Clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands: A systematic review and meta‐analysis

Abstract

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‐analysis 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 7.67–12.37) and 0.23% (95% CI 0.16–0.31), respectively. Severe forms of dengue occurred in 1.92% (95% CI 0.72–3.63) of reported cases and 23.23% (95% CI 13.58–34.53) of hospitalised patients. Complications associated with Zika virus included Guillain‐Barré syndrome (GBS), estimated to occur in 14.08 (95% CI 11.71–16.66) 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 1.30–4.25) and the risk of GBS was estimated at 1.70 (95% CI 1.06–2.48) 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.

Anesthesia and perioperative care management in patients with Dengue Fever: considerations and challenges

“…Serological assays and polymerase chain reaction (PCR) testing for Dengue virus infection confirm the diagnosis. 1 , 9 , 10 …”

Clinical outcomes of chikungunya: A systematic literature review and meta-analysis

“…Despite the increasing interest in CHIKV and the recent announcement of a vaccine, uncertainties persist regarding the clinical burden of chikungunya. Although multiple studies have explored one or more health outcomes associated with chikungunya [ 3 , 13 , 14 ], to the best of our knowledge, no extensive meta-analysis was performed to quantify pooled estimates on the clinical presentation of chikungunya. To address this gap, we conducted a comprehensive systematic literature review (SLR) on the clinical manifestations of chikungunya, and proceeded with a robust yet flexible meta-analysis.…”