Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb 3;15(2):e0228347.
doi: 10.1371/journal.pone.0228347. eCollection 2020.

Interdependence between confirmed and discarded cases of dengue, chikungunya and Zika viruses in Brazil: A multivariate time-series analysis

Juliane F Oliveira  1   2 , Moreno S Rodrigues  1   3 , Lacita M Skalinski  4   5 , Aline E S Santos  5 , Larissa C Costa  1 , Luciana L Cardim  1 , Enny S Paixão  1   6 , Maria da Conceição N Costa  5 , Wanderson K Oliveira  7 , Maurício L Barreto  1   5 , Maria Glória Teixeira  5 , Roberto F S Andrade  1   8
Affiliations

Interdependence between confirmed and discarded cases of dengue, chikungunya and Zika viruses in Brazil: A multivariate time-series analysis

Juliane F Oliveira et al. PLoS One. .

Abstract

The co-circulation of different arboviruses in the same time and space poses a significant threat to public health given their rapid geographic dispersion and serious health, social, and economic impact. Therefore, it is crucial to have high quality of case registration to estimate the real impact of each arboviruses in the population. In this work, a Vector Autoregressive (VAR) model was developed to investigate the interrelationships between discarded and confirmed cases of dengue, chikungunya, and Zika in Brazil. We used data from the Brazilian National Notifiable Diseases Information System (SINAN) from 2010 to 2017. There were three peaks in the series of dengue notification in this period occurring in 2013, 2015 and in 2016. The series of reported cases of both Zika and chikungunya reached their peak in late 2015 and early 2016. The VAR model shows that the Zika series have a significant impact on the dengue series and vice versa, suggesting that several discarded and confirmed cases of dengue could actually have been cases of Zika. The model also suggests that the series of confirmed and discarded chikungunya cases are almost independent of the cases of Zika, however, affecting the series of dengue. In conclusion, co-circulation of arboviruses with similar symptoms could have lead to misdiagnosed diseases in the surveillance system. We argue that the routinely use of mathematical and statistical models in association with traditional symptom-surveillance could help to decrease such errors and to provide early indication of possible future outbreaks. These findings address the challenges regarding notification biases and shed new light on how to handle reported cases based only in clinical-epidemiological criteria when multiples arboviruses co-circulate in the same population.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Illustration of time series plots of confirmed and discarded cases of dengue, chikungunya and Zika by epidemiological week.
Brazil, January 2015 to December 2017.
Fig 2
Fig 2. Proportion of confirmed and discarded cases, per semester, of dengue, chikungunya and Zika in Brazil.
Proportions of dengue (from 2010 up to 2017); chikungunya (from 2014 up to 2017); Zika (from 2015 up to 2017).
See this image and copyright information in PMC

References

    1. Wilder-Smith A., Gubler D. J., Weaver S. C., Monath T. P., Heymann D. L., and Scott T. W. Epidemic arboviral diseases: priorities for research and public health. The Lancet infectious diseases, 17(3), e101–e106. (2017). 10.1016/S1473-3099(16)30518-7 - DOI - PubMed
    1. Paixão ES, Teixeira MG, Rodrigues LC. Zika, chikungunya and dengue: the causes and threats of new and re-emerging arboviral diseases. BMJ global health. 2018. January 1;3(Suppl 1):e000530 10.1136/bmjgh-2017-000530 - DOI - PMC - PubMed
    1. BRASIL., Ministério da Saúde. Secretaria de Vigilância em Saúde. Coordenação Geral de Desenvolvimento da Epidemiologia em Serviços. Guia de Vigilância em Epidemiológica. http://portalarquivos.saude.gov.br/images/pdf/2017/outubro/06/Volume-Uni....
    1. World Health Organization. Global strategy for dengue prevention and control 2012–2020.
    1. Teixeira Maria G., et al. East/Central/South African genotype chikungunya virus, Brazil, 2014. Emerging infectious diseases, 2015, 215: 906 10.3201/eid2105.141727 - DOI - PMC - PubMed

Publication types