"The circulation and detection of flavivirus and SARS-CoV-2 have been reported in flavivirus endemic areas.7, 8 The recent third serosurvey of COVID-19 by the Indian Council of Medical Research, India demonstrated high seroprevalence in Kerala state (11.6 per cent) compared to the national average of 21.9 per cent. This data demonstrates the effectiveness of robust surveillance adopted by the state. Similarly, the preparedness and active surveillance of the public health system of Kerala state has helped to timely identify the Zika cases among the healthcare workers," the study further said.