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Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas

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. Un...

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Autores principales: Oidtman, Rachel J., España, Guido, Perkins, T. Alex
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951986/
https://www.ncbi.nlm.nih.gov/pubmed/33647014
http://dx.doi.org/10.1371/journal.pntd.0009208
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author Oidtman, Rachel J.
España, Guido
Perkins, T. Alex
author_facet Oidtman, Rachel J.
España, Guido
Perkins, T. Alex
author_sort Oidtman, Rachel J.
collection PubMed
description 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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spelling pubmed-79519862021-03-22 Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas Oidtman, Rachel J. España, Guido Perkins, T. Alex PLoS Negl Trop Dis Research Article 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. Public Library of Science 2021-03-01 /pmc/articles/PMC7951986/ /pubmed/33647014 http://dx.doi.org/10.1371/journal.pntd.0009208 Text en © 2021 Oidtman et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Oidtman, Rachel J.
España, Guido
Perkins, T. Alex
Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas
title Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas
title_full Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas
title_fullStr Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas
title_full_unstemmed Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas
title_short Co-circulation and misdiagnosis led to underestimation of the 2015–2017 Zika epidemic in the Americas
title_sort co-circulation and misdiagnosis led to underestimation of the 2015–2017 zika epidemic in the americas
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951986/
https://www.ncbi.nlm.nih.gov/pubmed/33647014
http://dx.doi.org/10.1371/journal.pntd.0009208
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