Coinfections of Chikungunya, Dengue, and Zika Viruses in India: Rationale for a Unified Triple Surveillance Approach

Aedes-borne arboviruses are a major public health threat in India and globally. Arboviruses spread by the Aedes mosquito, namely, the Zika, chikungunya, and dengue viruses, pose overlapping and significant threats. In the Indian context, dengue is widespread and hyperendemic across many regions of the country, chikungunya has re-emerged markedly since the mid-2000s, and Zika outbreaks have appeared sporadically across several states. Because these viruses share the same mosquito vectors, the chances of coinfection and cocirculation increase, making diagnosis difficult. Moreover, clinical manifestations might become more complex in such coinfection scenarios. Despite this reality, most surveillance efforts look at each disease separately. In the present study, we review evidence of coinfection of dengue, chikungunya, and Zika in India, identify diagnostic and surveillance gaps, and propose an integrated "triple surveillance" approach to better track and manage these viral diseases.