Capacity of a Multiplex IgM Antibody Capture ELISA to Differentiate Zika and Dengue Virus Infections in Areas of Concurrent Endemic Transmission

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  • 1 Surveillance and Research Laboratory, Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico;
  • | 2 Department of Microbiology and Immunology University of North Carolina School of Medicine, Chapel Hill, North Carolina;
  • | 3 Ponce Health Sciences University, Ponce, Puerto Rico

Serological cross-reactivity has proved to be a challenge to diagnose Zika virus (ZIKV) infections in dengue virus (DENV) endemic countries. Confirmatory testing of ZIKV IgM positive results by plaque reduction neutralization tests (PRNTs) provides clarification in only a minority of cases because most individuals infected with ZIKV were previously exposed to DENV. The goal of this study was to evaluate the performance of a ZIKV/DENV DUO IgM antibody capture ELISA (MAC-ELISA) for discriminating between DENV and ZIKV infections in endemic regions. Our performance evaluation included acute and convalescent specimens from patients with real-time reverse transcription polymerase chain reaction (RT-PCR)-confirmed DENV or ZIKV from the Sentinel Enhanced Dengue Surveillance System in Ponce, Puerto Rico. The ZIKV/DENV DUO MAC-ELISA specificity was 100% for DENV (N = 127) and 98.4% for ZIKV (N = 275) when specimens were tested during the optimal testing window (days post-onset of illness [DPO] 6–120). The ZIKV/DENV DUO MAC-ELISA sensitivity of RT-PCR confirmed specimens reached 100% for DENV by DPO 6 and for ZIKV by DPO 9. Our new ZIKV/DENV DUO MAC-ELISA was also able to distinguish ZIKV and DENV regardless of previous DENV exposure. We conclude this novel serologic diagnostic assay can accurately discriminate ZIKV and DENV infections. This can potentially be useful considering that the more labor-intensive and expensive PRNT assay may not be an option for confirmatory diagnosis in areas that lack PRNT capacity, but experience circulation of both DENV and ZIKV.

Author Notes

Address correspondence to Jorge Muñoz-Jordán, Surveillance and Research Laboratory, Dengue Branch, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, Puerto Rico 00920. E-mail: ckq2@cdc.gov

Financial support: Funding was provided by the Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Authors’ addresses: Freddy A. Medina, Frances Vila, Olga Lorenzi, Gabriela Paz-Bailey, Steve Waterman, and Jorge Muñoz-Jordan, Surveillance and Research Laboratory, Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico, E-mails: fkt3@cdc.gov, njd0@cdc.gov, oal9@cdc.gov, gmb5@cdc.gov, shw2@cdc.gov, and ckq2@cdc.gov. Lakshmanane Premkumar and Aravinda de Silva, Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, E-mails: prem@med.unc.edu and aravinda_desilva@med.unc.edu. Luisa I. Alvarado and Vanessa Rivera-Amill, Ponce Health Sciences University/Ponce Research Institute, Ponce, Puerto Rico, E-mails: lalvarado@psm.edu and vrivera@psm.edu.

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