{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:44:55Z","timestamp":1785415495582,"version":"3.56.0"},"reference-count":46,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010628","name":"Universidad de La Sabana","doi-asserted-by":"publisher","award":["MED 241-2018"],"award-info":[{"award-number":["MED 241-2018"]}],"id":[{"id":"10.13039\/501100010628","id-type":"DOI","asserted-by":"publisher"}]},{"award":["MED 241-2018"],"award-info":[{"award-number":["MED 241-2018"]}],"id":[{"id":"https:\/\/ror.org\/02sqgkj21","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Hospital Militar Central","award":["106-2016"],"award-info":[{"award-number":["106-2016"]}]},{"award":["106-2016"],"award-info":[{"award-number":["106-2016"]}],"id":[{"id":"https:\/\/ror.org\/02bx25k35","id-type":"ROR","asserted-by":"publisher"}]},{"name":"COLCIENCIAS doctoral scholarship","award":["757-2016"],"award-info":[{"award-number":["757-2016"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>This study applied a syndemic framework to chikungunya virus (CHIKV) infection during the 2014\u20132015 Colombian epidemic, integrating biological and social determinants. Methods: A community-based cohort of 279 serologically confirmed adults from six cities was analyzed. Clinical, sociodemographic, and cytokine data were evaluated using multilevel and multivariate statistical approaches. Results: Among 279 patients, 141 (50.5%) met World Health Organization (WHO) criteria for acute CHIKV infection. The cohort was predominantly female and of lower socioeconomic status (SES). The most frequent manifestations were arthralgia (91%), fatigue (58%), fever (50.5%), myalgia (45.9%), and rash (45.2%). Multivariate models identified IL-15, IL-17A, IL-12p40, MCP-1, and MIP-1\u03b1 as significant correlates of fever, rash, and myalgia. Socioeconomic and ethnic factors influenced cytokine expression; Caucasian patients showed higher proinflammatory cytokine levels than Afro-American patients. Lower SES was associated with greater symptom burden. Network analyses revealed distinct immune signatures linking biological responses with clinical and demographic variables. Conclusion: Immune responses, clinical manifestations, and social disadvantages interact significantly in CHIKV infection. These findings support a syndemic model in which socioeconomic vulnerability amplifies disease impact, highlighting the need for integrated biosociological public health strategies, particularly targeting populations with low socioeconomic status.<\/jats:p>","DOI":"10.3390\/v18050549","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T16:07:26Z","timestamp":1779206846000},"page":"549","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intersecting Epidemics: A Multilevel Syndemic Analysis of a Chikungunya Virus Epidemic in Colombia Through Clinical, Biological, and Socioeconomic Factors"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6263-2914","authenticated-orcid":false,"given":"Juan C.","family":"Rueda","sequence":"first","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"},{"name":"Bioscience Programme, Faculty of Medicine and Engineering, Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"Santos","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Angarita","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5188-7375","authenticated-orcid":false,"given":"Ingris","family":"Pel\u00e1ez-Ballesta","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital General de M\u00e9xico Dr. Eduardo Liceaga, Dr. Balmis No. 148, Col. Doctores, Ciudad de M\u00e9xico 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9668-5822","authenticated-orcid":false,"given":"Alfonso","family":"Gastelum","sequence":"additional","affiliation":[{"name":"Instituto de Ciencias Aplicadas y Tecnolog\u00eda (ICAT), Universidad Nacional Aut\u00f3noma de M\u00e9xico, Ciudad Universitaria, Ciudad de M\u00e9xico 04510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0994-8810","authenticated-orcid":false,"given":"Igor","family":"Rueda","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"},{"name":"Bioscience Programme, Faculty of Medicine and Engineering, Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"},{"name":"Rheumatology Department, Hospital Militar Central, Transversal 9 No. 136-21, Bogot\u00e1 110121, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3808-0129","authenticated-orcid":false,"given":"Jaime","family":"Cort\u00e9s-Ramos","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7413-2413","authenticated-orcid":false,"given":"Cristian","family":"Astudillo","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3127-3749","authenticated-orcid":false,"given":"Daniel","family":"Rinc\u00f3n-Sierra","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5930-2672","authenticated-orcid":false,"given":"Karina","family":"Guzm\u00e1n","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas Giovanny","family":"Ballesteros","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital Militar Central, Transversal 9 No. 136-21, Bogot\u00e1 110121, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Manuel","family":"Bello","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital Militar Central, Transversal 9 No. 136-21, Bogot\u00e1 110121, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1074-644X","authenticated-orcid":false,"given":"John","family":"Londono","sequence":"additional","affiliation":[{"name":"Spondyloarthritis Study Group (GESPA), Universidad de La Sabana, Km 7 Autopista Norte, Ch\u00eda 250001, Colombia"},{"name":"Rheumatology Department, Hospital Militar Central, Transversal 9 No. 136-21, Bogot\u00e1 110121, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(17)30402-6","article-title":"Non-communicable disease syndemics: Poverty, depression, and diabetes among low-income populations","volume":"389","author":"Mendenhall","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.socscimed.2018.03.040","article-title":"Syndemics: A theory in search of data or data in search of a theory?","volume":"206","author":"Tsai","year":"2018","journal-title":"Soc. 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