Nota: Personnal translation from from French by Snowy Owl, not an academic one.
Whereas one often speaks about in the past or the future, it is at the present that many Réunionnais - especially of the women and old people of more than 25 years - still suffer from the chikungunya.
They believed they where cure but the articular pains persist or return.
It is the implacable law of return or ''back-sliding''.
An interesting phenomenon that motivate from now on the scientists who launched clinical tests on Réunion patients that now have these prolonged forms.
If the epidemic recovery monopolizes the attention of the medical authorities at the dawn of the southern summer, it must not occults the factual reality.
Because the viral transmission might be at its lowest level now, but the people contaminated by the chikungunya last year are still numerous to suffer.
According to S.O.S doctors North, there is only 30% of the patients who consult for a chik come for the first time, against 70% which present after-effects or "back-sliding".
The number of people that have to stop working recorded by the CGSS confirm the trend.
Over the week going from the 11 to September 17 for example, 37 stops of work for a "back-sliding" of the chikungunya were received by the social security out of 84.
Dr. Bernard-Alex Gaüzère, chief of the intensive care unit to the CHD of Bellepierre and specialist in tropical medicine, observe in an empirical way that the proportion of patients having recurring episodes of clinical demonstrations would be of "less than one person out of two".
The interregional cell of epidemiology of la Réunion has launched a study to know this proportion precisely.
There is no result yet since there remains 25 % of the patients to be included, but Daoudo Sissoko, doctor epidemiologist considers this data "exaggerated in comparison with the intermediate data obtained with the La Réunion and Mayotte".
Women and Adults
If it thus seems difficult to estimate the percentage of the population concerned with this phenomenon, we at least know one knows better, the profile of these patients.
As Éric Bouquillard explains it, rheumatologist with the Southern Hospital complex of La Réunion (GHSR):
"One realized that there was a great proportion of women who made chronic forms.
" We know that they represent already more than 60% of the total of the cases of chikungunya.
Dr. Gaüzère also notices that, observing a better immunizing response to the virus by people less than 20-25 years are very slightly affected by the recurrences.
"The age is a factor determining for the problems of articulation."
Fever, headaches, cutaneous eruption... the clinical signs of the chikungunya can be multiple with the acute phase, even if it is known that it is a disease with mainly articular expression in nearly 95% of the cases.
It is in fact these principal symptoms which are observed in the cases of repetition or persistence.
"The attack is mainly articular, never osseous, but the tendons can be sometimes reached, indicates the rheumatologist of the GHSR.
With the survey, one observes in the majority of the cases a great stiffness in the morning, a derusting which can take several hours."
We know that the articular pains is on the wrists preferentially.
Many chikungunyés complain to develop new hyperalgic episodes, however like specifies the rheumatologist, it should not be forgotten "that there is not only the chik which gives pains and fever".
Leptospirosis, drop, lupus, rubella, dengue... a heap of other diseases develop articular pains.
Several people thinking of presenting the symptoms of the chikungunya are actually reached of another affection.
But those represent a minority.
The dangers of cortisone
For the experts, the concerns is now to try to include/understand why certain patients develop prolonged forms and others not.
The mystery remains insoluble to date even if there are assumptions.
The doctors have some problemsl to evaluate if the persistent arthralgies are related to a chronic bearing of the virus or an immunological reaction (production of autoantibody).
"In order to know, it would be necessary to seek the virus in blood at the time of the push, explains Dr. Bouquillard.
If the virus is found, that wants to say that the person reinfected herself following a new bite of the mosquito (what few doctors believes since the chikungunyés alive in metropolis present the same relapses of articular pains, without it being possible to accuse the mosquito).
That is to say it remained in the body before passing by again in blood.
And if one does not find the virus in blood, that can be related to an inflammatory push or on the stop of a drug." Because it is frequently observed a relapse after the cortisone stop, drug of last recourse in the chikungunya.
If the doctors follow the protocol indeed, they recommend paracetamol initially and avoid the aspirin categorically.
If there is no effect, they pass to anti-inflammatory drugs non stéroïdians, and if that still does not function, at the end of three weeks, cortisone is possibly recommended.
"Cortisone is prescribed in short cure but it has many side effects.
One is then obliged to decrease the amounts.
It is often at this time that people ''back-sliding'', notes Dr. Gaüzère.
88% of the patients do not suffer any more at the end of 3 years
So what can we do to make when a patient that is not reactive with the symptomatic treatment most adequate in the absence of a treatment etiologic exist?
Knowing that the study "Nivachik" tests chloroquine only on patients in acute phase of the disease, excluding the victims of prolonged forms.
Research is thus currently trying to bring an answer to these patients through named clinical tests "Arthrochik".
From December 1 this hospital clinical research program (PHRC) will be launched at la Réunion on 140 patients of the chikungunya affected since since 6 weeks with articular pains.
A drug - held to date secret in order to not distort the study, will be managed in order to determine the effectiveness and the harmlessness of the molecule.
If the results prove to be convincing, the regulation of this drug could be generalized from that moment - let us hope - a few months and the victims of back-sliding will know finally a respite.
But while waiting for this expiry or a possible vaccine, the subjects with the double sorrow wonder about time that they remain in this condition.
The only study we have to date to answer this question was carried out in 1983 in South Africa (1).
The study shows that 87,9% of the people do not suffer any more of their articulations three years after the disease, 3,7% have an occasional articular stiffness, 2,8% of the patients have a stiffness without pain and 5,6% have persistent articular pains and, frequently, articular discharge.
But it is necessary to keep reserves on this old study only carried out on 107 cases, as Dr. Bouquillard underlines it: "One has the impression that these data are a little exaggerated compared to what one observes."
We must not forget that one does not know yet the long-term consequences of this infection since it was studied very little in the past.
La Réunion is currently sacrificed to become an experimental laboratory which will be used without any doubt for the next epidemics of chikungunya which will prevail in the world.
Can one have the chik twice?
Why articular pains develop after a remission of the chikungunya?
Can one have the chikungunya twice?
The assumption of a new infection is perhaps considered, but to date, the doctors, even if the debate is not sliced, lean more for the theory according to which the virus of the chikungunya would be immunizing, i.e. the disease could contract only once.
Dr. Christine Jaffar-Bandjee, doctor microbiologist with the CHD of Bellepierre and principal Co-investigator of the PHRC on the physiopathology of the chik in the adult, explain nevertheless that there is necessary to remain careful in this field: "We do not have enough retreat on the subject to be categorical.
It is thought that the disease is immunizing because it was not proven yet that patients had contracted it second once.
There is no reason that it is with different other virus.
The observation of the cases on a second epidemic will make it possible to answer this question.
Because one will be able to compare serologies of patients saying to relapse with those one has today."
cf: in French at