key: cord-0270728-u8zsgj8a authors: Webb, E.; Michelen, M.; Rigby, I.; Dagens, A.; Dahmash, D.; Cheng, V.; Joseph, R.; Lipworth, S.; Harriss, E.; Cai, E.; Nartowski, R.; Putu Januraga, P.; Gedela, K.; Sukmaningrum, E.; Groves, H.; Hart, P.; Fletcher, T.; Blumberg, L.; Horby, P. W.; Jacob, S. T.; Sigfrid, L. title: An evaluation of global Chikungunya clinical management guidelines - a systematic review date: 2022-02-25 journal: nan DOI: 10.1101/2022.02.23.22271379 sha: ab615884560342266a4c49ae77e817bcda607467 doc_id: 270728 cord_uid: u8zsgj8a 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 in up to 40% of infected individuals, impacting on livelihoods. Prevention, early identification, and clinical management are key for improving outcomes. This review aims to evaluate the availability of inclusive, evidence-based clinical management guidelines for CHIKV in a global context. Methods: Six databases were searched systematically from inception to 14 th October 2021 and complemented with a grey literature search until 16 th September 2021. We included CMGs providing supportive care and treatment recommendations. Two reviewers independently screened records, extracted data and assessed quality using the AGREE II tool. Findings are presented in a narrative synthesis. Results: Twenty-eight CMGs were included; most were of low-quality (median score 2 out of 7 (range 1-7)). None were produced specifically in a low-income country and 54% (15/28) were produced more than five years ago. There were variations in the CMGs guidance on the management of different at-risk populations, long-term sequelae, and the prevention of disease transmission in community and hospital settings. In the acute phase, 54% (15/28) recommended hospitalisation for severe cases, however only 39% (11/28) provided clinical management guidance for severe disease. Further, 46% (13/28) advocated for steroids in the chronic phase, yet 18% (5/28) advised against its use. Conclusion: There was a lack of high-quality CMGs that provided supportive care and treatment guidance; this scarcity 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. Chikungunya is a disease caused by the chikungunya virus (CHIKV); an arthropod-borne virus 118 transmitted to humans primarily by Aedes mosquitoes. Since its description in 1952, CHIKV has caused 119 millions of human infections in Africa, the Indian Ocean islands, Asia, Europe, and the Americas. 1 A 120 major outbreak in 2004 affected more than 100 countries with over 10 million cases and this was followed have increased CHIKV's recognition as an emerging global health threat. Parallels can be drawn between CHIKV, and SARS-CoV-2 given that both viruses can cause acute illness 143 followed by long-term sequelae in survivors, which can have a devastating impact on individuals' 144 psychological and physical health and capacity to return to work. Accordingly, public health 145 interventions adopted by many countries to slow the spread of COVID-19 (i.e., reduction in the number 146 of regular household surveys; diversion of resources towards the COVID-19 response; lockdowns) may 147 likely have had a negative impact on vector surveillance and control. 18, 19 As we are transitioning out of 148 the pandemic, we need to prepare to shift resources to identify and mitigate the wider pandemic 149 consequences and strengthen our capacity to respond to future epidemics. The overall quality of the CMGs ranged from one to seven (median: 2 out of 7) ( Table 2) . Most (86%, 249 24/28) were of low quality (score ≤ 3), two of median (scores 4-5) and two of high quality (score 6-7) . The . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 25, 2022. ; https://doi.org/10.1101/2022.02.23.22271379 doi: medRxiv preprint and signs of decompensation from underlying comorbidities (25%, 7/28). 29 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 25, 2022. ; https://doi.org/10.1101/2022.02.23.22271379 doi: medRxiv preprint reasons such as the risk of rebound symptoms (20%, 1/5) 55 and lack of published evidence (20%, 1/5). 34 The rest of the CMGs did not give a justification for avoidance (60%, 3/5 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. has not been found to have an effect in diminishing mortality. 66 A systematic review of five RCTs with . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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