Abstract
Our objective was to determine the frequency of zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) virus coinfection and describe the mortality cases that occurred during the epidemiologic surveillance of the ZIKV epidemic in Colombia. We analysed all cases of suspected ZIKV infection that were reported to the National Institute of Health (October 2015-December 2016). DENV, CHIKV and ZIKV RNA were detected in serum or tissue samples using polymerase chain reaction assay. Medical records of the fatal cases were reviewed. We identified that 23 871 samples were processed. The frequency of viral agents was 439 (1.84%) for DENV, 257 (1.07%) for CHIKV and 10118 (42.38%) for ZIKV. Thirty-four (0.14%) cases of coinfection were identified. The CHIKV-ZIKV coinfection was present in 28 cases (82.3%), DENV-CHIKV in three (8.8%) and DENV-ZIKV in three (8.8%). Seven (20.6%) coinfection cases were fatal (two DENV-CHIKV cases and five CHIKV-ZIKV cases). Two cases were foetal deaths and the others were related to neurological syndrome and sepsis. In conclusion, the frequency of arbovirus coinfection during epidemic of ZIKV was low, and CHIKV-ZIKV coinfection was the most common. Mortality was high among coinfection patients. The role of each virus in the mortality cases of coinfection warrants further studies.
Highlights
In recent years, the zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) viruses have produced a large number of epidemics worldwide, which has caused significant morbidity and mortality [1, 2]
According to the procedures established by the Colombian National Institute of Health, all patients with suspected infection of DENV [19], CHIKV [20] and ZIKV [21] have to be reported to the National Surveillance System in Public Health (SIVIGILA)
A total of 35 775 suspected cases of arbovirus infection were reported to the National Institute of Health during the ZIKV epidemic in Colombia, of which 11 904 were excluded for not complying to the procedures established by the Colombian National Institute of Health
Summary
The zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) viruses have produced a large number of epidemics worldwide, which has caused significant morbidity and mortality [1, 2]. DENV infection is frequently a self-limited disease. It is caused by one of the four single-stranded, positive-sense RNA viruses (DENV type 1 through type 4). 50–100 million cases of DENV infection are reported and 250 000 to 550 000 fatal cases are identified in more than 100 countries. In Colombia, the average incidence of DENV infection in endemic years is the 347.2 cases/100 000 inhabitants. Outbreaks of CHIKV were subsequently identified in Asia and recently in one region of the Americas. Millions of cases of CHIKV infection have been reported including severe cases and deaths [5, 6]. Colombia reported the first epidemic of CHIKV in 2014–2015, with an incidence of 1359 cases/100 000 inhabitants. Colombia reported the first autochthone cases in 2015, with an incidence of 377.7 cases/100 000 inhabitants. ZIKV infection has been associated with the development of several neurological diseases including microcephaly and Guillain–Barre syndrome [11,12,13]
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