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. 2018 Nov;23(11):1231-1241.
doi: 10.1111/tmi.13147. Epub 2018 Sep 19.

Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia

Mabel Carabali  1   2 , Jacqueline K Lim  1 , Diana C Palencia  3 , Anyela Lozano-Parra  3 , Rosa Margarita Gelvez  3 , Kang Sung Lee  1 , Janeth P Florez  3 , Victor Mauricio Herrera  3 , Jay S Kaufman  2 , Elsa M Rojas  3 , Luis Angel Villar  3
Affiliations

Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia

Mabel Carabali et al. Trop Med Int Health. 2018 Nov.

Abstract
in English, French

Objective: To estimate the age-specific incidence of symptomatic dengue and chikungunya in Colombia.

Method: A passive facility-based fever surveillance study was conducted among individuals with undifferentiated fever. Confirmatory diagnostics included serological and molecular tests in paired samples, and surveillance's underreporting was assessed using capture-recapture methods.

Results: Of 839 febrile participants 686 completed the study. There were 33.2% (295/839) dengue infections (51% primary infections), and 35.9% (191/532) of negative dengue cases there were chikungunya cases. On average, dengue cases were younger (median = 18 years) than chikungunya cases (median = 25 years). Thrombocytopaenia and abdominal pain were the main dengue predictors, while presence of rash was the main predictor for chikungunya diagnosis. Underreporting of dengue was 31%; the estimated expansion factors indicate an underreporting rate of dengue cases of threefold for all cases and of almost sixfold for inpatients.

Conclusions: These findings highlight the ongoing coexistence of both arboviruses, a distinct clinical profile of each condition in the study area that could be used by clinicians to generate a differential diagnosis, and the presence of underreporting, mostly among hospitalised cases.

Objectif: Estimer l'incidence selon l’âge de la dengue et du chikungunya symptomatiques en Colombie.

Méthode: Une étude de surveillance passive de la fièvre dans les établissements a été menée auprès d'individus présentant une fièvre indifférenciée. Les diagnostics de confirmation comprenaient des tests sérologiques et moléculaires sur des échantillons appariés et la sous‐déclaration dans la surveillance a été évaluée à l'aide de méthodes de capture‐recapture.

Résultats: Sur 839 participants fébriles, 686 ont terminé l’étude. Il y avait 33,2% (295/839) d'infections à la dengue (51% d'infections primaires) et 35,9% (191/532) des cas négatifs pour la dengue étaient des cas de chikungunya. En moyenne, les cas de dengue étaient plus jeunes (médiane = 18 ans) que les cas de chikungunya (médiane = 25 ans). La thrombocytopénie et les douleurs abdominales étaient les principaux facteurs prédictifs de la dengue, tandis que la présence d’éruptions cutanées était le principal facteur prédictif du diagnostic du chikungunya. La sous‐déclaration de la dengue était de 31%; les facteurs d'expansion estimés indiquent un taux de sous‐déclaration des cas de dengue de 3 fois pour tous les cas et de presque 6 fois pour les patients hospitalisés.

Conclusions: Ces résultats mettent en évidence la coexistence continue des deux arbovirus, un profil clinique distinct de chaque condition dans la zone d’étude qui pourrait être utilisé par les cliniciens pour générer un diagnostic différentiel et la présence de sous‐déclaration, principalement parmi les cas hospitalisés.

Keywords: Colombia; Colombie; caractérisation clinique; chikungunya; clinical characterisation; dengue; disease incidence; fever surveillance; incidence de la maladie; sous-déclaration; surveillance de la fièvre; underreporting.

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Figures

Figure 1
Figure 1
Enrollment and participation flowchart. First day of enrollment August 14, 2015, last day on enrolment July 24th, 2015, and last day of Follow‐up (second visit) August 15 of 2015.
Figure 2
Figure 2
Distribution of DENV and CHIKV cases in Piedecuesta, Colombia (2014–2015). Panel (a) Proportion of laboratory confirmed cases of DENV, CHIKV, or other undifferentiated fever causes by age group. Panel (b) Predicted probabilities and 95%CI of DENV and CHIKV by age. Estimates obtained from the model comparing DENV vs. CHIKV (n = 486).
See this image and copyright information in PMC

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