title: Dengue and Chikungunya Virus Infections among Young Febrile Adults Evaluated for Acute HIV-1 Infection in Coastal Kenya.
abstract: BACKGROUND
  Fever is common among patients seeking care in sub-Saharan Africa (sSA), but causes other than malaria are rarely diagnosed. We assessed dengue and chikungunya virus infections among young febrile adults evaluated for acute HIV infection (AHI) and malaria in coastal Kenya.
  
  
  METHODS
  We tested plasma samples obtained in a cross-sectional study from febrile adult patients aged 18-35 years evaluated for AHI and malaria at urgent care seeking at seven health facilities in coastal Kenya in 2014-2015. Dengue virus (DENV) and chikungunya virus (CHIKV) were amplified using quantitative real-time reverse-transcription polymerase chain reaction. We conducted logistic regression analyses to determine independent predictors of dengue virus infection.
  
  
  RESULTS
  489 samples that were negative for both AHI and malaria were tested, of which 43 (8.8%, 95% confidence interval [CI]: 6.4-11.7) were positive for DENV infection. No participant was positive for CHIKV infection. DENV infections were associated with clinic visits in the rainy season (adjusted odds ratio (AOR) = 3.0, 95% CI: 1.3-6.5) and evaluation at a private health facility (AOR 5.2, 95% CI: 2.0-13.1) or research health facility (AOR = 25.6, 95% CI: 8.9-73.2) instead of a public health facility.
  
  
  CONCLUSIONS
  A high prevalence of DENV infections was found in febrile young adult patients evaluated for AHI. Our data suggests that DENV, along with AHI and malaria, should be considered in the differential diagnosis of the adult patient seeking care for fever in coastal Kenya.
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
authors.forename: Carolyne N
authors.initials: CN
authors.lastname: Ngoi
authors.affiliation: International AIDS Vaccine Initiative (IAVI) New York, New York, United States of America.|Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States of America.
authors.forename: Matt A
authors.initials: MA
authors.lastname: Price
authors.affiliation: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.
authors.forename: Barry
authors.initials: B
authors.lastname: Fields
authors.affiliation: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.
authors.forename: Juma
authors.initials: J
authors.lastname: Bonventure
authors.affiliation: Kenya Medical Research Institute- KEMRI-CDC, Nairobi, Kenya.
authors.forename: Caroline
authors.initials: C
authors.lastname: Ochieng
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Mwashigadi
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
authors.forename: Amin S
authors.initials: AS
authors.lastname: Hassan
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Thiong'o
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
authors.forename: Murugi
authors.initials: M
authors.lastname: Micheni
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Mugo
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.|Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Graham
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.|Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D065632:Chikungunya Fever / Q000453:epidemiology*; D060085:Coinfection; D003430:Cross-Sectional Studies; D003715:Dengue / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology*; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D015995:Prevalence; D055815:Young Adult