Faculty Opinions recommendation of A major epidemic of chikungunya virus infection on Reunion Island, France, 2005-2006.

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Abstract
The increased mortality and substantial numbers of neonatal infection, including encephalitis, are surprising in this study given that chikungunya has not typically caused fatal illness or frequently caused neuroinvasive disease. The extent to which chikungunya virus was the proximate cause of death, as opposed to exacerbating tenuous health status, is unclear but the findings of the article call for increased vigilance for neurologic manifestations of chikungunya infection, other severe consequences of infection, and maternal-neonatal transmission. Over 200,000 people were estimated to have had chikungunya fever during an outbreak on Reunion Island in early 2005. Contrary to previous understanding that chikungunya virus does not generally cause severe illness, many patients were hospitalized during this outbreak and an overall increase in mortality was noted. Forty-one cases of neonatal infection were reported, including ten cases of neonatal encephalitis. The estimates of total cases recorded are subject to surveillance biases. No serosurvey was carried out which would have estimated the attack rate more precisely. The details regarding maternal-neonatal transmission are not provided. Further studies will be needed to confirm or refute this study's findings. However, practitioners should be alert for severe manifestations of chikungunya infection and for transmission from mother to fetus or neonate.

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