Date of Award

January 2016

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Alison Galvani

Abstract

Background: Chikungunya virus (CHIKV) is a mosquito-transmitted virus that emerged in the Caribbean in late 2013 and proceeded to spread throughout the Americas. Acute CHIKV disease is characterized by high fever and potentially debilitating arthralgia. In a proportion of cases, serious long-term sequelae following acute disease have been reported. These conditions primarily include chronic inflammatory rheumatisms, but can also involve depression, sensorineural effects, headaches and cognitive delays following neonatal infection.

Methods: We developed data-driven computational simulation models for acute and long-term health conditions associated with CHIKV infection to estimate the economic cost and health burden of the 2013–2015 CHIKV epidemic in the Americas, accounting for underreporting of cases. We parameterized our models using clinical, epidemiological, and cost data which were collected through extensive literature review.

Findings: Accounting for underreporting, we estimated a total of over 39.9 million cases in the Americas, imposing a burden of over 23.8 million disability adjusted life years (DALYs) lost and about US$185 billion from a societal perspective. Burden and cost varied substantially by region, with the Caribbean accounting for nearly half of the entire disease burden and costs. Over 90% of DALYs and 95% of costs were attributable to chronic inflammatory rheumatism.

Interpretation: Given that there are no effective prevention methods or treatments for chikungunya, the emergence of CHIKV in the Americas creates a considerable strain on individuals and health systems, both currently and in the future. These results highlight the need for increased efforts in vector control to prevent new cases and in investigation into best practices for managing the growing burden of CHIKV-related long-term sequelae.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/06/2018

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