fever. Paracetamol in the correct dosage can be used to reduce fever and pain. It is important to avoid aspirin, as it can increase the risk of a further complication known as Reye’s syndrome in children.

In severe cases, hospitalisation and supportive care may be necessary. While most children recover from chikungunya without any major issues, some may experience long-term sequelae. Joint pain can persist for months or even years in some individuals, impacting their quality of life.

In rare cases, chikungunya can lead to chronic arthritis. Children that have suffered from neurological complications can have long term effects. The ultimate outcome or prognosis for chikungunya in children is generally favourable.

Most children recover fully within a few days or a couple of weeks. However, the duration and severity of symptoms can vary quite significantly. Prevention is key to controlling the spread of chikungunya.

Mosquito control is of paramount importance. These include eliminating stagnant water sources where mosquitoes breed, using mosquito repellents, wearing long-sleeved clothing and pants, using mosquito nets, especially for young children and installing protective screens on windows and doors. While a chikungunya vaccine is available, its current use is mainly for adults, especially those traveling to at risk areas.

More research is being conducted for child vaccinations. Chikungunya outbreaks can strain healthcare systems and have significant economic consequences. Public health initiatives aimed at mosquito control and disease surveillance are crucial for preventing and managing outbreaks.

Key considerations for children are that some of them, especially infants and young children, are more vulnerable to severe chikungunya complications and early diagnosis and supportive care are essential for minimising the risk of long-term sequelae. Preventing mosquito bites is the most effective way to protect children from chikungunya. By understanding the causation, clinical features, treatment, and prevention of chikungunya, parents, caregivers, and healthcare professionals can work together to protect children from this illness that could sometimes be quite debilitating.

Dr B. J. C.

Perera MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL) Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

Joint Editor, Sri Lanka Journal of Child Health and Section Editor, Ceylon Medical Journal Founder President, Sri Lanka College of Paediatricians – 1996-97).