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Morales I, Rosenberger KD, Magalhaes T, Morais CNL, Braga C, Marques ETA, Calvet GA, Damasceno L, Brasil P, Bispo de Filippis AM, Tami A, Bethencourt S, Alvarez M, Martínez PA, Guzman MG, Souza Benevides B, Caprara A, Quyen NTH, Simmons CP, Wills B, de Lamballerie X, Drexler JF, Jaenisch T. Diagnostic performance of anti-Zika virus IgM, IgAM and IgG ELISAs during co-circulation of Zika, dengue, and chikungunya viruses in Brazil and Venezuela. PLoS Negl Trop Dis 2021; 15:e0009336. [PMID: 33872309 PMCID: PMC8084345 DOI: 10.1371/journal.pntd.0009336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/29/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background Serological diagnosis of Zika virus (ZIKV) infection is challenging because of the antibody cross-reactivity among flaviviruses. At the same time, the role of Nucleic Acid Testing (NAT) is limited by the low proportion of symptomatic infections and the low average viral load. Here, we compared the diagnostic performance of commercially available IgM, IgAM, and IgG ELISAs in sequential samples during the ZIKV and chikungunya (CHIKV) epidemics and co-circulation of dengue virus (DENV) in Brazil and Venezuela. Methodology/Principal findings Acute (day of illness 1–5) and follow-up (day of illness ≥ 6) blood samples were collected from nine hundred and seven symptomatic patients enrolled in a prospective multicenter study between June 2012 and August 2016. Acute samples were tested by RT-PCR for ZIKV, DENV, and CHIKV. Acute and follow-up samples were tested for IgM, IgAM, and IgG antibodies to ZIKV using commercially available ELISAs. Among follow-up samples with a RT-PCR confirmed ZIKV infection, anti-ZIKV IgAM sensitivity was 93.5% (43/46), while IgM and IgG exhibited sensitivities of 30.3% (10/33) and 72% (18/25), respectively. An additional 24% (26/109) of ZIKV infections were detected via IgAM seroconversion in ZIKV/DENV/CHIKV RT-PCR negative patients. The specificity of anti-ZIKV IgM was estimated at 93% and that of IgAM at 85%. Conclusions/Significance Our findings exemplify the challenges of the assessment of test performance for ZIKV serological tests in the real-world setting, during co-circulation of DENV, ZIKV, and CHIKV. However, we can also demonstrate that the IgAM immunoassay exhibits superior sensitivity to detect ZIKV RT-PCR confirmed infections compared to IgG and IgM immunoassays. The IgAM assay also proves to be promising for detection of anti-ZIKV seroconversions in sequential samples, both in ZIKV PCR-positive as well as PCR-negative patients, making this a candidate assay for serological monitoring of pregnant women in future ZIKV outbreaks. Zika virus (ZIKV) is transmitted through the bite of infected Aedes mosquitos but can also be transmitted sexually or vertically from mother-to-child. The same mosquitoes transmit dengue virus (DENV) and chikungunya virus (CHIKV), which cause similar clinical syndromes. The ZIKV epidemics in the Pacific and the Americas that occurred between 2015 and 2017 were linked to congenital abnormalities, most prominently microcephaly, in newborns. Because most infections are asymptomatic, diagnosis via indirect serological assays is an important strategy. On the other hand, many serological assays are affected by cross-reactivity resulting from prior infections by closely related viruses, such as DENV. This study evaluated three commercially available and widely used immunoassays that detect IgG, IgM or IgA and M (IgAM) antibodies to ZIKV. Our results suggest that the IgAM test performs best by detecting around 90% of RT-PCR confirmed infections. We also detected additional infections that were not detected by RT-PCR. The strength of this study is that it was carried out in two different countries of the American region where several arboviruses are endemic and that sequential blood samples from individual patients were available to evaluate the performance of the tests over time.
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Affiliation(s)
- Ivonne Morales
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Infection Research (DZIF), associated partner Heidelberg University Hospital, Heidelberg, Germany
| | - Kerstin D. Rosenberger
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Infection Research (DZIF), associated partner Heidelberg University Hospital, Heidelberg, Germany
| | - Tereza Magalhaes
- Center for Vector-Borne Infectious Diseases (CVID), Department of Microbiology, Immunology and Pathology, Colorado State University (CSU), Fort Collins, Colorado, United States of America
| | - Clarice N. L. Morais
- Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Cynthia Braga
- Department of Parasitology, Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Recife, Brazil
- Institute of Integral Medicine Professor Fernando Figueira (Instituto de Medicina Integral Professor Fernando Figueira-IMIP), Recife, Brazil
| | - Ernesto T. A. Marques
- Laboratory of Virology and Experimental Therapeutics, Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Recife, Brazil
- Department of Infectious Diseases, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Guilherme Amaral Calvet
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luana Damasceno
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Patricia Brasil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Adriana Tami
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
- Facultad de Ciencias de la Salud, Universidad de Carabobo,
Valencia, Venezuela
| | - Sarah Bethencourt
- Facultad de Ciencias de la Salud, Universidad de Carabobo,
Valencia, Venezuela
| | | | | | | | | | | | - Nguyen Than Ha Quyen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Cameron P. Simmons
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Institute for Vector-Borne Disease, Monash University, Melbourne, Australia
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
| | - Xavier de Lamballerie
- Unité des Virus Emergents (UVE Aix Marseille Université, IRD 190, Inserm 1207-IHUMéditerranée Infection), Marseille, France
| | - Jan Felix Drexler
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Sechenov University, Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases, Moscow, Russia
- German Centre for Infection Research (DZIF), associated partner Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Jaenisch
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Infection Research (DZIF), associated partner Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
- * E-mail:
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