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Re-evaluation of routine dengue virus serology in travelers in the era of Zika virus emergence.
J Clin Virol 2017; 92:25-31JC

Abstract

BACKGROUND

Diagnostic requests for both Zika virus (ZIKV) and dengue virus (DENV) infections in returning travelers have significantly increased during the recent ZIKV outbreak in the Americás. These flaviviruses have overlapping clinical syndromes and geographical distribution, but diagnostic differentiation is important because of different clinical consequences. As flaviviruses are known to have a short viremic period, diagnostics often rely on serological methods, which are challenging due to extensive cross-reactive antibodies.

OBJECTIVE

To re-evaluate the performance of DENV serological assays in laboratory confirmed ZIKV-infected travelers.

STUDY DESIGN

The extent of cross-reactivity of the DENV NS1 antigen, IgM and IgG ELISA was analyzed in 152 clinical blood samples collected from 69 qRT-PCR and 24 virus neutralization titer (VNT) confirmed ZIKV-infected travelers.

RESULTS

The majority of travelers in the presented cohort returned to the Netherlands from Suriname and presented with symptoms of fever and rash. Twenty-three percent of the female travelers were pregnant. None of the 39 ZIKV RNA positive blood samples were cross-reactive in the DENV NS1 antigen ELISA. The rates of cross-reactivity of the DENV IgM and IgG ELISÁs were 31% and 54%, respectively, after excluding travelers with (potential) previous DENV exposure.

CONCLUSIONS

Although the DENV NS1 antigen assay was highly specific in this cohort of laboratory confirmed ZIKV-infected travelers, we demonstrate high percentages of cross-reactivity of DENV IgM and IgG ELISÁs of which diagnostic laboratories should be aware. In addition, the high rate of DENV IgG background of >25% complicates a proper serological diagnosis in this group.

Authors+Show Affiliations

Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: m.p.a.vanmeer@erasmusmc.nl.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: c.geurtsvankessel@erasmusmc.nl.

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28505571

Citation

van Meer, Maurits P A., et al. "Re-evaluation of Routine Dengue Virus Serology in Travelers in the Era of Zika Virus Emergence." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 92, 2017, pp. 25-31.
van Meer MPA, Mögling R, Klaasse J, et al. Re-evaluation of routine dengue virus serology in travelers in the era of Zika virus emergence. J Clin Virol. 2017;92:25-31.
van Meer, M. P. A., Mögling, R., Klaasse, J., Chandler, F. D., Pas, S. D., van der Eijk, A. A., ... GeurtsvanKessel, C. H. (2017). Re-evaluation of routine dengue virus serology in travelers in the era of Zika virus emergence. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 92, pp. 25-31. doi:10.1016/j.jcv.2017.05.001.
van Meer MPA, et al. Re-evaluation of Routine Dengue Virus Serology in Travelers in the Era of Zika Virus Emergence. J Clin Virol. 2017;92:25-31. PubMed PMID: 28505571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Re-evaluation of routine dengue virus serology in travelers in the era of Zika virus emergence. AU - van Meer,Maurits P A, AU - Mögling,Ramona, AU - Klaasse,Janienne, AU - Chandler,Felicity D, AU - Pas,Suzan D, AU - van der Eijk,Annemiek A, AU - Koopmans,Marion P G, AU - Reusken,Chantal B E M, AU - GeurtsvanKessel,Corine H, Y1 - 2017/05/03/ PY - 2017/02/06/received PY - 2017/04/26/revised PY - 2017/05/02/accepted PY - 2017/5/16/pubmed PY - 2018/3/1/medline PY - 2017/5/16/entrez SP - 25 EP - 31 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J. Clin. Virol. VL - 92 N2 - BACKGROUND: Diagnostic requests for both Zika virus (ZIKV) and dengue virus (DENV) infections in returning travelers have significantly increased during the recent ZIKV outbreak in the Americás. These flaviviruses have overlapping clinical syndromes and geographical distribution, but diagnostic differentiation is important because of different clinical consequences. As flaviviruses are known to have a short viremic period, diagnostics often rely on serological methods, which are challenging due to extensive cross-reactive antibodies. OBJECTIVE: To re-evaluate the performance of DENV serological assays in laboratory confirmed ZIKV-infected travelers. STUDY DESIGN: The extent of cross-reactivity of the DENV NS1 antigen, IgM and IgG ELISA was analyzed in 152 clinical blood samples collected from 69 qRT-PCR and 24 virus neutralization titer (VNT) confirmed ZIKV-infected travelers. RESULTS: The majority of travelers in the presented cohort returned to the Netherlands from Suriname and presented with symptoms of fever and rash. Twenty-three percent of the female travelers were pregnant. None of the 39 ZIKV RNA positive blood samples were cross-reactive in the DENV NS1 antigen ELISA. The rates of cross-reactivity of the DENV IgM and IgG ELISÁs were 31% and 54%, respectively, after excluding travelers with (potential) previous DENV exposure. CONCLUSIONS: Although the DENV NS1 antigen assay was highly specific in this cohort of laboratory confirmed ZIKV-infected travelers, we demonstrate high percentages of cross-reactivity of DENV IgM and IgG ELISÁs of which diagnostic laboratories should be aware. In addition, the high rate of DENV IgG background of >25% complicates a proper serological diagnosis in this group. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/28505571/Re_evaluation_of_routine_dengue_virus_serology_in_travelers_in_the_era_of_Zika_virus_emergence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-6532(17)30127-0 DB - PRIME DP - Unbound Medicine ER -