Endemic and epidemic human alphavirus infections in Eastern Panama; An Analysis of Population-based Cross-Sectional Surveys

Abstract Background Madariaga virus (MADV), has recently been associated with severe human disease in Panama, where the closely related Venezuelan equine encephalitis virus (VEEV) also circulates. In June, 2017, a fatal MADV infection was confirmed in a community of Darien province. Methods We conducted a cross-sectional outbreak investigation with human and mosquito collections in July 2017, where sera were tested for alphavirus antibodies and viral RNA. Additionally, by applying a catalytic, force-of-infection statistical model to two serosurveys from Darien province in 2012 and 2017, we investigated whether endemic or epidemic alphavirus transmission occurred historically. Results In 2017, MADV and VEEV IgM seroprevalence was 1.6% and 4.4%, respectively; IgG antibody prevalences were MADV: 13.2%; VEEV: 16.8%; Una virus (UNAV): 16.0%; and Mayaro virus (MAYV): 1.1%. Active viral circulation was not detected. Evidence of MADV and UNAV infection was found near households — raising questions about its vectors and enzootic transmission cycles. Insomnia was associated with MADV and VEEV infection, depression symptoms were associated with MADV, and dizziness with VEEV and UNAV. Force-of-infection analyses suggest endemic alphavirus transmission historically, with recent increased human exposure to MADV and VEEV in some regions. Conclusions The lack of additional neurological cases suggest that severe MADV and VEEV infections occur only rarely. Our results indicate that, over the past five decades, alphavirus infections have occurred at low levels in eastern Panama, but that MADV and VEEV infections have recently increased — potentially during the past decade. Endemic infections and outbreaks of MADV and VEEV appear to differ spatially. Author summary Prior to 2010, it was believed that the Madariaga virus (MADV) was primarily associated with equine disease. However, an outbreak reported in Panama, in an endemic area where Venezuelan equine encephalitis virus (VEEV) also circulates, suggested a change in its epidemiological profile. We aimed to reconstruct the epidemiological dynamics of MADV and VEEV, as well as additional alphaviruses known to circulate in the region in order to understand MADV emergence. For this, cross-sectional serosurveys were used to demonstrate that the Alphaviruses MADV, VEEV and Una virus have repeatedly infected humans in eastern Panama over the past five decades. Whilst their historical transmission has been low, we confirm that the transmission has recently increased for both MADV and VEEV.