Use of a Rapid Test for Diagnosis of Dengue during Suspected Dengue Outbreaks in Resource-Limited Regions

Abstract

G lobally, over 2.5 billion people are estimated to be at risk of dengue virus (DENV) infection with an estimated 96 million symptomatic cases of dengue occurring annually (1). Despite ongoing research efforts, there are no sustainable vector control approaches or effective antiviral drugs to prevent or treat dengue, and vaccines have only recently been licensed by few countries and with suboptimal efficacy (2, 3, 4, 5). However, improvements in patient clinical management has been shown to reduce mortality among patients with severe dengue from 5% to Ͻ0.5% (6-9).Delayed dengue case identification often occurs in areas with limited diagnostics or surveillance resources, especially where dengue outbreaks are episodic or have been under-recognized (e.g., Africa and Oceania) (10, 11). These factors decrease health care provider awareness to include dengue in the differential diagnosis with other acute febrile illnesses (AFIs) such as malaria, leptospirosis, and influenza (12). Lastly, minimal or no laboratory infrastructure to conduct standard dengue diagnostic assays or perform them in a timely manner limits their utility for case management (13).Laboratory diagnosis of dengue can be achieved with a single serum specimen obtained during the febrile phase of the illness by testing for DENV analytes (e.g., nucleic acid, nonstructural protein 1 [NS1], and anti-DENV IgM) (14). DENV viremia occurs for up to 7 days after the onset of fever, and anti-DENV IgM begins to appear around 3 days after fever onset (15, 16). Although detection of DENV nucleic acid by real-time reverse transcriptase PCR (rRT-PCR) is the most sensitive and specific means to detect DENV viremia (17), immunoassays to detect DENV NS1 antigen provide acceptable levels of detection sensitivity and specificity (18,19). Immunoassays with good sensitivities and specificities to detect anti-DENV IgM are also widely available (20). However, both of these diagnostic approaches are instrument dependent and require facilities capable of performing complex diagnostic tests.The availability of dengue rapid diagnostic tests (RDTs) has the potential to change the current situation in resource-limited areas and improve dengue clinical management. We evaluated an RDT that detected both DENV NS1 antigen and anti-DENV IgM for its ability to provide accurate information for detecting dengue from outbreaks as the main cause of febrile illness in areas without ongoing laboratory testing. In all settings, a suspected dengue case was defined as a person with an AFI presenting for medical care. Serum specimens were collected from all suspected dengue cases upon initial presentation along with patient demographics, days post onset of illness (DPO), and specimen collection date (Table 1). Second convalescent specimens were not collected for patients, and only specimens collected upon patient presentation to hospital or clinic were used in this study. MATERIALS AND METHODS Study design. The Centers for Disease Control and PreventionDiagnostic testing. The RDT used during each ...

Enhanced surveillance during a public health emergency in a resource-limited setting: Experience from a large dengue outbreak in Solomon Islands, 2016-17

“…Dengue RDTs are useful for identifying a dengue outbreak but are less useful in individual case management in clinical settings. The sensitivity and specificity of dengue RDTs are variable depending on factors including DENV serotype, date of collection, the skill of technician and history of previous DENV infections in individuals [ 54 ]. The lack of guideline for the appropriate use of dengue RDTs during an outbreak likely contribute to their inappropriate use and stock depletion.…”

Use of rapid immunochromatographic test to detect dengue infection in community-based patients in Indonesia

“…23 Another study also showed that the highest IgM antibody positivity (83%) was detected on the 5 th day of fever. 24 Therefore for patients with 5-day fever, accompanied by signs and symptoms relevant with DENV infection, detection of IgM and IgG anti-DENV antibody should be considered.…”

Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT‐PCR

“…Moreover, it is reported that the RDTs have different sensitivity and specificity in primary and secondary infection, Timing and storage of specimen, and to the infection by different serotypes . Another resent study that compared the RDT test with qRT‐PCR and reported that RDT was useful in limited resource areas.…”

“…These tests are economical and are easy to perform. Several studies have reported evaluation of RDTs, using different study designs and comparing the RDTs with ELISA, RT‐PCR, and qRT‐PCR in different conditions . But there are limited studies documenting DENV serotype specific evaluation of RDTs.…”