Concomitant Transmission of Dengue, Chikungunya, and Zika Viruses in Brazil: Clinical and Epidemiological Findings from Surveillance for Acute Febrile Illness

SILVA, MONAÍSE M. O.; ANJOS, ROSÂNGELA O.; PAPLOSKI, IGOR A. D.; CAMPOS, GÚBIO S.; REIS, MITERMAYER G.; TAURO, LAURA B.; SANTOS, VIVIANE C.; MOREIRA, PATRÍCIA S. S.; KO, ALBERT I.; KITRON, URIEL; KIKUTI, MARIANA; GONÇALVES, THAIZA S. F.; NASCIMENTO, LEILE C. J.; WEAVER, SCOTT C.; RIBEIRO, GUILHERME S.

CLINICAL INFECTIOUS DISEASES

UNIV CHICAGO PRESS

Año: 2019 vol. 69 p. 1353 - 1359

1058-4838

Background: Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viruses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil. Methods: Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil, between September 2014 and July 2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or nonspecific flavivirus (FLAV) diagnosis. Results: Of 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV, 32 [3.4%]; CHIKV, 159 [16.7%]; ZIKV, 13 [1.4%]; and FLAV, 20 [2.1%]) and 23 (2.4%) coinfections (DENV/CHIKV, 13 [1.4%]; CHIKV/FLAV, 9 [0.9%]; and DENV/ZIKV, 1 [0.1%]). An additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with ZIKV presented with rash and pruritus (69.2% each) more frequently than those with DENV (37.5% and 31.2%, respectively) and CHIKV (22.9% and 14.7%, respectively) (P