Profiling the clinico-epidemiological, genomic, and immunological markers of dengue and Zika infections and co-infections in Kerala, India via longitudinal studies

Dengue and Zika are major health threats in Kerala, with co-circulation of both viruses complicating the region's health landscape. This five-year longitudinal study, in partnership with the Kerala health system, aims to evaluate the burden, and distribution of ZIKV and DENV infections. The study will recruit >17000 probable dengue or zika patients within five days of symptom onset from healthcare facilities of all levels. Patients will be screened for infections and antibody status to determine primary or secondary infections. Active surveillance of contacts in geographical clusters will be conducted. Additionally, an antenatal cohort will be recruited and monitored for these infections. They will undergo serology testing post-delivery to assess new infections and infants will be followed for congenital anomalies in positive cases. Immune responses in asymptomatic and symptomatic individuals will be analyzed, focusing on antibody and T cell responses in mono- infections, co-infections, and sequential infections. Vectors will be examined for infection rates. A database of genomic heterogeneity will be established through next-generation sequencing to correlate with disease outcomes. The study aims to understand transmission dynamics and significant genomic and immunological readouts will help sharpen our responses to diagnostic, prognostic and management policies and potentially guiding future immunotherapeutic and vaccine developments.