Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics

Submitted by Fátima Lopes ([email protected]) on 2017-07-04T14:24:02Z No. of bitstreams: 1 AccuracyZikaVirusDisease.pdf: 1798607 bytes, checksum: 2bfc7352e132877c5b78d9a76c2e1a85 (MD5)Approved for entry into archive by Fátima Lopes ([email protected]) on 2017-07-04T14:40:39Z (GMT) No. of bitstreams: 1 AccuracyZikaVirusDisease.pdf: 1798607 bytes, checksum: 2bfc7352e132877c5b78d9a76c2e1a85 (MD5)Made available in DSpace on 2017-07-04T14:40:39Z (GMT). No. of bitstreams: 1 AccuracyZikaVirusDisease.pdf: 1798607 bytes, checksum: 2bfc7352e132877c5b78d9a76c2e1a85 (MD5) Previous issue date: 2017Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Referência de Flavivírus. Rio de Janeiro, RJ, Brasil.David Geffen UCLA School of Medicine. Los Angeles, United States of America.Universidade Federal de Pernambuco. Departamento de Clinica Medica. Recife, Pernambuco, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Referência de Flavivírus. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Background: Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barre syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic. Methodology: We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features. Results and discussion: Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86_6% and 78_3%, respectively. This Zika case definition also had the highest values for auROC (0_903) and R2 (0_417), and the lowest Brier score 0_096. Conclusions: In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition

Sociodemographic and environmental factors associated with dengue, Zika, and chikungunya among adolescents from two Brazilian capitals.

Among the emerging and reemerging arboviral diseases, Zika, dengue and chikungunya deserve special attention due to their wide geographical distribution and clinical severity. The three arboviruses are transmitted by the same vector and can present similar clinical syndromes, bringing challenges to their identification and register. Demographic characteristics and individual and contextual social factors have been associated with the three arboviral diseases. However, little is known about such associations among adolescents, whose relationships with the social environment are different from those of adult populations, implying potentially different places, types, and degrees of exposure to the vector, particularly in the school context. This study aims to identify sociodemographic and environmental risk factors for the occurrence of Zika, dengue, and chikungunya in a cohort of adolescents from the Study of Cardiovascular Risks in Adolescents-ERICA-in the cities of Rio de Janeiro/RJ and Fortaleza/CE, from January 2015 to March 2019. Cases were defined as adolescents with laboratory or clinical-epidemiological diagnosis of Zika, dengue, or chikungunya, notified and registered in the Information System for Notifiable Diseases (SINAN). The cases were identified by linkage between the databases of the ERICA cohort and of SINAN. Multilevel Cox regression was employed to estimate hazard ratios (HR) as measures of association and respective 95% confidence intervals (95%CI). In comparison with adolescents living in lower socioeconomic conditions, the risk of becoming ill due to any of the three studied arboviral diseases was lower among those living in better socioeconomic conditions (HR = 0.43; 95%CI: 0.19-0.99; p = 0.047) and in the adolescents who attended school in the afternoon period (HR = 0.17; 95%CI: 0.06-0.47; p<0.001). When compared to areas whose Building Infestation Index (BII) for Aedes aegypti was considered satisfactory, a BII in the school region classified as "alert" and "risk" was associated with a higher risk of arboviral diseases (HR = 1.62, 95%CI: 0.98-2.70; p = 0.062; HR = 3.72, 95%CI: 1.27-10.9; p = 0.017, respectively). These findings indicate that living in less favored socioeconomic conditions, attending school in the morning, and having a high BII for Ae. aegypti in school's region can contribute to an increased risk of infection by Zika, dengue, or chikungunya in adolescents. The identification of residential or school areas based on those variables can contribute to the implementation of control measures in population groups and priority locations

Derived clinical prediction models of ZIKV infection.

<p>Derived clinical prediction models of ZIKV infection.</p

Accuracy of Zika case definitions in simultaneous epidemics of dengue and chikungunya.

<p>Accuracy of Zika case definitions in simultaneous epidemics of dengue and chikungunya.</p

Clinical signs and symptoms associated with ZIKV infection.

<p>Clinical signs and symptoms associated with ZIKV infection.</p

Socio-demographic characteristics of the population studied according to the presence of Zika, dengue or chikungunya diagnosis.

<p>Socio-demographic characteristics of the population studied according to the presence of Zika, dengue or chikungunya diagnosis.</p