Endemic and epidemic human alphavirus infections in eastern Panama: An analysis of population-based cross-sectional surveys

J. P. Carrera, Zulma M. Cucunuba, Karen Neira, Ben Lambert, Yaneth Pitti, Jesus Liscano, Jorge L. Garzon, Davis Beltran, Luisa Collado-Mariscal, Lisseth Saenz, Nestor Sosa, Luis D. Rodriguez-Guzman, Publio Gonzalez, Andres G. Lezcano, Renee Pereyra-Elias, Anayansi Valderrama, Scott C. Weaver, Amy Y. Vittor, Blas Armien, Juan Miguel PascaleChristl A. Donnelly

Research output: Contribution to journalReview articlepeer-review


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. 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. In addition, by applying a catalytic, force-of-infection (FOI) statistical model to two serosurveys from Darien Province in 2012 and 2017, we investigated whether endemic or epidemic alphavirus transmission occurred historically. In 2017, MADV and VEEV IgM seroprevalences were 1.6% and 4.4%, respectively; IgG antibody prevalences were MADV: 13.2%, VEEV: 16.8%, Una virus (UNAV): 16.0%, and Mayaro virus: 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 withMADVand VEEV infections, 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 Aruza and Mercadeo, respectively. The lack of additional neurological cases suggests 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 in some locations of eastern Panama.

Original languageEnglish (US)
Pages (from-to)2429-2437
Number of pages9
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number6
StatePublished - Dec 2020

ASJC Scopus subject areas

  • Infectious Diseases
  • Virology
  • Parasitology


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