Pediatric investigation study re-examines chikungunya in neglected pediatric victims

Chikungunya is a viral disease that is primarily transmitted through mosquitoes, especially Aedes aegypti and Aedes albopictus mosquitoes. The characteristic symptom of chikungunya is joint pain, which is accompanied by the sudden onset of high fever, joint stiffness, and skin rash. The causative organism for this disease is the chikungunya virus (CHIKV). It affects both adults and children. However, the true impact of the virus on pediatric health is less explored despite it being associated with serious complications.

To encourage further studies on pediatric chikungunya, a team of researchers, including Dr. Zhengde Xie and Dr. Ran Wang from Beijing Children’s Hospital, Capital Medical University, China, and Dr. Kevin Kain from University Health Network-Toronto General Hospital, Canada, has now provided a commentary on the diagnosis, prevention, and management of chikungunya in children. The study was published in the journal of Pediatric Investigation on 31 August 2025.

“CHIKV infections in children are not well studied owing to diagnostic challenges resulting from shared symptomology with dengue virus and Zika virus infections. This has led to improper or delayed treatments for pediatric CHIKV infection cases,” explains Dr. Zhengde Xie.

Infants aged less than two years are especially susceptible to CHIKV infection-related hospitalization and mortality. This increased susceptibility can be explained by incomplete immune development and insufficient antiviral response, which lead to increased viral replication. The other risk factors for pediatric CHIKV infections are malnutrition, low birth weight, and immunosuppressive conditions. In addition, the causes of perinatal (time around childbirth) CHIKV infections include a disrupted placenta and maternal blood contamination during labor. Infants with perinatal CHIKV infections may present with encephalitis, sepsis-like manifestations, and neurological delays that may lead to death. Moreover, perinatal CHIKV infections can cause injuries to the central nervous system, resulting in lifelong disabilities, including cognitive disabilities. The other common neurological presentations associated with perinatal CHIKV infections are seizures, cerebral edema, and hemorrhage.

Multiple organ systems are involved in pediatric CHIKV infection cases. Infection with CHIKV results in cardiac (arrhythmia, myocarditis, heart failure, myocardial hypertrophy, and ventricular dysfunction), neurological (encephalopathy, seizures, and encephalitis), and skin manifestations (bullous rashes, necrotic lesions, and purpura). The long-term pathological manifestations in pediatric cases include joint pain.

Although CHIKV can have adverse effects on children, pediatric cases have limited exposure to public health responses. For example, epidemiological studies analyzing pediatric CHIKV infection cases as a separate group are scarce. Pediatric CHIKV infections may be underdiagnosed, especially in resource-limited regions.

In clinical trials on CHIKV vaccines, the pediatric population is not systematically analyzed and the number of recruited children is often low. This leads to a limited understanding of the safety and efficacy of vaccines in pediatric populations. However, vaccine efficacy evaluation is challenging in children, especially in those aged less than two years, due to the incomplete development of the immune system. Such data scarcity prevents the allocation of adequate public health resources and the development of specific treatment strategies. Despite these challenges, some progress has been achieved in CHIKV vaccine development for children. For example, the Valneva VLA1553 vaccine has provided promising results in a Phase II clinical trial. Meanwhile, the PXVX0317 vaccine has been approved for usage in children aged ≥12 years.

Several factors contribute to the risk of CHIKV infections in children. Climate change and urbanization have contributed to mosquito expansion, increasing the risk of CHIKV infections in children. Inadequate resources and preventive measures in high-density exposure settings, such as schools, daycare centers, and maternity wards, further increase the risk of CHIKV infections.

To tackle the underrepresentation of pediatric CHIKV in prevention and control efforts, measures must be undertaken at the levels of research, diagnostics, surveillance, and policy. Clinical trials must analyze pediatric cases as a separate subgroup and focus on recruiting more children and establishing age-specific standards for immunogenicity and safety evaluation. Surveillance can be improved by establishing sentinel networks for pediatric CHIKV infections. Perinatal CHIKV infections can be prevented by improving maternal screening during pregnancy, viral testing of mother and baby at delivery, following up neonates, and implementing early intervention. Increased investment in pediatric research, surveillance, and policy is essential to close the current gap in chikungunya prevention and control.

“Automation of diagnosis and surveillance in low-resource settings, usage of advanced neuroimaging techniques, development of pediatric patient-specific treatment regimens, and implementation of mosquito bite prevention strategies are the need of the hour to reduce the burden of pediatric CHIKV infections,” concludes Dr. Zhengde Xie.

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Reference

DOI: https://doi.org/10.1002/ped4.70022

About Dr. Zhengde Xie

Dr. Zhengde Xie is the Director of Infection and Virology Laboratory at the Beijing Pediatric Research Institute and the Director of the Research Unit of Critical Infection in Children at the Chinese Academy of Medical Sciences. His research focuses on the etiology and immune mechanism of common viral infectious diseases in children. He has published more than 200 papers in several esteemed journals, including Cell and the American Journal of Respiratory and Critical Care Medicine.