ArticlePLoS neglected tropical diseases2021
Co-circulation and misdiagnosis led to underestimation of the 2015-2017 Zika epidemic in the Americas.
Article in PLoS neglected tropical diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Forgotten in the tropics: research on Culex mosquitoes is overshadowed in malaria and dengue-endemic regions.Parasites & vectors · 2026Pooled it
- Co-circulating pathogens of humans: a systematic review of mechanistic transmission models.Proceedings. Biological sciences · 2025Pooled it
- Integrated surveillance resolves Darién paradox of Oropouche virus emergence in Panama's migration corridor.Research square · 2026Article
- Technical validation and implementation of a multiplex real-time PCR for differential diagnostic detection of Zika virus, yellow fever virus, dengue virus and chikungunya virus (ZYDC-PCR).BMC infectious diseases · 2026Article
- Rewiring of host cell signaling in chikungunya virus infection: a mechanism for pathogenesis and therapeutic approaches.Archives of microbiology · 2026Review
- Integrated surveillance of arboviruses in febrile patients from the Brazilian Amazon reveals complex co-circulation dynamics and hidden viral diversity.Revista da Sociedade Brasileira de Medicina Tropical · 2026Article
- Design and Implementation of a One Health Framework for Evaluating the Transmission Potential of Pathogens of Public Health Interest for Surveillance Studies.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Predictability of infectious disease outbreak severity: Chikungunya as a case study.Science advances · 2025Article
- Technical validation of a multiplex real-time PCR for combined detection of Rift Valley fever, chikungunya, Zika and dengue viruses.Journal of virological methods · 2025Article
- Estimating transmissibility of Zika virus in Colombia in the presence of surveillance bias.Nature communications · 2025Article
- Mothers and mosquitoes: climate change contributes to the spread of vector-borne pathogens posing a substantial threat to pregnant women.Seminars in immunopathology · 2025Review
- EpiFusion: Joint inference of the effective reproduction number by integrating phylodynamic and epidemiological modelling with particle filtering.PLoS computational biology · 2024Article
- Shifting patterns of dengue three years after Zika virus emergence in Brazil.Nature communications · 2024Article
- ARCA: the interactive database for arbovirus reported cases in the Americas.BMC bioinformatics · 2023Article
- Article
- Anopheles albimanus is a Potential Alphavirus Vector in the Americas.The American journal of tropical medicine and hygiene · 2023Article
- A Poisson-multinomial spatial model for simultaneous outbreaks with application to arboviral diseases.Statistical methods in medical research · 2022Article
- A Chikungunya Virus Multiepitope Recombinant Protein Expressed from the Binary System Insect Cell/Recombinant Baculovirus Is Useful for Laboratorial Diagnosis of Chikungunya.Microorganisms · 2022Article
- Congenital Zika syndrome and living conditions in the largest city of northeastern Brazil.BMC public health · 2022Article
- Arboviral disease record data - Dengue and Chikungunya, Brazil, 2013-2020.Scientific data · 2022Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
During the 2015-2017 Zika epidemic, dengue and chikungunya-two other viral diseases with the same vector as Zika-were also in circulation. Clinical presentation of these diseases can vary from person to person in terms of symptoms and severity, making it difficult to differentially diagnose them. Under these circumstances, it is possible that numerous cases of Zika could have been misdiagnosed as dengue or chikungunya, or vice versa. Given the importance of surveillance data for informing epidemiological analyses, our aim was to quantify the potential extent of misdiagnosis during this epidemic. Using basic principles of probability and empirical estimates of diagnostic sensitivity and specificity, we generated revised estimates of reported cases of Zika that accounted for the accuracy of diagnoses made on the basis of clinical presentation with or without laboratory confirmation. Applying this method to weekly reported case data from 43 countries throughout Latin America and the Caribbean, we estimated that 944,700 (95% CrI: 884,900-996,400) Zika cases occurred when assuming all confirmed cases were diagnosed using molecular methods versus 608,400 (95% CrI: 442,000-821,800) Zika cases that occurred when assuming all confirmed cases were diagnosed using serological methods. Our results imply that misdiagnosis was more common in countries with proportionally higher reported cases of dengue and chikungunya, such as Brazil. Given that Zika, dengue, and chikungunya appear likely to co-circulate in the Americas and elsewhere for years to come, our methodology has the potential to enhance the interpretation of passive surveillance data for these diseases going forward. Likewise, our methodology could also be used to help resolve transmission dynamics of other co-circulating diseases with similarities in symptomatology and potential for misdiagnosis.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.