Assessing the burden of arboviral diseases using a multiplexed serological survey in French Guiana
Authors: Flamand Claude , Fritzell Camille , Bertheot Lena , Vanhomwegen Jessica , Bailly Sarah , Hoze Nathanael , Matheus Severine , Enfissi Antoine , Salje Henrik , Djossou Felix , Fernandes-Pellerin Sandrine , Kazanji Mirdad , Cauchemez Simon , Rousset Dominique 
Published: May 2019

ObjectiveTo assess the level of circulation of DENV, CHIKV, ZIKV, MAYV in French Guiana.IntroductionArboviral infections have become a significant public health problem with the emergence and re-emergence of arboviral diseases worldwide in recent decades [1-6]. Given the increasing number of cases, geographic spread, but also health, social and economic impact of arboviral outbreaks, estimating their true burden represents a crucial issue but remains a difficult task [7-10].In French Guiana, the epidemiology of arboviral diseases has been marked by the occurrence several major dengue fever (DENV) outbreaks over the past few decades, recent emergences of Chikungunya (CHKV) and Zika virus (ZIKV) and the circulation of Mayaro virus (MAYV) [11-14].MethodsTo assess antibody seroprevalence against DENV, CHIKV, ZIKV, MAYV a random 2-stage household cross-sectional survey was conducted among the general population. We enrolled 2,697 individuals aged 1-87 years from June 1 to 12 October 2017. We performed detection of DENV, CHIKV, ZIKV, MAYV IgG antibodies on collected blood samples using a microsphere immunoassay (MIA). Socio-economic data, environmental variables and exposure to mosquitoes, perceptions of the illness and risk of contracting arboviral infections were collected using a standardized questionnaire administrated to all individuals included in the survey. Cross-reactivity between same families of viruses was taking into account using seroneutralisation and modeling approaches.ResultsOverall seroprevalence rates for antibodes against DENV were 69.5% [66.4%-72.5%] and differed significantly according to age and geographical area. Seroprevalence rates of CHIKV, ZIKV and MAYV antibodies were respectively 19.3% [16.5%-22.5%], 23.1% [19.5%-27.2%] and 9.6% [8.1%-11.3%] and did not differed significantly according to gender or age.The distribution of seroprevalence rates for CHIKV, ZIKV antibodies differed from extrapolations obtained from routine surveillance systems and brings valuable information to assess the epidemic risk of future outbreaks. MAYV has been circulating in the southern part of FG, at levels that appear to be substantially higher than those estimated from epidemiological and virological surveillance.ConclusionsSerological surveys provide the most direct measurement for defining the immunity landscape for infectious diseases, but the methodology remains difficult to implement particularly in the context of high cross-reactivity between flaviviruses or alphaviruses [15]. The development of reliable, rapid and affordable diagnosis tools and the use of innovative modeling approaches represent a significant issue concerning the ability of seroprevalence surveys to differentiate infections when multiple viruses co-circulate.References1. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496: 504–507. pmid:235632662. Stanaway JD, Shepard DS, Undurraga EA, Halasa YA, Coffeng LE, Brady OJ, et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis. 2016;16: 712–723. pmid:268746193. Brathwaite Dick O, San Martín JL, Montoya RH, del Diego J, Zambrano B, Dayan GH. The history of dengue outbreaks in the Americas. Am J Trop Med Hyg. 2012;87: 584–593. pmid:230428464. Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika Virus. N Engl J Med. 2016;374: 1552–1563. pmid:270285615. Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009;49: 942–948. pmid:196636046. Duffy MR, Chen T-H, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika Virus Outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009;360: 2536–2543. pmid:195160347. Donoso Mantke O, Lemmer K, Biel SS, Groen J, Schmitz H, Durand JP, et al. Quality control assessment for the serological diagnosis of dengue virus infections. J Clin Virol. 2004;29: 105–112. pmid:147470298. Noden BH, Musuuo M, Aku-Akai L, van der Colf B, Chipare I, Wilkinson R. Risk assessment of flavivirus transmission in Namibia. Acta Trop. 2014;137: 123–129. pmid:248657929. Martins AC, Pereira TM, Oliart-Guzmán H, Delfino BM, Mantovani SAS, et al. Seroprevalence and Seroconversion of Dengue and Implications for Clinical Diagnosis in Amazonian Children, Seroprevalence and Seroconversion of Dengue and Implications for Clinical Diagnosis in Amazonian Children. Interdiscip Perspect Infect Dis Interdiscip Perspect Infect Dis. 2014;2014: e703875. pmid:2554855810. Conlan JV, Vongxay K, Khamlome B, Jarman RG, Gibbons RV, Fenwick SG, et al. Patterns of Flavivirus Seroprevalence in the Human Population of Northern Laos. Am J Trop Med Hyg. 2015;93: 1010–1013. pmid:2630492511. Flamand C, Quenel P, Ardillon V, Carvalho L, Bringay S, Teisseire M. The epidemiologic surveillance of dengue-fever in French Guiana: when achievements trigger higher goals. Stud Health Technol Inform. 2011;169: 629–633. pmid:2189382412. Adde A, Roucou P, Mangeas M, Ardillon V, Desenclos J-C, Rousset D, et al. Predicting Dengue Fever Outbreaks in French Guiana Using Climate Indicators. PLOS Negl Trop Dis. 2016;10: e0004681. pmid:2712831213. Fritzell C, Raude J, Adde A, Dusfour I, Quenel P, Flamand C. Knowledge, Attitude and Practices of Vector-Borne Disease Prevention during the Emergence of a New Arbovirus: Implications for the Control of Chikungunya Virus in French Guiana. PLOS Negl Trop Dis. 2016;10: e0005081. pmid:2780227514. Flamand C, Fritzell C, Matheus S, Dueymes M, Carles G, Favre A, et al. The proportion of asymptomatic infections and spectrum of disease among pregnant women infected by Zika virus: systematic monitoring in French Guiana, 2016. Eurosurveillance. 2017;22.15. Fritzell C, Rousset D, Adde A, Kazanji M, Van Kerkhove MD, Flamand C (2018) Current challenges and implications for dengue, chikungunya and Zika seroprevalence studies worldwide: A scoping review. PLoS Negl Trop Dis 12(7): e0006533.