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A Chikungunya Outbreak in a Dengue-endemic Region in Rural Northern Coastal Ecuador

Sully MárquezInstituto de Microbiología, Universidad San Francisco de Quito, Quito, Ecuador;

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Gwenyth O. LeeDepartment of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;

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Paulina AndradeColegio de Ciencias Biológicas y Ambientales COCIBA, Universidad San Francisco de Quito, Quito, Ecuador;
Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California

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Julio ZunigaDepartment of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;

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Gabriel TruebaInstituto de Microbiología, Universidad San Francisco de Quito, Quito, Ecuador;

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Joseph N. S. EisenbergDepartment of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;

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Josefina ColomaDivision of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California

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ABSTRACT.

Dengue virus (DENV) reemerged in the Americas in the 1980s and 1990s, whereas chikungunya virus (CHIKV) emerged in 2014. Although CHIKV produced large epidemics from 2014 to 2017, dengue fever has been the prominent arboviral disease identified through passive surveillance, bringing to question the degree to which cases are misdiagnosed. To address this concern, we conducted an active household-based surveillance of arboviral-like illnesses in six rural and remote communities in northern coastal Ecuador from May 2019 to February 2020. Although passive surveillance conducted by the Ecuadorian Ministry of Health reported only DENV cases in the region, more than 70% of the arbovirus-like illnesses detected by active surveillance in our study were positive for CHIKV. These findings underline the need for active surveillance of arboviral infections with laboratory confirmation, especially in rural communities where arboviral illnesses are more likely to be underreported.

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Author Notes

Address correspondence to Josefina Coloma, Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA. E-mail: colomaj@berkeley.edu

These authors contributed equally to this work.

Financial support: This study was funded by the National Institute of Allergy and Infectious Diseases, National Institute of Health (R01 AI132372-02), titled “Zika and Dengue Co-circulation Under Environmental Change and Urbanization” and by Universidad San Francisco de Quito (USFQ) Collaboration Grant Hubi 12477, titled “Detección metagenomica de nuevos virus causantes de enfermedades febriles en la población de la Costa Ecuatoriana.”

Authors’ addresses: Sully Márquez and Gabriel Trueba, Instituto de Microbiología, Universidad San Francisco de Quito, Quito, Ecuador, E-mails: smarqueza@usfq.edu.ec and gtrueba@usfq.edu.ec. Gwenyth O. Lee, Julio Zuniga, and Joseph N. S. Eisenberg, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, E-mails: golee@umich.edu, julioz@umich.edu, and jnse@umich.edu. Paulina Andrade, Colegio de Ciencias Biológicas y Ambientales COCIBA, Universidad San Francisco de Quito, Quito, Ecuador, and Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, E-mail: paulinaandradeproano@berkeley.edu. Josefina Coloma, Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, E-mail: colomaj@berkeley.edu.

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