Advancing Chikungunya Prevention and Vaccination in Mexico: A Position Paper by the Immunization Committee of the Mexican Association of Pediatric Infectious Diseases.

Abstract

Background: Chikungunya virus (CHIKV) is a mosquito-borne alphavirus transmitted predominantly by Aedes aegypti and Aedes albopictus. Infection is characterized by an acute febrile illness accompanied by debilitating polyarthralgia, myalgia, and cutaneous manifestations. Although the acute syndrome is usually self-limited, a substantial proportion of patients experience persistent musculoskeletal symptoms that may progress to chronic inflammatory arthritis, resulting in prolonged disability and impaired quality of life. Objective: To summarize current evidence on the epidemiology, virology, immunopathogenesis, clinical manifestations, laboratory diagnosis, prevention, and vaccine development of CHIKV, with particular emphasis on its implications for public health policy and immunization strategies in Mexico. Methods: This position paper was developed through a structured narrative review of the scientific literature. Publications indexed in PubMed, Scopus, and Embase, together with documents issued by the World Health Organization (WHO), Pan American Health Organization (PAHO), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and European Medicines Agency (EMA), were critically reviewed. Evidence was selected according to its scientific quality and relevance to Mexico and Latin America. Because this work represents an expert consensus rather than a systematic review, no formal risk-of-bias assessment was performed. Results: CHIKV circulates through both urban and sylvatic transmission cycles and continues to expand into regions where competent mosquito vectors are established. Disease progression is driven by complex innate and adaptive immune responses, with exaggerated inflammatory activation contributing to chronic rheumatologic sequelae. Laboratory confirmation relies primarily on molecular assays during the viremic phase and serological testing thereafter. Recent advances in vaccine development-including live-attenuated and virus-like particle (VLP) platforms-have demonstrated favorable immunogenicity and acceptable safety profiles. However, vaccination should be considered one component of an integrated prevention strategy that also includes vector surveillance, environmental control, and rapid outbreak detection. Conclusions: Chikungunya remains an emerging global public health challenge because of its expanding geographic distribution, epidemic potential, and long-term clinical consequences. Incorporating vaccination into comprehensive arboviral control programs, together with strengthened surveillance and integrated vector management, may substantially reduce disease burden. This position paper provides evidence-based recommendations to support future chikungunya prevention and vaccination policies in Mexico.