Evidence of chikungunya virus infections among febrile patients at three secondary health facilities in the Ashanti and the Bono Regions of Ghana

Abstract

Background Chikungunya is now of public health concern globally due to its re-emergence in endemic areas and introduction into new areas of the world. Worldwide, the vectors for transmission of the chikungunya virus are Aedes mosquitoes and these are prevalent in Ghana. Despite its global significance, the true burden of chikungunya virus infection in Ghana is largely unknown and the threat of outbreak remains high owing to international travel. This study sought to determine chikungunya virus infection among febrile patients suspected of having malaria infections at some selected health facilities in the Ashanti, Bono East, and Bono Regions of Ghana. Methodology This cross-sectional study recruited six hundred (600) febrile patients suspected of having malaria who submitted their clinical samples to the laboratories of the selected health facilities for the diagnosis of their infections. Five to ten millilitres (5-10ml) of venous blood were collected from each study participant. Sera were separated and tested for anti-chikungunya (IgM and IgG) antibodies using InBios ELISA kit following the manufacturer’s instruction. Samples positive for chikungunya IgM and IgG were selected and tested for chikungunya virus RNA using Reverse Transcription-quantitative Polymerase Chain Reaction. Malaria Rapid Diagnostic Test kits were used to screen the participants for malaria. Structured questionnaires were administered to obtain demographic and clinical information of the study participants. Result Of the 600 samples tested, the overall seroprevalence of chikungunya was 6%. The seroprevalence of chikungunya IgM and IgG antibodies were 1.8% and 4.2% respectively. None of the chikungunya IgM and IgG positive samples tested positive for chikungunya RNA by RT-qPCR. Of the 600 samples, tested 32.3% (194/600) were positive for malaria parasites. Malaria and chikungunya co-infection was detected in 1.8% (11/600) of the participants. Conclusion Findings from the current study indicate low-level exposure to the chikungunya virus suggesting the virus is circulating and potentially causing morbidity in Ghana.

The Seroprevalence and Hidden Burden of Chikungunya Endemicity and Malaria Mono- and Coinfection in Nigeria

“…The seroprevalence and heterogeneity of infections across the various geographical regions may be explained by differences in vegetation, human population, climate change (increasing the reproductive activities and shortening the extrinsic cycle of chikungunya and malaria in the vector), vector adaptations, variations in temperatures and humidity, changes in habitats and microclimates, and unplanned urbanisation in the various regions that favour transmission dynamics of the mosquito-borne vectors of these diseases [ 15 , 16 ]. These findings are consistent with other seroprevalence studies conducted in other parts of Nigeria, west Africa, and the rest of the world [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 7 , 8 , 10 , 16 , 18 , 25 ]. Misdiagnosis and inadequate or underestimated testing capacities of Nigerian laboratories to diagnose these mosquito-borne coinfections make quantifying the hidden burden and endemicity difficult [ 1 , 2 , 3 , 4 ].…”

“…Aedes aegypti and Aedes albopictus are the primary vectors of the chikungunya virus (CHIKV), but it is also maintained in sylvatic cycles involving primates and forest dwelling Aedes species. Chikungunya is one of the most common vector-borne diseases [ 5 , 6 , 7 , 8 ], and its related symptoms (fever, headaches, rash, muscular pains, joint pains) are similar to those of malaria and other febrile illnesses. The possibility of misdiagnosis in the case of these AFIs is therefore high, particularly in sub-Saharan Africa [ 4 , 5 , 6 , 9 ].…”

“…On the other hand, malaria is a major cause of fever in all age groups, contributing to significant infant mortality in Nigeria [ 7 , 8 , 10 ]. Anopheles gambiae is the principal vector of malaria in Nigeria and An.…”

“…funestus are secondary [ 10 ]. Secondary vectors often have relatively little contact with humans and may be less susceptible to residual insecticide spraying or insecticide-impregnated bednets than primary vectors [ 7 ]. There is an increased risk of chikungunya and malaria occurring concurrently and causing malaria and nonmalaria febrile illnesses [ 11 , 12 , 13 ].…”

“…Malaria and chikungunya coinfections are among the most common mosquito-borne infections in Nigeria [ 18 , 19 , 20 ], in addition to dengue/chikungunya and malaria/dengue/chikungunya [ 1 , 4 , 5 , 6 , 7 , 8 , 16 , 17 , 18 ]. Studies have shown that the prevalence of coinfections of AFIs, such as malaria and chikungunya, can lead to severe disease and fatal outcomes [ 4 , 5 , 6 , 7 , 8 , 16 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] with serious public health implications [ 7 , 10 , 14 , 15 , 29 ]. To our knowledge, there is insufficient evidence on the seroprevalence, hidden burden (morbidity associated with misdiagnosis) and endemicity of chikungunya and malaria coinfections in Nigeria and many other parts of western Africa.…”