Comparative Evaluation of Three Assays for Measurement of Dengue Virus Neutralizing Antibodies

J. Robert Putnak Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Rafael de la Barrera Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Timothy Burgess Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Jorge Pardo Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Francis Dessy Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Dirk Gheysen Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Yves Lobet Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Sharone Green Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Timothy P. Endy Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Stephen J. Thomas Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Kenneth H. Eckels Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Bruce L. Innis Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Wellington Sun Division of Viral Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland; Naval Medical Research Center, Silver Spring, Maryland; Global Vaccine Development, GlaxoSmithKline Biologicals, Rixensart, Belgium; Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worchester, Massachusetts; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

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Plaque reduction neutralization tests (PRNTs) are commonly used for measuring levels of dengue virus (DENV) neutralizing antibodies. However, these assays lack a standardized format, generally have a low sample throughput, and are labor-intensive. The objective of the present study was to evaluate two alternative DENV neutralizing antibody assays: an enzyme-linked immunosorbent assay–based microneutralization (MN) assay, and a fluorescent antibody cell sorter–based, DC-SIGN expresser dendritic cell (DC) assay. False-positive rates, serotype specificity, reproducibility, sensitivity, and agreement among the assay methods were assessed using well-characterized but limited numbers of coded test sera. Results showed that all three assays had false-positive rates of less than 10% with titers near the cut-off and generally below the estimated limits of detection. All three methods demonstrated a high degree of specificity and good agreement when used to assay sera and serum mixtures from monovalent vaccinees and sera from patients after primary natural infection, with the only notable exception being moderate-to-high neutralizing antibody titers against DENV 2 measured by PRNT in a mixture containing only DENV 3 and DENV 4 sera. The MN and DC assays demonstrated good reproducibility. All three assays were comparable in their sensitivity, except that the PRNT was less sensitive for measuring DENV 4 antibody, and the MN and DC assays were less sensitive for measuring DENV 2 antibody. However, when used to test sera from persons after tetravalent DENV vaccination or secondary DENV infection, there was poor specificity and poor agreement among the different assays.

Author Notes

Reprint requests: J. Robert Putnak, Division of Viral Diseases, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Suite 3A12, Silver Spring, MD 20910, E-mail: robert.putnak@na.amedd.army.mil.
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