Mayaro virus detection in patients from rural and urban areas in Trinidad and Tobago during the Chikungunya and Zika virus outbreaks.

Mayaro virus, which can often go undetected due to its clinical manifestations and intimate alignment with dengue and chikungunya viruses, is one of the most neglected arboviruses. The virus has been found in several outbreaks, where a moderate-to-severe and potentially incapacitating joint disease has been observed. MAYV usually circulates in a sylvan cycle of forest mosquitoes and vertebrates, causing sporadic sylvatic infections to humans, and some outbreaks in sub-urban areas. This study focuses on the demonstration of the possible co-circulation of Mayaro virus with chikungunya virus and Zika virus during the outbreaks that occurred in Trinidad and Tobago in 2014 and 2016, respectively. Acute samples from patients who previously tested negative for chikungunya, dengue, and Zika, and specifically exhibiting joint pain were selected and investigated for the presence of Mayaro virus genome using real-time RT-PCR techniques. Nine persons were shown to be positive for Mayaro virus during the chikungunya outbreak of 2014, while no one during the Zika outbreak in 2016. Five results correspond to persons living in highly urbanized areas across Trinidad. These findings provide evidence that multiple arboviral circulations are possible and could easily go undetected especially during outbreak situations. Our study is the first to demonstrate the possible co-circulation of Mayaro and chikungunya viruses and the occurrence of human cases for both diseases during an outbreak in the Caribbean. A possible change in the pattern of distribution of human cases to more urbanized areas is also discussed.