An evaluation of global Chikungunya clinical management guidelines: a systematic review

Eika Webb, Melina Michelen, Ishmeala Rigby, Andrew Dagens, Dania Dahmash, Vincent Cheng, Reena Joseph, Samuel Lipworth, Eli Harriss, Erhui Cai, Robert Nartowski, Pande Putu Januraga, Keerti Gedela, Evi Sukmaningrum, Muge Cevik, Helen Groves, Peter Hart, Tom Fletcher, Lucille Blumberg, Peter W HorbyShevin T Jacob, Louise Sigfrid*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Background
Chikungunya virus (CHIKV) has expanded its geographical reach in recent decades and is an emerging global health threat. CHIKV can cause significant morbidity and lead to chronic, debilitating arthritis/arthralgia in up to 40% of infected individuals. Prevention, early identification, and clinical management are key for improving outcomes. The aim of this review is to evaluate the quality, availability, inclusivity, and scope of evidence-based clinical management guidelines (CMG) for CHIKV globally.
Methods
We conducted a systematic review. Six databases were searched from Jan 1, 1989, to 14 Oct 2021 and grey literature until Sept 16, 2021, for CHIKV guidelines providing supportive care and treatment recommendations. Quality was assessed using the appraisal of Guidelines for Research and Evaluation tool. Findings are presented in a narrative synthesis. PROSPERO registration: CRD42020167361.
Findings
28 CMGs were included; 54% (15/28) were produced more than 5 years ago, and most were of low-quality (median score 2 out of 7 (range 1–7)). There were variations in the CMGs’ guidance on the management of different at-risk populations, long-term sequelae, and the prevention of disease transmission. While 54% (15/28) of CMGs recommended hospitalisation for severe cases, only 39% (11/28) provided guidance for severe disease management. Further, 46% (13/28) advocated for steroids in the chronic phase, but 18% (5/28) advised against its use.
Interpretation
There was a lack of high-quality CMGs that provided supportive care and treatment guidance, which may impact patient care and outcomes. It is essential that existing guidelines are updated and adapted to provide detailed evidence-based treatment guidelines for different at-risk populations. This study also highlights a need for more research into the management of the acute and chronic phases of CHIKV infection to inform evidence-based care.
Funding
The UK Foreign, Commonwealth and Development Office, Wellcome Trust [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135].
Original languageEnglish
Article number101672
Number of pages15
JournalEClinicalMedicine
Volume54
Early online date28 Sept 2022
DOIs
Publication statusPublished - 1 Dec 2022

Keywords

  • AGREE II
  • Emerging infections
  • Chikungunya
  • Supportive care
  • Clinical management guidelines

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