article · Vector-Borne and Zoonotic Diseases
Surveillance for yellow fever in the Democratic Republic of the Congo frequently encounters acute febrile jaundice cases that lack a confirmed cause. An investigation examined 453 suspected yellow fever patients who tested negative for yellow fever antibodies between 2003 and 2012, screening them for seven other arboviruses using real-time polymerase chain reaction. Testing revealed sixteen cases of dengue virus, spanning serotypes 1 and 2, and two cases of Chikungunya virus. Three individuals had concurrent infections involving both dengue serotypes. Furthermore, three dengue cases coincided with a laboratory-confirmed yellow fever outbreak in the city of Titule during July 2010, pointing to the simultaneous circulation of both viruses. These results show that dengue and Chikungunya contribute to acute febrile jaundice in the region and demonstrate the necessity of integrating testing for these pathogens into existing national disease surveillance and response systems.
Patients displaying symptoms of acute febrile jaundice are routinely suspected of having yellow fever, yet most cases remain undiagnosed. Recognising that dengue and Chikungunya cause similar symptoms and circulate alongside yellow fever allows public health authorities to broaden diagnostic testing. This awareness ensures patients receive appropriate clinical management and helps health systems detect and control concurrent arboviral outbreaks more effectively.
The findings support the inclusion of dengue and Chikungunya assays within national integrated disease surveillance and diagnostic response programmes. The primary users are public health laboratories, hospital diagnostics services, and epidemic monitoring agencies in central Africa. This represents early-stage applied public health research, as prospective epidemiological studies and standardised surveillance protocols are still required before broad operational integration can occur.
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For more than 95% of acute febrile jaundice cases identified through surveillance for yellow fever, a reemerging arthropod-borne viral disease, no etiological exploration is ever done. The aim of this study was to test for other arthropod-borne viruses that can induce the same symptoms in patients enrolled in the yellow fever surveillance in the Democratic Republic of the Congo (DRC). Of 652 patients included in the surveillance of yellow fever in DRC from January 2003 to January 2012, 453 patients that tested negative for yellow fever virus (YFV) immunoglobulin M (IgM) antibodies were selected for the study. Real-time polymerase chain reaction was performed for the detection of dengue, West Nile, Chikungunya, O'nyong-nyong, Rift Valley fever, Zika, and YFV. The average age of patients was 22.1 years. We reported 16 cases (3.5%; confidence interval [CI]: 0.8-5.2) of dengue (serotypes 1 and 2) and 2 cases (0.4%; CI: 0.0-1.0) of Chikungunya. Three patients were co-infected with the two serotypes of dengue virus. Three cases of dengue were found in early July 2010 from the city of Titule (Oriental province) during a laboratory-confirmed outbreak of yellow fever, suggesting simultaneous circulation of dengue and yellow fever viruses. This study showed that dengue and Chikungunya viruses are potential causes of acute febrile jaundice in the DRC and highlights the need to consider dengue and Chikungunya diagnosis in the integrated disease surveillance and response program in the DRC. A prospective study is necessary to establish the epidemiology of these diseases.
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DOI: 10.1089/vbz.2017.2176
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