{
  "abstract": "Introduction Chikungunya virus, an arbovirus transmitted by Aedes mosquitoes, causes epidemics in tropical regions with potential risk in higher latitudes. Our aim is to estimate the global, regional and national burden of chikungunya across affected and environmentally suitable at-risk regions.Methods We used a random forest model to predict force of infection and estimate chikungunya burden at high spatial resolution (5×5 km) using covariates from climatic, socioeconomic and ecological domains. We used a focal scenario to estimate the observed burden (lower bound) and an at-risk scenario to estimate the potential burden (upper bound) of chikungunya transmission.Results We predicted global long-term average annual force of infection at 0.012 (95% UI: 0.007 to 0.019) for focal scenario and 0.013 (95% UI: 0.005 to 0.03) for at-risk scenario in 103 countries. We estimated global chikungunya burden annually of 14.4 million (95% UI: 11.0 to 17.8 million) infections and 0.96 million (95% UI: 0.56 to 1.6 million) disability-adjusted life years (DALYs) in the focal scenario, and 34.9 million infections (95% UI: 26.7 to 43.1 million) and 2.3 million DALYs (95% UI: 1.4 to 3.8 million) in the at-risk scenario for 2020. The chronic phase accounts for 54% of chikungunya burden, with relatively higher burden among 40–60-year-old population, with mortality disproportionately affecting children under 10 and adults over 80.Conclusion While chikungunya transmission has high geographical uncertainty, high force of infection is not limited to tropical regions and is distributed across all continents. Our estimates of chikungunya burden are useful for prioritisation of regions and target age groups for chikungunya vaccine introduction.",
  "authors": [
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK",
        "School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan",
        "Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan"
      ],
      "name": "Hyolim Kang"
    },
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Ahyoung Lim"
    },
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK",
        "Imperial College London, London, UK"
      ],
      "name": "Megan Auzenbergs"
    },
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Andrew Clark"
    },
    {
      "affiliations": [
        "Data for Science and Health, Wellcome Trust, London, UK"
      ],
      "name": "Felipe J Colón-González"
    },
    {
      "affiliations": [
        "Department of Genetics, University of Cambridge, Cambridge, UK"
      ],
      "name": "Henrik Salje"
    },
    {
      "affiliations": [
        "Saw Swee Hock School of Public Health, National University of Singapore, Singapore"
      ],
      "name": "Hannah Clapham"
    },
    {
      "affiliations": [
        "Gorgas Memorial Institute for Health Studies, Panama City, Panama"
      ],
      "name": "Jean Paul Carrera"
    },
    {
      "affiliations": [
        "International Vaccine Institute, Seoul, South Korea"
      ],
      "name": "Jong-Hoon Kim"
    },
    {
      "affiliations": [
        "Gavi, the Vaccine Alliance, Geneva, Switzerland"
      ],
      "name": "Maya Malarski"
    },
    {
      "affiliations": [
        "Gorgas Memorial Institute for Health Studies, Panama City, Panama",
        "Sistema Nacional de Investigación AIP (SNI-AIP), Panama City, Panama"
      ],
      "name": "Sandra López-Vergès"
    },
    {
      "affiliations": [
        "Pontificia Universidad Javeriana, Bogota, Colombia"
      ],
      "name": "Zulma M Cucunubá"
    },
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Thiago Cerqueira-Silva"
    },
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK",
        "School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan",
        "Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan"
      ],
      "name": "William John Edmunds"
    },
    {
      "affiliations": [
        "Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan",
        "International Vaccine Institute, Seoul, South Korea",
        "Department of Microbiology, Yonsei University, Seoul, South Korea",
        "Université Jean Monnet of Saint-Etienne, Saint-Étienne, France"
      ],
      "name": "Sushant Sahastrabuddhe"
    },
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Oliver J Brady"
    },
    {
      "affiliations": [
        "London School of Hygiene and Tropical Medicine, London, UK",
        "School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan",
        "Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan",
        "Public Health Foundation of India, New Delhi, India",
        "National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"
      ],
      "name": "Kaja Abbas"
    }
  ],
  "title": "Global, regional and national burden of chikungunya: force of infection mapping and spatial modelling study",
  "uid": "c21f8700-cea5-594b-b2cd-9ebed6342168"
}