Ability To Serologically Confirm Recent Zika Virus Infection in Areas with Varying Past Incidence of Dengue Virus ... - Journal of Clinical Microbiology

1. Nicole P. Lindsey^a,
2. J. Erin Staples^a,
3. Krista Powell^c,
4. Ingrid B. Rabe^a,
5. Marc Fischer^a,
6. Ann M. Powers^a,
7. Olga I. Kosoy^a,
8. Eric C. Mossel^a,
9. Jorge L. Munoz-Jordan^b,
10. Manuela Beltran^b,
11. W. Thane Hancock^d,
12. Karrie-Ann E. Toews^d,
13. Esther M. Ellis^e,
14. Brett R. Ellis^e,
15. Amanda J. Panella^a,
16. Alison J. Basile^a,
17. Amanda E. Calvert^a,
18. Janeen Laven^a,
19. Christin H. Goodman^a,
20. Carolyn V. Gould^a,
21. Stacey W. Martin^a,
22. Jennifer D. Thomas^f,
23. Julie Villanueva^f,
24. Mary L. Mataia^g,
25. Rebecca Sciulli^h,
26. Remedios Gose^h,
27. A. Christian Whelen^h and
28. Susan L. Hills^a

1. ^aDivision of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
2. ^bDivision of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
3. ^cDivision of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
4. ^dDivision of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
5. ^eU.S. Virgin Islands Department of Health, Christiansted, U.S. Virgin Islands, USA
6. ^fDivision of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
7. ^gAmerican Samoa Department of Health, Fagaalu, American Samoa
8. ^hState Laboratories Division, Hawaii Department of Health, Pearl City, Hawaii, USA

ABSTRACT

Cross-reactivity within flavivirus antibody assays, produced by shared epitopes in the envelope proteins, can complicate the serological diagnosis of Zika virus (ZIKAV) infection. We assessed the utility of the plaque reduction neutralization test (PRNT) to confirm recent ZIKAV infections and rule out misleading positive immunoglobulin M (IgM) results in areas with various levels of past dengue virus (DENV) infection incidence. We reviewed PRNT results of sera collected for diagnosis of ZIKAV infection from 1 January through 31 August 2016 with positive ZIKAV IgM results, and ZIKAV and DENV PRNTs were performed. PRNT result interpretations included ZIKAV, unspecified flavivirus, DENV infection, or negative. For this analysis, ZIKAV IgM was considered false positive for samples interpreted as a DENV infection or negative. In U.S. states, 208 (27%) of 759 IgM-positive results were confirmed to be ZIKAV compared to 11 (21%) of 52 in the U.S. Virgin Islands (USVI), 15 (15%) of 103 in American Samoa, and 13 (11%) of 123 in Puerto Rico. In American Samoa and Puerto Rico, more than 80% of IgM-positive results were unspecified flavivirus infections. The false-positivity rate was 27% in U.S. states, 18% in the USVI, 2% in American Samoa, and 6% in Puerto Rico. In U.S. states, the PRNT provided a virus-specific diagnosis or ruled out infection in the majority of IgM-positive samples. Almost a third of ZIKAV IgM-positive results were not confirmed; therefore, providers and patients must understand that IgM results are preliminary. In territories with historically higher rates of DENV transmission, the PRNT usually could not differentiate between ZIKAV and DENV infections.

KEYWORDS

FOOTNOTES

• • Received 13 July 2017.
  • Returned for modification 27 July 2017.
  • Accepted 27 September 2017.
  • Accepted manuscript posted online 1 November 2017.
• Address correspondence to Nicole P. Lindsey, frd3{at}cdc.gov.

• Citation Lindsey NP, Staples JE, Powell K, Rabe IB, Fischer M, Powers AM, Kosoy OI, Mossel EC, Munoz-Jordan JL, Beltran M, Hancock WT, Toews K-AE, Ellis EM, Ellis BR, Panella AJ, Basile AJ, Calvert AE, Laven J, Goodman CH, Gould CV, Martin SW, Thomas JD, Villanueva J, Mataia ML, Sciulli R, Gose R, Whelen AC, Hills SL. 2018. Ability to serologically confirm recent Zika virus infection in areas with varying past incidence of dengue virus infection in the United States and U.S. territories in 2016. J Clin Microbiol 56:e01115-17. http://ift.tt/2BFDmo7.

• This is a work of the U.S. Government and is not subject to copyright protection in the United States. Foreign copyrights may apply.

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