DOI: 10.1101/19010256Oct 25, 2019Paper

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

MedRxiv : the Preprint Server for Health Sciences
Rachel J OidtmanA. Perkins


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 Zika incidence that accounted for the accuracy of diagnoses made on the basis of clinical presentation with or without molecular confirmation. Applying this method to weekly incidence data from 43 countries throughout Latin America and the Caribbean, we estimated that 1,062,821 (95% CrI: 1,014,428-1,104,794) Zika cases occurred during this epidemic, which is 56.4% (95% CrI: 49.3-62.6%) more than the 679,743 cases diagnosed as Zika. Our results imply that misdiagnosis was more common in countrie...Continue Reading

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