Arboviruses in southern Africa: are we missing something?

The occurrence of the tick-borne zoonosis Crimean-Congo hemorrhagic fever is well established in South Africa. Similarly, mosquito-borne viruses Rift Valley fever, West Nile, Wesselsbron and Sindbis cause sporadic outbreaks. There is serological and/or virological evidence supporting the presence of lesser known arboviruses: the flaviviruses Usutu, Banzi and Spondweni, an Old World alphavirus Middelburg, orthobunyaviruses Germiston and Shuni and a tick-borne nairovirus, Dugbe. The medical significance of these viruses has not been established and lack of awareness and diagnostic capacity may lead to misdiagnosis. Historically, there have been outbreaks of chikungunya virus and dengue fever. This review focuses on arboviruses known to cause disease in South Africa or that have historically been shown to occur with potential for re-emergence.