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Chikungunya and Dengue Fever among Hospitalized Febrile Patients in Northern Tanzania
Julian T. Hertz
Julian T. Hertz
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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O. Michael Munishi
O. Michael Munishi
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Eng Eong Ooi
Eng Eong Ooi
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Shiqin Howe
Shiqin Howe
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Wen Yan Lim
Wen Yan Lim
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Angelia Chow
Angelia Chow
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Anne B. Morrissey
Anne B. Morrissey
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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John A. Bartlett
John A. Bartlett
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Jecinta J. Onyango
Jecinta J. Onyango
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Venance P. Maro
Venance P. Maro
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Grace D. Kinabo
Grace D. Kinabo
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Wilbrod Saganda
Wilbrod Saganda
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Duane J. Gubler
Duane J. Gubler
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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John A. Crump
John A. Crump
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania; Department of Pathology, Duke University Medical Center, Durham, North Carolina
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Consecutive febrile admissions were enrolled at two hospitals in Moshi, Tanzania. Confirmed acute Chikungunya virus (CHIKV), Dengue virus (DENV), and flavivirus infection were defined as a positive polymerase chain reaction (PCR) result. Presumptive acute DENV infection was defined as a positive anti-DENV immunoglobulin M (IgM) enzyme-linked immunsorbent assay (ELISA) result, and prior flavivirus exposure was defined as a positive anti-DENV IgG ELISA result. Among 870 participants, PCR testing was performed on 700 (80.5%). Of these, 55 (7.9%) had confirmed acute CHIKV infection, whereas no participants had confirmed acute DENV or flavivirus infection. Anti-DENV IgM serologic testing was performed for 747 (85.9%) participants, and of these 71 (9.5%) had presumptive acute DENV infection. Anti-DENV IgG serologic testing was performed for 751 (86.3%) participants, and of these 80 (10.7%) had prior flavivirus exposure. CHIKV infection was more common among infants and children than adults and adolescents (odds ratio [OR] 1.9, P = 0.026) and among HIV-infected patients with severe immunosuppression (OR 10.5, P = 0.007). CHIKV infection is an important but unrecognized cause of febrile illness in northern Tanzania. DENV or other closely related flaviviruses are likely also circulating.
Author Notes
Financial support: This work was supported by an International Studies on AIDS Associated Co-infections (ISAAC) award, a United States National Institutes of Health (NIH) funded program (U01 AI062563). Authors received support from the NIH Fogarty International Center through the International Clinical Research Fellows Program at Vanderbilt University (R24 TW007988 to JTH, OMM), AIDS International Training and Research Program (D43 PA-03-018 to OMM, JAB, JJO, VPM, GDK, JAC), the Duke Clinical Trials Unit and Clinical Research Sites (U01 AI069484 to JAB, VPM, JAC), and the Center for AIDS Research (2P30 AI064518 to JAB, JAC).
Disclosure: Presented in part at the 60th American Society of Tropical Medicine and Hygiene Annual Meeting, Philadelphia, PA, December 4–8, 2011, Abstracts 435 and 828.
Authors' addresses: Julian T. Hertz, Anne B. Morrissey, John A. Bartlett, and John A. Crump, Department of Medicine, Duke University Medical Center, Durham, NC, E-mails: julian.hertz@gmail.com, amorr1023@gmail.com, john.bartlett@duke.edu, and john.crump@duke.edu. O. Michael Munishi, Jecinta J. Onyango, Venance P. Maro, Grace D. Kinabo, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mails: godhappyus@yahoo.com, jeccy_onyango@yahoo.com, venmaro@yahoo.co.uk, and gkinabo@hotmail.com. Eng Eong Ooi, Shiqin Howe, Wen Yan Lim, Angelia Chow, and Duane J. Gubler, Emerging Infectious Diseases Signature Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore, E-mails: engeong.ooi@duke-nus.edu.sg, shiqin.howe@duke-nus.edu.sg, wenyan.lim@duke-nus.edu.sg, angelia.chow@duke-nus.edu.sg, and duane.gubler@duke-nus.edu.sg. Wilbrod Saganda, Mawenzi Regional Hospital, Moshi, Tanzania.
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