Author (year) | Location | Study year | Study design | Study population* | % female | Mean age (years) | N, total study population | Coinfecting agent(s) | N, coinfection cases | Other pathogens tested (negative) | Frequency of WHO ZIKV signs and symptoms (%) | Frequency of other reported signs and symptoms (%) | Level of evidence† | ||||||
Rash | Fever | Arthralgia | Conjunctivitis | Myalgia | Headache | URT symptoms | GI symptoms | ||||||||||||
Mercado-Reyes et al28 (2018) | Colombia | 2015/2016 | Cross-sectional study | Suspected arbovirus infections | 74 | 28 | 23 871 | CHIKV | 28 | DENV | NR | NR | NR | NR | NR | NR | NR | NR | 2c |
Ball et al20 (2018) | Haiti | 2014/2015 | Cohort study | AFI cases | 48 | 7.5 | 252 | CHIKV | 6 | DENV2/ MAYV | 0 | 33% | 67% | NR | 67% | 17% | NR | 17% | 2b |
Azeredo et al19 (2018) | Brazil | 2016 | Cross-sectional study | Suspected arbovirus infections | NR | 34 | 134 | DENV‡ | 18§ | CHIKV | 53% | 73% | 87% | 60% | 93% | 67% | 13% | 40%¶ | 2c |
Mercado-Reyes et al28 (2018) | Colombia | 2015/2016 | Cross-sectional study | Suspected arbovirus infections | 74 | 28 | 23 871 | DENV | 3 | CHIKV | NR | NR | NR | NR | NR | NR | NR | NR | 2c |
Araújo et al38 (2019) | Brazil | 2014/2016 | Cross-sectional study | AFI cases | NR | NR | 9 | DENV | 1 | CHIKV | 100% | NR | 100% | NR | NR | 100% | NR | 100% | 2c |
Alva-Urcia et al30 (2016) | Peru | 2016 | Cross-sectional study | AFI cases | 63 | NR | 139 | DENV | 1 | NR | NR | 100% | NR | NR | NR | NR | NR | NR | 2c |
de Souza Costa et al42 (2019) | Brazil | 2015/2016 | Cross-sectional study | AFI cases | 59 | NR | 453 | MAYV | 1 | DENV, CHIKV, YFV, SLEV, ILHV, ROCV, WNV, EEEV, WEEV, VEEV | NR** | NR** | NR** | NR** | NR** | NR** | NR** | NR** | 2c |
URT symptoms: pharyngitis, sore throat, cough, pharyngeal congestion, adenopathy. GI symptoms: nausea, diarrhoea, vomiting, constipation, stomach ache.
*Online supplementary table 2 gives details of all study populations.
†All articles were rated according to level of evidence using the Oxford Centre for Evidence-based Medicine’s Levels of Evidence, March 2009.11
‡Seventeen cases of DENV-1 and one case of DENV-4.
§Signs and symptoms were only reported for 15 patients.
¶Forty per cent of cases presented with nausea, and 13% of cases with vomiting.
**Case was described to present with typical ZIKV signs for 3 days, but specific details were not reported.
AFI, acute febrile illness; CHIKV, chikungunya virus; DENV, dengue virus; EEV, east equine encephalitis virus; GI, gastrointestinal; ILHV, Ilheus virus; MAYV, Mayaro virus; NR, not reported; ROCV, Rocio virus; SLEV, Saint Louis encephalitis virus; URT, upper respiratory tract; VEEV, Venezuelan equine encephalitis virus; WEEV, west equine encephalitis virus; WNV, West Nile virus; YFV, yellow fever virus; ZIKV, Zika virus.