Frequency & persistence of post-acute symptoms after chikungunya, dengue, Zika, & malaria in travellers: a prospective multi-centre study, 2026, Hamer

[Dolphin]

https://academic.oup.com/jtm/advance-article-abstract/doi/10.1093/jtm/taag037/8686407

Journal Article Accepted manuscript

Frequency and persistence of post-acute symptoms after chikungunya, dengue, Zika, and malaria in travellers: a prospective multi-centre study​

Davidson H Hamer, MD ,
Jean Marie Loreau, MD, MSc ,
Ralph Huits, MD, PhD ,
Marta Díaz-Menéndez, MD ,
Martin P Grobusch, MD, PhD ,
Sapha Barkati, MD, MSc ,
Cédric P Yansouni, MD ,
Federico Gobbi, MD, PhD ,
Emmanuel Bottieau, MD, PhD ,
Lin H Chen, MD
... Show more
Journal of Travel Medicine, taag037, https://doi.org/10.1093/jtm/taag037
Published:

18 May 2026

Abstract​

Background
Long term follow-up data on the travel-associated burden of vector-borne diseases (VBDs) are scarce. A prospective multi-site observational study was conducted to delineate the longitudinal course, symptom patterns, physical and mental burden, and factors associated with prolonged illness in travellers after four VBDs.

Methods
Patients with confirmed travel-associated acute chikungunya, dengue, Zika, or falciparum malaria were recruited at 15 GeoSentinel sites from 2016 to 2021. Persistent signs and symptoms were evaluated at one, three, six, 12 and 18 months (M) post-diagnosis, using a multi-modular study questionnaire with quality of life (QOL) evaluated by 12-item short-form health survey (SF-12). Demographic, premorbid, and acute disease characteristics were tested in multivariate analyses to determine factors associated with persistence of symptoms at M3. Missing data were imputed by rules and statistical methods.

Results

Among 273 patients enrolled, 35 (13%) had chikungunya, 110 (40%) dengue, 19 (7%) Zika, and 109 (40%) falciparum malaria. Median age was 38 years (interquartile range 30-49), 148/273 (54%) were men. At M3, 24/35 (69%) of chikungunya, 27/110 (25%) of dengue, 8/19 (42%) of Zika, and 12/109 (11%) of malaria patients had persistent symptoms. The proportion of symptomatic chikungunya patients was 18/35 (51%) at M6, mainly due to musculoskeletal symptoms including arthritis and stiffness. In dengue patients, fatigue and musculoskeletal symptoms without arthritis persisted until one year. Zika patients reported persisting headaches, musculoskeletal symptoms including arthritis, and fatigue. One month after malaria, fatigue was the main persisting symptom, which resolved almost completely at M3. At M12, 6/35 (17%) of chikungunya, 5/110 (5%) dengue, 3/19 (16%) Zika, and only 1/109 (1%) of malaria patients were still symptomatic.

Impaired QOL was noted at M3 by 23/35 (66%) of patients with chikungunya, 20/110 (18%) with dengue, 6/19 (32%) with Zika, but only 4/109 (4%) with malaria. Female sex, Zika, chikungunya, and musculoskeletal symptoms during acute infection were associated with persistent M3 symptoms.

Conclusions
Post-arboviral symptoms and impaired QOL persisted beyond six months after chikungunya, dengue and Zika. In contrast, post-malaria fatigue syndrome resolved within three months.
Traveller, arbovirus, arthropod-borne disease, quality of life, fatigue, musculoskeletal, Plasmodium falciparum
Issue Section:
Original Article

 

[Hutan]

The proportion of symptomatic chikungunya patients was 18/35 (51%) at M6, mainly due to musculoskeletal symptoms including arthritis and stiffness.

We've seen reports of this before - it seems more like a fibromyalgic/arthritis sort of response to chikungunya than an ME/CFS pattern. But, it does seem to be a replicated story.

At M12, 6/35 (17%) of chikungunya, 5/110 (5%) dengue, 3/19 (16%) Zika, and only 1/109 (1%) of malaria patients were still symptomatic.

Female sex, Zika, chikungunya, and musculoskeletal symptoms during acute infection were associated with persistent M3 symptoms.

Looks like an interesting paper to have a look at. Probably the samples aren't quite large enough to be really helpful. I wonder if there was much sex bias in the drop out rates from onset through to 12 months that might skew towards that female predominance finding.

Just noting as I add tags to the paper, we don't actually have a malaria tag, which probably says something about the low incidence of ME/CFS-like post-infection symptoms for malaria. This study seems to confirm that. That's interesting given it is an intra-cellular infection, but caused by a protozoan. The others looked at in this paper are viruses.

 

[nataliezzz]

We've seen reports of this before - it seems more like a fibromyalgic/arthritis sort of response to chikungunya than an ME/CFS pattern. But, it does seem to be a replicated story.

This happened to me with chikungunya (not directly confirmed by testing, but I had all the classic symptoms including rash, joint pain, etc. right when chikungunya was first exploding in the Dominican Republic in 2014); the joint pain persisted in my hands and feet for months afterwards and largely resolved with steroids (prescribed for an unrelated issue), but I still have some mild arthritis in my big toes to this day (12 years later).

The chikungunya infection/surrounding circumstances did lead to an enduring decline in my ME/CFS though (I was a supervisor with a volunteer program abroad and I was not able to sufficiently rest/recover).

 

[Hutan]

First author is
Davidson Hamer
Department of Global Health, Boston University School of Public Health, Boston, MA USA
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA,
Center for Emerging Infectious Diseases Research and Policy, Boston University, Boston, MA, USA
National Emerging Infectious Diseases Laboratory, Boston University, Boston, MA,

Senior and corresponding author is
Emilie Javelle, MD, PhD
Aix Marseille Univ, IRD, AP-HM, SSA, RITMES, Marseille, France
Laveran Military Hospital, Department of Infectious Diseases and Tropical Medicine, Marseille,
IHU, Méditerranée Infection, Marseille, France
Unité Parasitologie et Entomologie, Département Risques vectoriels, Institut de Recherche Biomédicale des Armées (IRBA), Centre National de Référence du Paludisme, Marseille, France
Corresponding author: Emilie Javelle, Email address: emilie.javelle@gmail.com

It could be worth inviting them to the forum.