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- Title
Standardized evaluation of Zika nucleic acid tests used in clinical settings and blood screening.
- Authors
Stone, Mars; Bakkour, Sonia; Grebe, Eduard; Emperador, Devy M.; Escadafal, Camille; Deng, Xutao; Dave, Honey; Kelly-Cirino, Cassandra; Lackritz, Eve; Rojas, Diana P.; Simmons, Graham; Rabe, Ingrid B.; Busch, Michael P.
- Abstract
Early detection of Zika virus (ZIKV) transmission within geographic regions informs implementation of community mitigation measures such as vector reduction strategies, travel advisories, enhanced surveillance among pregnant women, and possible implementation of blood and organ donor screening or deferral. Standardized, comparative assessments of ZIKV assay and testing lab performance are important to develop optimal approaches to ZIKV diagnostic testing and surveillance. We conducted an expanded blinded panel study to characterize and compare the analytical performance of fifteen diagnostic and blood screening ZIKV NAT assays, including detection among single- and multiplex assays detecting ZIKV, dengue virus (DENV) and chikungunya virus (CHIKV). A 300 member blinded panel was constructed, consisting of 11 serial half-log dilutions ranging from ~104 to 10−1 genome equivalents/mL in 25 replicates each of the Tahitian Asian ZIKV isolate in ZIKV-negative human serum. Additionally, clinical samples from individuals with DENV-like syndrome or suspected ZIKV infection in Brazil were evaluated. The majority of assays demonstrated good specificity. Analytical sensitivities varied 1–2 logs, with a substantially higher limit of detection (LOD) in one outlier. Similar analytical sensitivity for ZIKV RNA detection in singleplex and multiplex assays of the Grifols and ThermoFisher tests were observed. Coefficient of Assay Efficiency (CE), calculated to characterize assays' RNA extraction and amplification efficiency, ranged from 0.13 for the Certest VIASURE multiplex and 0.75 for the Grifols multiplex assays. In general, assays using transcription mediated amplification (TMA) technology had greater CE compared to assays using conventional PCR technology. Donor screening NAT assays were significantly more sensitive than diagnostic RT-qPCR assays, primarily attributable to higher sample input volumes. However, ideal assays to maximize sensitivity and throughput may not be a viable option in all contexts, with other factors such as cost, instrumentation, and regulatory approval status influencing assay availability and selection, particularly in resource constrained settings. Author summary: Having standardized, comparative studies of Zika virus (ZIKV) tests are important for implementing optimal diagnostic testing and disease surveillance. Detection of ZIKV nucleic acid is ideal for confirming infection; however, knowing the sensitivity and specificity of a test is needed for selecting the right test in a given laboratory. We looked at the analytical performance of 15 diagnostic and blood screening ZIKV molecular tests, including tests that detect ZIKV only and tests that detect ZIKV plus other arboviruses. We found donor screening NAT assays were significantly more sensitive than diagnostic RT-qPCR assays, mostly due to the higher sample input volumes. We also found no difference in analytical sensitivity between tests that only detected ZIKV compared to tests that detected ZIKV and related viruses. The ideal molecular test will depend on the testing context, with other factors such as cost, instrumentation, and regulatory approval status influencing assay availability and selection.
- Subjects
BRAZIL; MEDICAL screening; NUCLEIC acids; ZIKA virus infections; ZIKA virus; DENGUE viruses; DENGUE hemorrhagic fever
- Publication
PLoS Neglected Tropical Diseases, 2023, Vol 16, Issue 3, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0011157