Comparison of two rapid diagnostic tests during a large dengue virus serotype 3 outbreak in the Solomon Islands in 2013.

Li-Teh Liu,Wen-Ter Lai,Ping-Chang Lin,Jih-Jin Tsai,Rooney Jagilly,Tenneth Dalipanda,Ying-Hui Wang,Ching-Yi Tsai

doi:10.1371/journal.pone.0202304

Abstract

Dengue virus (DENV) infection causes various clinical presentations, including asymptomatic infection, dengue with or without warning signs and severe dengue. An early and accurate diagnosis of DENV infection during the first few days of illness supports clinical management and significantly reduces dengue-associated mortality and morbidity. However, it is very difficult to confirm DENV infection in endemic regions without qualified dengue diagnostic laboratories. In this study, we evaluated the performance of two commercially available rapid diagnostic tests (RDTs) using serum samples collected in the Solomon Islands during the 2013 DENV-3 outbreak. The sensitivity and specificity of the tests were calculated by comparing the results of DENV nonstructural protein 1 (NS1), IgM and IgG RDTs with those obtained by qRT-PCR. We also compared the results of the DENV IgM/IgG RDT with those obtained using an IgM/IgG capture enzyme-linked immune-sorbent assay (ELISA). The sensitivities of the SD and CTK NS1 RDTs were similar (90.9% and 92.6%), and the specificity of the SD NS1 RDT was significantly higher than that of the CTK NS1 RDT (100% versus 78.8%). The inclusion of IgM and IgG in the RDT did not significantly increase the sensitivity for DENV diagnosis. Compared with the SD IgM RDT, IgM capture ELISA had the same specificity but higher sensitivity. User-friendly RDTs remain the first choice and the most convenient tool in dengue endemic regions, where laboratory facilities and the corresponding infrastructure are lacking. Our study provided important and practical information for comparing the performance and validity of the different RDTs for rapid dengue detection.

Highlights

Dengue is a mosquito-borne viral disease prevalent in the tropics and subtropics, where it causes significant morbidity and mortality
Thirteen of the 15 IgG-positive cases were cases of secondary infection. These results suggested that the presence of dengue virus (DENV) IgG in the test sample might hinder the detection of DENV nonstructural protein 1 (NS1) using the SD NS1 rapid diagnostic tests (RDTs)
We evaluated the sensitivity and specificity of two commercially available dengue NS1 and IgM/IgG RDTs using acute-phase sera collected in the Solomon Islands (SI) during the 2013 DENV-3 outbreak

Summary

Introduction

Dengue is a mosquito-borne viral disease prevalent in the tropics and subtropics, where it causes significant morbidity and mortality. The distribution of dengue has increased greatly over the past 50 years, and this expansion is likely due to global warming and travel, which have increased the geographic expansion of the mosquito vectors. The disease is caused by infection with the dengue virus (DENV), an RNA virus consisting of a positive-sense RNA genome of approximately 11 kilobases. The DENV genome encodes three structural proteins (capsid, premembrane and envelope) and seven nonstructural proteins (NS1, NS2A/B, NS3, NS4A/B and NS5) [1]. It has been estimated that 390 million DENV infections occur each year. DENV infection results in a wide spectrum of presentations, ranging from asymptomatic or mild illness to dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) [3], dengue with or without warning signs and severe dengue [4]

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