Investigation of antibodies against Chikungunya, Dengue and Zika virus in serum samples from febrile patients and its co-occurrence with malaria in six districts highly endemic for malaria in Mozambique between 2017 – 2018

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ABSTRACT Introduction Arboviruses and malaria are both mosquito-borne diseases, with overlapping symptoms and geographic distribution in tropical settings. However, little information is available on the co-occurrence of arboviruses and malaria in areas highly endemic for malaria in Africa. This study was conducted with the aim to determine the frequency of recent Dengue (DENV), Chikungunya (CHIKV) and Zika (ZIKV) infections and their co-occurrence with malaria in six highly endemic districts for malaria in Mozambique. Methods Blood samples were collected from febrile outpatients between January 2017 and December 2018 and were then tested for Malaria using RDT. Serum samples from these patients were also tested using commercially available ELISA for the presence of IgM antibodies against CHIKV, ZIKV and DENV, as well as NS1 antigen for DENV. Concurrently, a questionnaire was administered to collect socio-demographic characteristics of patients. Results Of the 906 participants enrolled, IgM antibodies against CHIKV, DENV and ZIKV were identified in 134 (14.8%), 64 (7.4%) and 83 (9.2%) individuals, respectively. Malaria was diagnosed in 56 (6.2%) participants, of which 16 (28.6%) were also positive for IgM anti CHIKV, 1 (1.8%) for DENV-NS1, 3 (5.4%) for IgM anti-DENV and 10 (17.8%) for IgM anti-ZIKV. There was a trend towards an increase in the frequency of IgM anti CHIKV positive samples, from 7.0% in 2014 to 14.8% in 2018 and IgM anti-ZIKV positive samples increased from 4.9% in 2015 to 9.2% in 2018. Conclusion This study showed an increased frequency of arbovirus in Mozambique thus far, as well as a frequent occurrence of arbovirus among malaria positive patients. This highlighted the urgency for the establishment of sentinel surveillance sites for arboviruses and the need for an integrated management of febrile illnesses in places where arboviruses and malaria are both prevalent. AUTHOR SUMMARY Arbovirus and malaria share clinical features, which might make the differential diagnosis of acute febrile illnesses significantly difficult, leading to frequent over diagnosis of malaria and under diagnosis of arbovirus in places where both co-occur. In Mozambique and other sub-Saharan countries, epidemiological data on the burden and temporal trend of arbovirus, as well as on co-occurrence with malaria are Chikungunya virus (CHIKV) and Dengue virus (DENV) and its co-occurrence with malaria among 609 febrile patients in six health centres located in five provinces in Mozambique. Recent CHIKV, DENV and ZIKV infection, as measured by presence of IgM antibodies, were found in 14.8%, 7.4% and 9.2% of participants and among 28.6%, 5.4% and 17.8%, of malaria positive patients. These findings suggest that arboviruses are frequent among malaria and non-malaria febrile patients, reinforcing the need for increased awareness of arbovirus in the management of acute febrile illness.

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