{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:42:42Z","timestamp":1790376162933,"version":"4.1.0"},"reference-count":86,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,2,10]],"date-time":"2024-02-10T00:00:00Z","timestamp":1707523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Reviews in Medical Virology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Dengue, Zika and chikungunya outbreaks pose a significant public health risk to Pacific Island communities. Differential diagnosis is challenging due to overlapping clinical features and limited availability of laboratory diagnostic facilities. There is also insufficient information regarding the complications of these arboviruses, particularly for Zika and chikungunya. We conducted a systematic review and meta\u2010analysis to calculate pooled prevalence estimates with 95% confidence intervals (CI) for the clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands. Based on pooled prevalence estimates, clinical features that may help to differentiate between the arboviruses include headache, haemorrhage and hepatomegaly in dengue; rash, conjunctivitis and peripheral oedema in Zika; and the combination of fever and arthralgia in chikungunya infections. We estimated that the hospitalisation and mortality rates in dengue were 9.90% (95% CI 7.67\u201312.37) and 0.23% (95% CI 0.16\u20130.31), respectively. Severe forms of dengue occurred in 1.92% (95% CI 0.72\u20133.63) of reported cases and 23.23% (95% CI 13.58\u201334.53) of hospitalised patients. Complications associated with Zika virus included Guillain\u2010Barr\u00e9 syndrome (GBS), estimated to occur in 14.08 (95% CI 11.71\u201316.66) per 10,000 reported cases, and congenital brain malformations such as microcephaly, particularly with first trimester maternal infection. For chikungunya, the hospitalisation rate was 2.57% (95% CI 1.30\u20134.25) and the risk of GBS was estimated at 1.70 (95% CI 1.06\u20132.48) per 10,000 reported cases. Whilst ongoing research is required, this systematic review enhances existing knowledge on the clinical manifestations of dengue, Zika and chikungunya infections and will assist Pacific Island clinicians during future arbovirus outbreaks.<\/jats:p>","DOI":"10.1002\/rmv.2521","type":"journal-article","created":{"date-parts":[[2024,2,10]],"date-time":"2024-02-10T09:23:25Z","timestamp":1707557005000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2313-2420","authenticated-orcid":false,"given":"Sahil","family":"Kharwadkar","sequence":"first","affiliation":[{"name":"School of Public Health The University of Adelaide  Adelaide South Australia Australia"},{"name":"Adelaide Medical School The University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nipun","family":"Herath","sequence":"additional","affiliation":[{"name":"Adelaide Medical School The University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,10]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1473\u20103099(16)30518\u20107"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.onehlt.2017.06.001"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature12060"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1473\u20103099(19)30161\u20106"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.14423\/smj.0000000000001152"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/v11010011"},{"issue":"2","key":"e_1_2_15_8_1","first-page":"45","article-title":"Arboviruses and their vectors in the Pacific\u2010\u2010status report","volume":"12","author":"Guillaumot L","year":"2005","journal-title":"Pac Health Dialog"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2006.131413"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11010074"},{"key":"e_1_2_15_11_1","volume-title":"Guidelines for the Clinical Diagnosis and Treatment of Dengue, Chikungunya, and Zika","author":"Pan American Health Organization","year":"2022"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303112"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11050819"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.9.30904"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(97)12483\u20107"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000514206"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102017\u2010000530"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hgmx.2016.09.011"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2018.1559708"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.2093"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_15_22_1","unstructured":"WellsGA SheaB O\u2019ConnellD et\u00a0al.The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses;2000."},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/2049\u20103258\u201072\u201039"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/21925682221110527"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech\u20102013\u2010203104"},{"key":"e_1_2_15_26_1","volume-title":"Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control","author":"World Health Organization","year":"1997"},{"key":"e_1_2_15_27_1","volume-title":"Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control","author":"World Health Organization","year":"2009"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f4040"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_15_31_1","volume-title":"Cochrane handbook for systematic reviews of interventions version","author":"Higgins J","year":"2011"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.2000.10473905"},{"key":"e_1_2_15_33_1","first-page":"417","volume-title":"Handbook of research synthesis and meta\u2010analysis","author":"Iyengar S","year":"2009"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2008.130696"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2410.172079"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005262"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(16)00625\u20105"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560\u20107917.ES.2016.21.13.30181"},{"issue":"4","key":"e_1_2_15_39_1","first-page":"215","article-title":"Dengue fever in Fiji","volume":"36","author":"Koroivueta J","year":"1994","journal-title":"Trop Med"},{"key":"e_1_2_15_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0399\u2010077X(05)80880\u20107"},{"issue":"3","key":"e_1_2_15_41_1","first-page":"381","article-title":"The dengue epidemic in Tahiti 1971. Evolution of the hemorrhagic tendency and comparison with the preceding epidemics","volume":"66","author":"Saugrain J","year":"1973","journal-title":"Bulletin de la Societe de Pathologie Exotique et de ses Filiales"},{"issue":"1","key":"e_1_2_15_42_1","first-page":"93","article-title":"Dengue outbreak by virus type 4 in French Polynesia. I. General epidemiology. Clinical specific aspects","volume":"41","author":"Parc F","year":"1981","journal-title":"Med Trop"},{"key":"e_1_2_15_43_1","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2007.0241"},{"key":"e_1_2_15_44_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1105.041063"},{"key":"e_1_2_15_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(16)00651\u20106"},{"key":"e_1_2_15_46_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.16.171892"},{"issue":"5","key":"e_1_2_15_47_1","first-page":"513","article-title":"Materno\u2010fetal dengue. Apropos of 5 cases observed during the epidemic in Tahiti (1989)","volume":"84","author":"Poli L","year":"1991","journal-title":"Bull Soc Pathol Exot"},{"key":"e_1_2_15_48_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1977.26.775"},{"key":"e_1_2_15_49_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6747a5"},{"key":"e_1_2_15_50_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss7204a1"},{"issue":"28","key":"e_1_2_15_51_1","first-page":"570","article-title":"Dengue outbreak \u2010 Federated States OF Micronesia, 2012\u20102013","volume":"62","author":"Taulung LA","year":"2013","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_2_15_52_1","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2021.1899057"},{"key":"e_1_2_15_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0929\u2010693X(01)00651\u20100"},{"key":"e_1_2_15_54_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1508.081500"},{"key":"e_1_2_15_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(16)00562\u20106"},{"key":"e_1_2_15_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13365\u2010018\u20100621\u20109"},{"key":"e_1_2_15_57_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003257"},{"key":"e_1_2_15_58_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916\u2010018\u20101052\u20104"},{"key":"e_1_2_15_59_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560\u20107917.es2014.19.41.20929"},{"key":"e_1_2_15_60_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0805715"},{"key":"e_1_2_15_61_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1909.130130"},{"key":"e_1_2_15_62_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560\u20107917.ES.2015.20.48.30079"},{"key":"e_1_2_15_63_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005410"},{"key":"e_1_2_15_64_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2404.161536"},{"key":"e_1_2_15_65_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2017.00317"},{"key":"e_1_2_15_66_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879\u2010021\u201006788\u2010z"},{"key":"e_1_2_15_67_1","doi-asserted-by":"publisher","DOI":"10.2149\/tmh.2011\u2010S10"},{"key":"e_1_2_15_68_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12098\u2010010\u20100202\u20102"},{"key":"e_1_2_15_69_1","doi-asserted-by":"publisher","DOI":"10.4103\/aian.AIAN_157_21"},{"key":"e_1_2_15_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2021.07.062"},{"key":"e_1_2_15_71_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007389"},{"key":"e_1_2_15_72_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0010966"},{"key":"e_1_2_15_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1995\u20107645(13)60075\u20109"},{"key":"e_1_2_15_74_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006618"},{"key":"e_1_2_15_75_1","doi-asserted-by":"publisher","DOI":"10.1179\/2046904712z.00000000046"},{"key":"e_1_2_15_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2014.07.020"},{"key":"e_1_2_15_77_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009516"},{"key":"e_1_2_15_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apjtm.2016.03.036"},{"key":"e_1_2_15_79_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1114525"},{"key":"e_1_2_15_80_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.19918.1"},{"key":"e_1_2_15_81_1","unstructured":"World Health Organization.Guidelines on Clinical Management of Chikungunya Fever;2008."},{"key":"e_1_2_15_82_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007084"},{"key":"e_1_2_15_83_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1503.071482"},{"key":"e_1_2_15_84_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.15\u20100753"},{"key":"e_1_2_15_85_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13365\u2010017\u20100516\u20101"},{"key":"e_1_2_15_86_1","doi-asserted-by":"publisher","DOI":"10.3390\/tropicalmed6030108"},{"key":"e_1_2_15_87_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000002234"}],"container-title":["Reviews in Medical Virology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/rmv.2521","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T22:54:16Z","timestamp":1711493656000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/rmv.2521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,10]]},"references-count":86,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/rmv.2521"],"URL":"https:\/\/doi.org\/10.1002\/rmv.2521","archive":["Portico"],"relation":{},"ISSN":["1052-9276","1099-1654"],"issn-type":[{"value":"1052-9276","type":"print"},{"value":"1099-1654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,10]]},"assertion":[{"value":"2023-12-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2521"}}