Understanding the factors contributing to dengue virus and chikungunya virus seropositivity and seroconversion among children in Kenya

Abstract

Dengue virus (DENV) and chikungunya virus (CHIKV) are causes of endemic febrile disease among Kenyan children. The exposure risk to these infections is highly multifactorial and linked to environmental factors and human behavior. We investigated relationships between household, socio-economic, demographic, and behavioral risk factors for DENV and CHIKV seropositivity and seroconversion in four settlements in Kenya. We prospectively followed a pediatric cohort of 3,445 children between 2014-2018. We utilized the Kaplan-Meier curves to describe the temporal patterns of seroconversion among tested participants. We employed logistic regression built using generalized linear mixed models, to identify potential exposure risk factors for DENV and CHIKV seroconversion and seropositivity. Overall, 5.2% children were seropositive for DENV, of which 59% seroconverted during the study period. The seroprevalence for CHIKV was 9.2%, of which 54% seroconverted. The fraction of seroconversions per year in the study cohort was <2% for both viruses. Multivariable analysis indicated that older age and the presence of water containers ((OR: 1.15 [95% CI: 1.10, 1.21]), (OR: 1.50 [95% CI: 1.07, 2.10])) increased the odds of DENV seropositivity, whereas higher wealth (OR: 0.83 [95% CI: 0.73, 0.96]) decreased the odds of DENV seropositivity. Multivariable analysis for CHIKV seropositivity showed older age and the presence of trash in the housing compound to be associated with increased odds of CHIKV seropositivity ((OR: 1.11[95% CI: 1.07, 1.15]), (OR: 1.34 [95% CI: 1.04, 1.73])), while higher wealth decreased the odds of CHIKV seropositivity (OR: 0.74[95% CI: 0.66, 0.83]). A higher wealth index (OR: 0.82 [95% CI: 0.69, 0.97]) decreased the odds of DENV seroconversion, whereas a higher age (OR: 1.08 [95% CI: 1.02, 1.15]) and the presence of water containers in the household (OR: 1.91[95% CI: 1.24, 2.95]) were significantly associated with increased odds of DENV seroconversion. Higher wealth was associated with decreased odds for CHIKV seroconversion (OR: 0.75 [95% CI: 0.66, 0.89]), whereas presence of water containers in the house (OR: 1.57 [95% CI: 1.11, 2.21]) was a risk factor for CHIKV seroconversion. Our study links ongoing CHIKV and DENV exposure to decreased wealth and clean water access, underscoring the need to combat inequity and poverty and further enhance ongoing surveillance for arboviruses in Kenya to decrease disease transmission. The study emphasizes the co-circulation of DENV and CHIKV and calls for strengthening the targeted control strategies of mosquito borne diseases in Kenya including vector control, environmental management, public education, community engagement and personal protection.

Fig 1. Map of Kenya showing the location of our study sites created in ArcGIS using the modern antique map as the basemap; https://www.arcgis.com/home/item.html?id=effe3475f05a4d608e66fd6eeb2113c0.

Fig 2. DENV and CHIKV seropositivity and seroconversion status of the study participants from the longitudinal cohort in Kenya by each village, 2014–2018.

Fig 3

Panel A. Overall survival probability for the participants who seroconverted for DENV. Panel B. Survival probability for the participants who seroconverted for DENV by the village. Panel C. Survival probability for the participants who seroconverted for DENV by “urban” (more densely populated) and “rural” (less densely populated) location. Panel D. Survival probability for the participants who seroconverted for DENV by the region.

Fig 4

Panel A. Overall survival probability for the participants who seroconverted for CHIKV. Panel B. Survival probability for the participants who seroconverted for CHIKV by village. Panel C. Survival probability for the participants who seroconverted for CHIKV by “urban” (more densely populated) and “rural” (less densely populated) location. Panel D. Survival probability for the participants who seroconverted for CHIKV by region.