An Enzyme-Linked Immunosorbent Assay to Characterize Dengue Infections Where Dengue and Japanese Encephalitis Co-Circulate

B. L. InnisDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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A. NisalakDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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S. NimmannityaDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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S. KusalerdchariyaDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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V. ChongswasdiDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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S. SuntayakornDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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P. PuttisriDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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C. H. HokeDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Division of Infectious Diseases, Children's Hospital, Ministry of Public Health, Maternal and Child Hospital, Khon Kaen, Ministry of Public Health, and Department of Pediatrics, Kampangphet Provincial Hospital, Ministry of Public Health, Bangkok, Thailand

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The diagnostic sensitivity and specificity of detection of anti-dengue IgM by antibody capture enzyme-linked immunosorbent assay (ELISA) was investigated in dengue infections in a variety of clinical settings. Sera from uninfected controls were uniformly negative. Serial specimens from experimental and natural infections showed that viremia and fever terminated as anti-dengue IgM became detectable. Anti-dengue IgM appeared in most cases by the 3rd afebrile day of illness and declined to undetectable levels after 30–60 days. Assay sensitivity was 78% in admission sera (924/1,183; 95% CI = 75–81%) and 97% in paired sera (1,030/1,062; 95% CI = 96–98%) thus exceeding or matching the performance of the hemagglutination-inhibition assay. Measurement of the anti-dengue IgM to anti-Japanese encephalitis IgM ratio correctly identified all sera from 112 patients with strictly defined Japanese encephalitis and 98% (307/312; 95% CI = 96–99%) of sera from patients whose dengue infections were confirmed by virus isolation. Dengue infections could be classified as primary or secondary by determining the ratio of units of dengue IgM to IgG antibody. We propose that measurement of dengue and Japanese encephalitis IgM and IgG antibodies upon admission and discharge from hospital care should replace the hemagglutination inhibition assay as the standard dengue serologic technique in regions where these 2 viruses co-circulate.

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