article · American Journal of Tropical Medicine and Hygiene
Flaviviruses such as dengue, Zika, and yellow fever cause significant illness globally, but their epidemiology in Africa remains incompletely understood. Using biospecimens from the nationally representative 2013 to 2014 Demographic and Health Survey in the Democratic Republic of the Congo, this research examined evidence of flavivirus infection and vaccination among children aged six months to five years. Testing via enzyme-linked immunosorbent assays and neutralisation assays confirmed the presence of neutralising antibodies to all three viruses. Estimated seroprevalence was 6.0 percent for yellow fever, 0.4 percent for dengue, and 0.1 percent for Zika. Notably, there was marked discordance between reported yellow fever vaccination status and measured serological immunity, indicating a need for targeted prospective studies to evaluate vaccination programmes and quantify flavivirus-related febrile illness.
Mosquito-borne flaviviruses can cause severe outbreaks, yet their true impact in central Africa is often unrecognised. Proving that dengue and Zika circulate among young children helps clarify the causes of childhood fevers. Furthermore, the mismatch between vaccination records and detectable yellow fever antibodies highlights potential vulnerabilities in disease control efforts, providing vital data to improve future immunisation and monitoring initiatives.
This work represents early-stage epidemiological research rather than a commercial technology. The findings could assist public health authorities, vaccine programme evaluators, and diagnostics researchers seeking to design targeted prospective surveillance studies in the Democratic Republic of the Congo. The abstract does not indicate a direct pathway to commercial product development or near-market application.
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Flaviviruses such as Zika, dengue, and yellow fever cause epidemics throughout the tropics and account for substantial global morbidity and mortality. Although malaria and other vector-borne diseases have long been appreciated in Africa, flavivirus epidemiology is incompletely understood. Despite the existence of an effective vaccine, yellow fever continues to cause outbreaks and deaths, including at least 42 fatalities in the Democratic Republic of the Congo (DRC) in 2016. Here, we leveraged biospecimens collected as part of the nationally representative 2013-2014 Demographic and Health Survey in the DRC to examine serological evidence of flavivirus infection or vaccination in children aged 6 months to 5 years. Even in this young stratum of the Congolese population, we find evidence of infection by dengue and Zika viruses based on results from enzyme-linked immunosorbent assay and neutralization assay. Surprisingly, there was remarkable discordance between reported yellow fever vaccination status and results of serological assays. The estimated seroprevalences of neutralizing antibodies against each virus are yellow fever, 6.0% (95% confidence interval [CI] = 4.6-7.5%); dengue, 0.4% (0.1-0.9%); and Zika, 0.1% (0.0-0.5%). These results merit targeted, prospective studies to assess effectiveness of yellow fever vaccination programs, determine flavivirus seroprevalence across a broader age range, and investigate how these emerging diseases contribute to the burden of acute febrile illness in the DRC.
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DOI: 10.4269/ajtmh.18-0156
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