{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T15:55:54Z","timestamp":1764172554472},"reference-count":42,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,14]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>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.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0296","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T13:26:24Z","timestamp":1668432384000},"page":"1226-1233","source":"Crossref","is-referenced-by-count":5,"title":["A Chikungunya Outbreak in a Dengue-endemic Region in Rural Northern Coastal Ecuador"],"prefix":"10.4269","volume":"107","author":[{"given":"Sully","family":"M\u00e1rquez","sequence":"first","affiliation":[{"name":"Instituto de Microbiolog\u00eda, Universidad San Francisco de Quito, Quito, Ecuador;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gwenyth O.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulina","family":"Andrade","sequence":"additional","affiliation":[{"name":"Colegio de Ciencias Biol\u00f3gicas y Ambientales COCIBA, Universidad San Francisco de Quito, Quito, Ecuador;"},{"name":"Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio","family":"Zuniga","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Trueba","sequence":"additional","affiliation":[{"name":"Instituto de Microbiolog\u00eda, Universidad San Francisco de Quito, Quito, Ecuador;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph N. S.","family":"Eisenberg","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josefina","family":"Coloma","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Parasit Vectors","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1186\/s13071-021-05114-5","article-title":"Circulating dengue virus serotypes and vertical transmission in Aedes larvae during outbreak and inter-outbreak seasons in a high dengue risk area of Sri Lanka","volume":"14","author":"Wijesinghe","year":"2021"},{"key":"b2","series-title":"BMC Infect Dis","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1186\/s12879-019-3857-y","article-title":"Chikungunya virus infection in Indonesia: a systematic review and evolutionary analysis","volume":"19","author":"Harapan","year":"2019"},{"key":"b3","year":"2022"},{"key":"b4","series-title":"Nat Rev Dis Primers","doi-asserted-by":"publisher","first-page":"16055","DOI":"10.1038\/nrdp.2016.55","article-title":"Dengue infection","volume":"2","author":"Guzman","year":"2016"},{"key":"b5","series-title":"Dis Mon","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.disamonth.2018.01.009","article-title":"Selected mosquito-borne illnesses-Chikungunya","volume":"64","author":"McFee","year":"2018"},{"key":"b6","series-title":"Clin Med","doi-asserted-by":"publisher","first-page":"381","DOI":"10.7861\/clinmed.2019-0035","article-title":"Chikungunya arthritis","volume":"19","author":"Pathak","year":"2019"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"1","article-title":"Assessing the reporting of dengue, chikungunya and zika to the national surveillance system in Colombia from 2014\u20132017: a capture-recapture analysis accounting for misclassification of arboviral diagnostics","volume":"15","author":"Carabali","year":"2021"},{"key":"b8","series-title":"One Health","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.onehlt.2017.06.001","article-title":"Emerging arboviruses: why today?","volume":"4","author":"Gould","year":"2017"},{"key":"b9","series-title":"Sci Transl Med","doi-asserted-by":"publisher","first-page":"eaax4144","DOI":"10.1126\/scitranslmed.aax4144","article-title":"Mapping global variation in dengue transmission intensity","volume":"12","author":"Cattarino","year":"2020"},{"key":"b10","series-title":"Rev Soc Bras Med Trop","first-page":"1","article-title":"Classification of chikungunya cases: a proposal","volume":"53","author":"de Brito","year":"2020"},{"key":"b11","doi-asserted-by":"publisher","year":"2019","DOI":"10.1093\/cid\/ciaa1038"},{"key":"b12","series-title":"Clin Infect Dis","first-page":"e2436","article-title":"Fatal outcome of chikungunya virus infection in Brazil","volume":"73","author":"de Lima","year":"2021"},{"key":"b13","series-title":"An Fac Med (Per\u00fa)","first-page":"29","article-title":"Evoluci\u00f3n del virus dengue en el Ecuador: Per\u00edodo 2000 a 2015 [Evolution of dengue virus in Ecuador 2000\u20132015]","volume":"78","author":"Real","year":"2017"},{"key":"b14","doi-asserted-by":"publisher","year":"2021","DOI":"10.1016\/j.actatropica.2017.09.029"},{"key":"b15","doi-asserted-by":"publisher","year":"2019","DOI":"10.1098\/rsif.2011.0499"},{"key":"b16","series-title":"Acta Trop","doi-asserted-by":"publisher","first-page":"74","DOI":"10.3201\/eid1910.130137","article-title":"Zika and Chikungunya virus detection in naturally infected Aedes aegypti in Ecuador","volume":"177","author":"Cevallos","year":"2018"},{"key":"b17","series-title":"J R Soc Interface","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.2105\/AJPH.2012.300795","article-title":"In-roads to the spread of antibiotic resistance: regional patterns of microbial transmission in northern coastal Ecuador","volume":"9","author":"Eisenberg","year":"2012"},{"key":"b18","series-title":"Emerg Infect Dis","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1073\/pnas.0609431104","article-title":"Transition in the cause of fever from malaria to dengue, northwestern Ecuador, 1990\u20132011","volume":"19","author":"Cifuentes","year":"2013"},{"key":"b19","series-title":"Am J Public Health","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1017\/S0376892999000181","article-title":"Social connectedness and disease transmission: social organization, cohesion, village context, and infection risk in rural Ecuador","volume":"102","author":"Zelner","year":"2012"},{"key":"b20","series-title":"Proc Natl Acad Sci USA","doi-asserted-by":"publisher","first-page":"19460","DOI":"10.3201\/eid2207.160326","article-title":"Environmental change and infectious disease: how new roads affect the transmission of diarrheal pathogens in rural Ecuador","volume":"103","author":"Eisenberg","year":"2006"},{"key":"b21","series-title":"Environ Conserv","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1128\/JCM.36.9.2634-2639.1998","article-title":"Traditional resource-use systems and tropical deforestation in a multi-ethnic region in north-west Ecuador","volume":"26","author":"Sierra","year":"1999"},{"key":"b22","series-title":"Emerg Infect Dis","first-page":"1295","article-title":"Single-reaction multiplex reverse transcription PCR for detection of Zika, chikungunya, and dengue viruses","volume":"22","author":"Waggoner","year":"2016"},{"key":"b23","series-title":"J Clin Microbiol","first-page":"2634","article-title":"Typing of dengue viruses in clinical specimens and mosquitoes by single-tube multiplex reverse transcriptase PCR","volume":"36","author":"Harris","year":"1998"},{"key":"b24","series-title":"PLoS Negl Trop Dis","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.diagmicrobio.2009.03.014","article-title":"Oropouche virus cases identified in Ecuador using an optimised qRT-PCR informed by metagenomic sequencing","volume":"14","author":"Wise","year":"2020"},{"key":"b25","series-title":"Diagnostic Virology Protocols","author":"Powers","year":"2010"},{"key":"b26","series-title":"Diagn Microbiol Infect Dis","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1038\/ncomms11257","article-title":"Detection of pathogenic Leptospira spp. through TaqMan polymerase chain reaction targeting the LipL32 gene","volume":"64","author":"Stoddard","year":"2009"},{"key":"b27","series-title":"Euro Surveill","first-page":"1800228","article-title":"Assessment of metagenomic Nanopore and Illumina sequencing for recovering whole genome sequences of chikungunya and dengue viruses directly from clinical samples","volume":"23","author":"Kafetzopoulou","year":"2018"},{"key":"b28","series-title":"Nat Commun","doi-asserted-by":"publisher","first-page":"11257","DOI":"10.1186\/s12936-019-2891-y","article-title":"Fast and sensitive taxonomic classification for metagenomics with Kaiju","volume":"7","author":"Menzel","year":"2016"},{"key":"b29","series-title":"Methods Mol Biol","doi-asserted-by":"publisher","first-page":"263","DOI":"10.3201\/eid2405.171569","article-title":"Detection and identification of the four malaria parasite species infecting humans by PCR amplification","volume":"50","author":"Snounou","year":"1996"},{"key":"b30","series-title":"Malar J","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1371\/journal.pntd.0009679","article-title":"Diverse origin of Plasmodium falciparum in northwest Ecuador","volume":"18","author":"Vera-Arias","year":"2019"},{"key":"b31","author":"Wise","year":"2018"},{"key":"b32","series-title":"PLoS Negl Trop Dis","doi-asserted-by":"publisher","first-page":"e0009679","DOI":"10.1016\/j.jcv.2012.10.019","article-title":"A dengue outbreak in a rural community in Northern Coastal Ecuador: an analysis using unmanned aerial vehicle mapping","volume":"15","author":"Lee","year":"2021"},{"key":"b33","series-title":"Rev Med Hosp Gen (Mex)","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1371\/journal.pntd.0004101","article-title":"Clinical and differential diagnosis: dengue, chikungunya and Zika","volume":"81","author":"Beltr\u00e1n-Silva","year":"2018"},{"key":"b34","series-title":"J Clin Virol","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/INF.0b013e31824bb06d","article-title":"Chikungunya infection in Malaysia: comparison with dengue infection in adults and predictors of persistent arthralgia","volume":"56","author":"Mohd Zim","year":"2013"},{"key":"b35","series-title":"PLoS Negl Trop Dis","doi-asserted-by":"publisher","first-page":"e0004101","DOI":"10.1371\/journal.pntd.0000903","article-title":"A re-examination of the history of etiologic confusion between dengue and Chikungunya","volume":"9","author":"Kuno","year":"2015"},{"key":"b36","series-title":"Pediatr Infect Dis J","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1017\/S0950268818000341","article-title":"Differential diagnosis of Chikungunya, dengue viral infection and other acute febrile illnesses in children","volume":"31","author":"Laoprasopwattana","year":"2012"},{"key":"b37","series-title":"PLoS Negl Trop Dis","doi-asserted-by":"publisher","first-page":"e903","DOI":"10.1136\/bmjopen-2020-040735","article-title":"Dengue incidence in urban and rural Cambodia: results from population-based active fever surveillance, 2006\u20132008","volume":"4","author":"Vong","year":"2010"},{"key":"b38","series-title":"Epidemiol Infect","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.3201\/eid2304.161716","article-title":"Individual and contextual risk factors for chikungunya virus infection: the SEROCHIK cross-sectional population-based study","volume":"146","author":"Fred","year":"2018"},{"key":"b39","series-title":"BMJ Open","doi-asserted-by":"publisher","first-page":"e040735","DOI":"10.1016\/j.ijid.2016.01.015","article-title":"Age-dependent seroprevalence of dengue and chikungunya: inference from a cross-sectional analysis in Esmeraldas province in coastal Ecuador","volume":"10","author":"Chis Ster","year":"2020"},{"key":"b40","series-title":"Emerg Infect Dis","first-page":"677","article-title":"Assessing sensitivity and specificity of surveillance case definitions for Zika virus disease","volume":"23","author":"Chow","year":"2017"},{"key":"b41","series-title":"Int J Infect Dis","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s13071-021-05114-5","article-title":"A comparative study on active and passive epidemiological surveillance for dengue in five countries of Latin America","volume":"44","author":"Sarti","year":"2016"},{"key":"b42","series-title":"A Toolkit for National Dengue Burden Estimation","doi-asserted-by":"publisher","year":"2018","DOI":"10.1186\/s12879-019-3857-y"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/107\/6\/article-p1226.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/107\/6\/article-p1226.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/107\/6\/article-p1226.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T18:49:20Z","timestamp":1675709360000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/107\/6\/article-p1226.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,14]]},"references-count":42,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.22-0296","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,14]]}}}