Chikungunya virus infection in children: Clinical spectrum, neurological complications, and contemporary management strategies - A systematic review and update

Background: Chikungunya virus (CHIKV) infection is an important and expanding global health concern, with increasing recognition of severe and potentially persistent disease in pediatric populations. Although most children experience a self-limited febrile illness, neonates, young infants, and children with neurological or multisystem involvement may develop severe complications requiring intensive care. Objective: To systematically synthesize and critically appraise the available evidence on the clinical spectrum, neurological complications, perinatal and neonatal manifestations, management, preventive interventions, and outcomes of CHIKV infection in children, with particular emphasis on severe disease and implications for pediatric critical care. Methods: A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed/MEDLINE, Scopus, WHO Global Index Medicus, and PAHO/IRIS were searched from inception through August 11, 2026, supplemented by backward citation searching, examination of reference lists, conference proceedings, and preprint servers. Eligible studies reported original pediatric clinical data concerning laboratory-confirmed CHIKV infection or evaluated CHIKV-specific preventive interventions in pediatric or adolescent populations. Two reviewers independently performed study selection, data extraction, and methodological appraisal using the Newcastle–Ottawa Scale, design-appropriate Joanna Briggs Institute critical appraisal tools, and the Cochrane Risk of Bias 2 tool. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively without meta-analysis. Results: The searches identified 1,253 records: 1,103 through databases and registers and 150 through other methods. After duplicate and automated removal, screening, retrieval, and full-text eligibility assessment, 32 primary studies, represented by 32 reports, were included in the qualitative synthesis.Fever and rash were among the most consistently reported manifestations, whereas arthralgia was less readily recognized in infants and younger children. Severe disease occurred disproportionately among neonates, young infants, and children with neurological or multisystem involvement and included encephalitis, encephalopathy, seizures, shock, respiratory failure, cardiac dysfunction, coagulopathy, and multiorgan dysfunction. Perinatal infection was associated with substantial acute morbidity and persistent neurological, cognitive, motor, behavioral, and neurodevelopmental abnormalities in selected survivors. Management was predominantly supportive, including fluid therapy, respiratory and hemodynamic support, seizure control, and other organ support. Pediatric comparative evidence was insufficient to establish corticosteroids or intravenous immunoglobulin as CHIKV-specific therapies. No antiviral therapy with established clinical efficacy in children was identified. Conclusions: Pediatric CHIKV infection encompasses a broad age-dependent clinical spectrum, from self-limited febrile illness to life-threatening neurological and multisystem disease. Neonates and young infants, particularly those with perinatally acquired infection, represent the population at greatest risk of severe outcomes. Early recognition, appropriate supportive and intensive care, and structured neurological and developmental follow-up after severe disease are essential. Prospective multicenter pediatric studies are needed to improve risk stratification, define long-term outcomes, and evaluate therapeutic and preventive strategies.