Diagnostic Accuracy of Parameters for Zika and Dengue Virus Infections, Singapore

Ho, Hanley J.; Wong, Joshua; Kyaw, Win Mar; Lye, David C.; Leo, Yee Sin; Chow, Angela

doi:10.3201/eid2312.171224

Cited by 11 publications

(7 citation statements)

References 13 publications

(17 reference statements)

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“…We selected predictors that could differentiate Zika virus and DENV infection as input for subsequent multivariate regression models and computed the area under the receiver operating characteristic curve (AUC) to compare model performance. We validated the results in a separate cohort of Zika virus and DENV patients from Tan Tock Seng Hospital, Singapore ( 5 ). From this validation cohort, we ascertained AUC and accuracy of the derived predictors.…”

Section: The Studymentioning

confidence: 82%

“…We confirmed Zika virus infection through testing for viral RNA in serum or urine, as described by Lanciotti et al ( 4 ). We confirmed DENV infection through testing for serum DENV nonstructural protein 1 (NS1) antigen (SD BIOLINE Dengue DUO Kit; Standard Diagnostics, Kyonggi-do, South Korea) or by reverse transcription PCR ( 5 ). The clinical information collected included demographics, symptomatology, examination findings, and laboratory investigations, including complete blood count (with the monocyte count automated) and liver function test.…”

Section: The Studymentioning

confidence: 99%

See 1 more Smart Citation

Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore

Yan¹,

Pang²,

Cook³

et al. 2018

Emerg. Infect. Dis.

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Section: The Studymentioning

confidence: 82%

Section: The Studymentioning

confidence: 99%

Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore

Yan¹,

Pang²,

Cook³

et al. 2018

Emerg. Infect. Dis.

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“…Set B consisted of 121 convalescent plasma samples from patients suspected of having DENV or ZIKV infection in two separate studies conducted at Tan Tock Seng Hospital (TTSH), Singapore [ 32 , 33 ]. Plasma samples were collected from 2010 to 2012, and from August 2016 to September 2016, for the DENV and ZIKV studies, respectively.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of eight commercial Zika virus IgM and IgG serology assays for diagnostics and research

et al. 2021

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Several commercial Zika virus (ZIKV) serology assays have been developed since the recognition of ZIKV outbreaks as a Public Health Emergency of International Concern in 2016. However, test interpretation for ZIKV serology can be challenging due to antibody cross-reactivity with other flaviviruses like dengue virus (DENV). Therefore, we sought to evaluate the performance of eight commercially available ZIKV IgM and IgG assays across three testing platforms, namely, immunochromatographic tests (ICT), ELISAs and immunofluorescence tests (IIFT). The test panel comprised of 278 samples, including acute and convalescent sera or plasma from ZIKV-confirmed, DENV-confirmed, non-ZIKV and non-DENV patients, and residual sera from healthy blood donors. The ZIKV IgM and IgG serology assays yielded higher test sensitivities of 23.5% - 97.1% among ZIKV convalescent samples as compared to 5.6% - 27.8% among ZIKV acute samples; the test specificities were 63.3% - 100% among acute and convalescent DENV, non-DENV samples. Among the ELISAs and IIFTs, the Diapro ZIKV IgM ELISA demonstrated high test sensitivity (96%) and specificity (80%) when tested on early convalescent samples, while the Euroimmun ZIKV IgG ELISA yielded the highest test specificity of 97% - 100% on samples from non-ZIKV patients and healthy blood donors. For rapid ICTs, the LumiQuick IgM rapid ICT yielded low test sensitivity, suggesting its limited utility. We showed that commercial ZIKV IgM and IgG serology assays have differing test performances, with some having moderate to high test sensitivities and specificities when used in a dengue endemic setting, although there were limitations in IgG serology.

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“…An estimated 50–80% of ZIKV infections are inapparent, , which has a significant impact on screening algorithms and the interpretation of diagnostic test results, as subclinical infection carries the same risk for transmission as acute, symptomatic disease. , For symptomatic ZIKV cases, a confirmed diagnosis requires laboratory testing to support clinical evaluation . Compared to DENV, symptoms such as rash (particularly an early, potentially pruritic rash) and conjunctivitis seem to be more prominent components of symptomatic ZIKV infections, which less commonly causes perturbations in hematologic lab tests. − Nevertheless, ZIKV ultimately causes a nonspecific acute illness that cannot be clinically distinguished from many alternate etiologies . The performance of case definitions may be positively skewed during an outbreak setting, but that should not distract from the critical role of reliable diagnostic tests in all aspects of clinical care and public health activities.…”

Section: Challenges and Current Practice For Diagnosing Congenital Zi...mentioning

confidence: 99%

Detecting Vertical Zika Transmission: Emerging Diagnostic Approaches for an Emerged Flavivirus

Collins

Waggoner

2019

ACS Infect. Dis.

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Zika virus (Zika) was recently responsible for a massive epidemic that spread throughout Latin America and beyond. Though Zika is typically asymptomatic or self-limiting, the sheer numbers of Zika infections led to the identification of unexpected phenotypes including sexual transmission, Guillain-Barrésyndrome, and teratogenicity. Thousands of infants in South, Central, and North America have now been born with microcephaly or one of a number of fetal anomalies constituting the congenital Zika syndrome (CZS). Diagnosing CZS is based on a combination of clinical risk assessment and laboratory testing (which includes determining whether the mother has experienced a possible Zika infection during her pregnancy). A newborn suspected of having congenital Zika infection (due to maternal Zika infection or a birth defect described in association with congenital Zika infection) is then specifically tested for presence of Zika virus in neonatal tissue or anti-Zika IgM in the blood or cerebrospinal fluid. Though the guidelines are clear, there is room for considerable practice variation to emerge from individualized patient−provider encounters, largely due to limitations in diagnostic testing for Zika. The natural history of Zika further obscures our ability to know who, when, and how to test. Molecular diagnostics are highly specific but may not serve well those with asymptomatic infection. Serologic assays expand the diagnostic window but are complicated by cross-reactivity among related flaviviruses and passive immunity transferred from mother to baby. Furthermore, existing and emerging diagnostic tools may not be widely available due to limitations in resources and infrastructure of health systems in affected areas. Improvements in assay parameters as well as advances in platforms and deployability hold promise for optimizing diagnostic approaches for congenital Zika infection. The diagnostic tools and technologies under development must be integrated with forthcoming clinical knowledge of congenital Zika infection to fully realize the value that laboratory testing holds for diagnosing in utero mother to child transmission but also for understanding, predicting, and managing the health outcomes due to congenital Zika infection.

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Diagnostic Accuracy of Parameters for Zika and Dengue Virus Infections, Singapore

Cited by 11 publications

References 13 publications

Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore

Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore

Evaluation of eight commercial Zika virus IgM and IgG serology assays for diagnostics and research

Detecting Vertical Zika Transmission: Emerging Diagnostic Approaches for an Emerged Flavivirus

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