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 Horby; Shevin T Jacob; Louise Sigfrid

doi:10.1016/j.eclinm.2022.101672

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

EClinicalMedicine. 2022 Sep 28:54:101672. doi: 10.1016/j.eclinm.2022.101672. eCollection 2022 Dec.

Authors

Eika Webb¹, Melina Michelen², Ishmeala Rigby², Andrew Dagens², Dania Dahmash², Vincent Cheng³, Reena Joseph⁴, Samuel Lipworth^{5

6}, Eli Harriss⁷, Erhui Cai², Robert Nartowski², Pande Putu Januraga⁸, Keerti Gedela⁴, Evi Sukmaningrum^{9

10}, Muge Cevik¹¹, Helen Groves¹², Peter Hart¹², Tom Fletcher¹, Lucille Blumberg¹³, Peter W Horby², Shevin T Jacob¹, Louise Sigfrid²

Affiliations

¹ Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK.
² International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK.
³ Bristol Medical School, University of Bristol, Bristol, UK.
⁴ Imperial College London, London, UK.
⁵ Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁶ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁷ Bodleian Health Care Libraries, University of Oxford, Oxford, UK.
⁸ Udayana University, Bali, Indonesia.
⁹ Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
¹⁰ HIV AIDS Research Centre-HPSI, AJCU, Jakarta, Indonesia.
¹¹ Department of Global Health and Infection Research, School of Medicine, University of St Andrews, Fife, Scotland, UK.
¹² Wellcome Trust, Euston Rd, London, UK.
¹³ National Institute for Communicable Diseases, Johannesburg, South Africa.

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].

Keywords: AGREE II; Chikungunya; Clinical management guidelines; Emerging infections; Supportive care.

Grants and funding

MR/T001151/1/MRC_/Medical Research Council/United Kingdom