Mosquito-borne viruses like dengue and chikungunya are frequent causes of acute febrile illnesses in Southeast Asia(1, 2). Dengue viruses are Orthoflavivirus genus and consist of four distinct serotypes (DENV 1–4), each containing multiple genotypes and offering transient cross-protective immunity(3). Chikungunya virus is an Alphavirus virus and has three genotypes, which includes the West African lineage, East, Central and South African (ECSA) lineage and an Asian lineage(4). During the initial presentation at the hospital, distinguishing between the two diseases can be challenging, as they manifest overlapping symptoms. Laboratory tests, such as antigen or antibody assays, or PCR, are necessary for a definitive diagnosis(5).
However, the clinical trajectories of both diseases differ greatly. In dengue, the majority of patients remain asymptomatic, and those who do develop symptoms typically experience a self-limited illness. In some cases, symptoms may include bleeding, plasma leakage, and shock(6). On the other hand, in chikungunya, the majority of patients develop symptoms characterized by arthralgia and arthritis(7). The clinical course is also much longer, with symptoms of arthritis persisting for several months(8).
In the Philippines, cases of chikungunya and dengue have been reported since the late 1950s. Dengue has remained a major public health problem in the country, and the growing magnitude of the disease prompted the government to provide free diagnostics for dengue to locals under the national insurance scheme(9). This facilitates large-scale screening of patients presenting to hospitals with acute febrile illness to determine whether they have dengue. Due to the significant disease burden, the Philippines was also the first country in Asia to approve and provide dengue vaccine.
In contrast, chikungunya has not garnered as much public health interest, despite evidence of its presence(10, 11). This disparity may be due to the significant higher mortality rates associated with dengue compared to chikungunya. However, chikungunya tends to result in more severe long-term effects, impacting daily activities, causing loss of workdays, and leading to increased unproductiveness(8). A prospective cohort study in Cebu, Philippines, reported a rate of 3 symptomatic chikungunya infections per 100,000 person-years at the end of one year into the outbreak, they also further reported that outbreaks lasted three years(12).
The Philippines, composed of 81 provinces, includes Davao de Oro, comprises 11 municipalities, has a population of approximately 767,547 people and features four secondary provincial hospitals located in Montevista, Laak, Pantukan, and Maragusan. Davao de Oro is home to migrants from Luzon and Visayas, as well as ethnic tribes such as the Mansaka, Mandaya, Davaoeno, and Kalagan. The main sources of income in the area are business establishments, banana plantations, and vast silver and gold mines across the province.
Chikungunya is likely under-reported in this area due to several reasons. Unlike dengue, which benefits from free diagnostic tests provided by the government to registered Filipinos under national insurance schemes, diagnostic tests for chikungunya are not widely available. Many residents, particularly migrants and their families working in the agriculture and mining sectors of Davao de Oro, may not be registered in the national insurance scheme and therefore lack access to diagnostics. This gap in access to diagnostics could contribute to the under-diagnosis and under-reporting of chikungunya in this region. Understanding the true prevalence of chikungunya in this context is crucial for implementing effective public health strategies and improving healthcare access for all residents of Davao de Oro. In this study, we aimed to estimate the proportion of acute chikungunya and dengue infection among patients with acute febrile illness in four provincial hospitals of Davao de Oro in the Davao region.