Chikungunya Fever in Southern Thailand, 2018

Infection by the mosquito-borne chikungunya virus (CHIKV) causes acute febrile illness and debilitating arthralgia. Outbreaks are sometimes not recognized because of its clinical resemblance to the more common dengue fever ubiquitous in tropical countries. An upsurge of dengue-like illness was reported in Satun province located in southern Thailand during the rainy season in 2018. We investigated probable outbreak of CHIKV disease. We collected serum samples from 127 patients and tested for CHIKV infection based on nucleic acid and serological tests. CHIKV RNA amplified by real-time reverse-transcription polymerase chain reaction (RT-PCR) and IgM antibody against CHIKV were determined by immunochromatographic rapid test. Mosquitoes in the community were also trapped and tested for CHIKV. Conventional RT-PCR on initially positive samples was performed to obtain nucleotide sequences for subsequent phylogenetic analysis. In all, 39% (50/127) of the samples tested positive for CHIKV RNA, IgM, or both. Of these, CHIKV RNA was identified in 17% (21/127) of the samples. Fourteen percent (18/127) of the samples were simultaneously positive for both IgM and IgG, which suggest recent infection. One sample tested positive for both CHIKV IgM and RNA. Several samples from Aedes aegypti and Aedes albopictus mosquitoes were also CHIKV RNA-positive. Sequence analysis revealed that the Satun CHIKV belonged to the Indian Ocean lineage within the East/Central/South African (ECSA) clade with residues K211E and A226 in the E1 gene, and G205S and V264A in the E2 gene. The ECSA strain of CHIKV continues to evolve and possesses virulent potential despite causing prior outbreaks in the region.