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

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 journal › Article (Academic Journal) › peer-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.

Original language	English
Article number	101672
Number of pages	15
Journal	EClinicalMedicine
Volume	54
Early online date	28 Sept 2022
DOIs	https://doi.org/10.1016/j.eclinm.2022.101672
Publication status	Published - 1 Dec 2022

Bibliographical note

Funding Information:
This work was supported by funding from the UK Foreign, Commonwealth and Development Office, Wellcome Trust [ 215091/Z/18/Z ] and the Bill & Melinda Gates Foundation [ OPP1209135 ]. Thanks to the ISARIC Global Support Centre for their invaluable logistical and administrative support on this project.

Publisher Copyright:
© 2022 The Authors

Keywords

AGREE II
Chikungunya
Clinical management guidelines
Emerging infections
Supportive care

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Webb, E., Michelen, M., Rigby, I., Dagens, A., Dahmash, D., Cheng, V., Joseph, R., Lipworth, S., Harriss, E., Cai, E., Nartowski, R., Januraga, P. P., Gedela, K., Sukmaningrum, E., Cevik, M., Groves, H., Hart, P., Fletcher, T., Blumberg, L., ... Sigfrid, L. (2022). An evaluation of global Chikungunya clinical management guidelines: A systematic review. EClinicalMedicine, 54, Article 101672. https://doi.org/10.1016/j.eclinm.2022.101672

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title = "An evaluation of global Chikungunya clinical management guidelines: A systematic review",

abstract = "BackgroundChikungunya 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.MethodsWe 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.Findings28 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{\textquoteright} 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.InterpretationThere 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.",

keywords = "AGREE II, Chikungunya, Clinical management guidelines, Emerging infections, Supportive care",

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

note = "Funding Information: This work was supported by funding from the UK Foreign, Commonwealth and Development Office, Wellcome Trust [ 215091/Z/18/Z ] and the Bill & Melinda Gates Foundation [ OPP1209135 ]. Thanks to the ISARIC Global Support Centre for their invaluable logistical and administrative support on this project. Publisher Copyright: {\textcopyright} 2022 The Authors",

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month = dec,

day = "1",

doi = "10.1016/j.eclinm.2022.101672",

language = "English",

volume = "54",

journal = "EClinicalMedicine",

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Webb, E, Michelen, M, Rigby, I, Dagens, A, Dahmash, D, Cheng, V, Joseph, R, Lipworth, S, Harriss, E, Cai, E, Nartowski, R, Januraga, PP, Gedela, K, Sukmaningrum, E, Cevik, M, Groves, H, Hart, P, Fletcher, T, Blumberg, L, Horby, PW, Jacob, ST & Sigfrid, L 2022, 'An evaluation of global Chikungunya clinical management guidelines: A systematic review', EClinicalMedicine, vol. 54, 101672. https://doi.org/10.1016/j.eclinm.2022.101672

TY - JOUR

T1 - An evaluation of global Chikungunya clinical management guidelines

T2 - A systematic review

AU - Webb, Eika

AU - Michelen, Melina

AU - Rigby, Ishmeala

AU - Dagens, Andrew

AU - Dahmash, Dania

AU - Cheng, Vincent

AU - Joseph, Reena

AU - Lipworth, Samuel

AU - Harriss, Eli

AU - Cai, Erhui

AU - Nartowski, Robert

AU - Januraga, Pande Putu

AU - Gedela, Keerti

AU - Sukmaningrum, Evi

AU - Cevik, Muge

AU - Groves, Helen

AU - Hart, Peter

AU - Fletcher, Tom

AU - Blumberg, Lucille

AU - Horby, Peter W.

AU - Jacob, Shevin T.

AU - Sigfrid, Louise

N1 - Funding Information: This work was supported by funding from the UK Foreign, Commonwealth and Development Office, Wellcome Trust [ 215091/Z/18/Z ] and the Bill & Melinda Gates Foundation [ OPP1209135 ]. Thanks to the ISARIC Global Support Centre for their invaluable logistical and administrative support on this project. Publisher Copyright: © 2022 The Authors

PY - 2022/12/1

Y1 - 2022/12/1

N2 - BackgroundChikungunya 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.MethodsWe 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.Findings28 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.InterpretationThere 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.

AB - BackgroundChikungunya 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.MethodsWe 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.Findings28 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.InterpretationThere 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.

KW - AGREE II

KW - Chikungunya

KW - Clinical management guidelines

KW - Emerging infections

KW - Supportive care

U2 - 10.1016/j.eclinm.2022.101672

DO - 10.1016/j.eclinm.2022.101672

M3 - Article (Academic Journal)

C2 - 36193172

AN - SCOPUS:85138813674

SN - 2589-5370

VL - 54

JO - EClinicalMedicine

JF - EClinicalMedicine

M1 - 101672

ER -

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

Abstract

Bibliographical note

Keywords

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