A Historic Report of Zika in Mozambique: Implications for Assessing Current Risk - Fig 1

<p>Geographical distribution of districts where study was conducted and where neutralizing antibodies against Zika were found during the Kokernot et al. study in 1957 (panel A) and where recent outbreaks of Dengue were reported (panel B). Credit: Américo Feriano José.</p

Serological Evidence of Chikungunya Virus among Acute Febrile Patients in Southern Mozambique

<div><p>Background</p><p>In the last two decades, chikungunya virus (CHIKV) has rapidly expanded to several geographical areas, causing frequent outbreaks in sub-Saharan Africa, South East Asia, South America, and Europe. Therefore, the disease remains heavily neglected in Mozambique, and no recent study has been conducted.</p><p>Methods</p><p>Between January and September 2013, acute febrile patients with no other evident cause of fever and attending a health center in a suburban area of Maputo city, Mozambique, were consecutively invited to participate. Paired acute and convalescent serum samples were requested from each participant. Convalescent samples were initially screened for anti-CHIKV IgG using a commercial indirect immunofluorescence test, and if positive, the corresponding acute sample was screened using the same test.</p><p>Results</p><p>Four hundred patients were enrolled. The median age of study participants was 26 years (IQR: 21–33 years) and 57.5% (224/391) were female. Paired blood samples were obtained from 209 patients, of which 26.4% (55/208) were presented anti-CHIKV IgG antibodies in the convalescent sample. Seroconversion or a four-fold titer rise was confirmed in 9 (4.3%) patients.</p><p>Conclusion</p><p>The results of this study strongly suggest that CHIKV is circulating in southern Mozambique. We recommend that CHIKV should be considered in the differential diagnosis of acute febrile illness in Mozambique and that systematic surveillance for CHIKV should be implemented.</p></div

Geographical representation of study area.

<p>Left panel shows the geographical localization of Mozambique in south east Africa (Mozambique is highlighted in pink) and map of Mozambique. Right panel is the representation of the neighborhood of Mavalane health area covered by the Mavalane health center. Mavalane health area comprises two geographical and well delimited areas, namely, Mavalane “A” (dark blue) and Mavalane “B” (pink) neighborhood.</p

Flowchart of recruitment of study participants and sample testing.

<p>Study participants were split into two groups, those who returned to the convalescent visit (left side of the flowchart) and those who were lost at follow-up (right side of the flow chart). The left side of the flow chart demonstrates that out of 400 recruited patients, 209 returned for the follow-up visit and their convalescent samples were initially screened for anti-CHIKV IgG. Out of 208 tested samples, 55 (26.4%) were positive and 153 (75.6%) were negative. Further, the corresponding 55 acute samples of the positive samples were screened for anti-CHIKV IgG. A total of 44 (21.2%) were positive with stationary titers, 3 (1.4%) were positive with four fold titer rise and 6 (2.9%) seroconverted. The right side of the flow chart demonstrates that 191 individuals did not return for their follow-up; 156 acute samples were available for testing and of these 38 (24.4%) and 118 (75.6%) were positive and negative, respectively. * Percentage against the total number of patients who returned to convalescent visit. ** Samples not tested because of insufficient volume</p

Epidemiological link between cases of human rabies admitted to Maputo Central Hospital and animal bite and human rabies cases identified at the community level.

<p>The left circles represent the dogs linked to cases initially identified at Maputo Central Hospital. The rectangles with numbered human rabies case (H.R. case #) inside at the right represent human rabies cases identified at Maputo Central Hospital. The rectangles at the right with non numbered human rabies case (H.R. case) or animal bite (A.B. case) represents cases of human rabies and animal bites identified during the community investigation.</p

Comparison of cases of animal bites and human rabies notified through the routine surveillance system and detected during the investigation in Maputo city, April-July 2014.

<p>Comparison of cases of animal bites and human rabies notified through the routine surveillance system and detected during the investigation in Maputo city, April-July 2014.</p

Frequency of signs and symptoms in cases of human rabies.

<p>Frequency of signs and symptoms in cases of human rabies.</p

Frequency of cases of animal bite and rabies deaths in Maputo city and Province, April to July 2014.

<p>Frequency of cases of animal bite and rabies deaths in Maputo city and Province, April to July 2014.</p

Serum viral load (DNA of HBV) in 17 HIV patients, with occult hepatitis B infection.

<p>Serum viral load (DNA of HBV) in 17 HIV patients, with occult hepatitis B infection.</p

Demographic, clinical and laboratorial characteristic in HIV patients with HBsAg negative.

<p>Demographic, clinical and laboratorial characteristic in HIV patients with HBsAg negative.</p