Arbovirus Epidemiology and Diagnosis Educational Session Curacao 2016 R. Steingrover Clinical Microbiologist ADC

Transcription

1 Arbovirus Epidemiology and Diagnosis Educational Session Curacao 2016 R. Steingrover Clinical Microbiologist ADC

2 Contents Serology Epidemiology arboviruses Brazil microcephaly Regional epidemiology Curacao data Serological testing for Zika PCR testing for Zika Take home messages

3 Zika virus Zikavirus ZIKV ARBO virus = arthropod borne virus, carried by insects Family of flaviviridae, genus flavivirus, type species = Yellow fever virus Enveloped, icosahedral nucleocapsid, single stranded RNA to bp Dengue virus West Nile virus Japanese Encephalitis virus

4 Serology

5 Serology Serology regards to: A testing of IgM and IgG (or IgA) in blood B testing of IgM and IgG in CSF C testing of antigen/toxins in blood D testing of DNA in blood E answers A+B+C

6 Serology

7 Serology True? A B C IgM always comes before IgG B-cells make only IgG IgG is more cross reactive than IgM

8 Serology

9 Serology

10 Serology

11 Serology

12 Serology

13 Serology

14 Serology

15 Serology

16 Serology Dengue and Chikungunya epidemics: A occur only once in a country? B only Dengue epidemics return in a country C both can cause cyclic epidemics in a country

17 Epidemiology /

18 Epidemiology /

19 Epidemiology /

20 Epidemiology

21 Epidemiology

22 Epidemiology

23 Serology Zika causes microcephaly A is a conspiracy B no, pesticides causes microcephaly C is a fact D is supported by evidence

24 Zika and the microcephaly ID week 2016

25 Epidemiology

26 Sources of data

27 Sources of data If I want to know how much Zika infections there are, I go to: A Facebook B C the newspaper D WHO/PAHO

28 Epidemiology

29 Epidemiology

30 Epidemiology

31 Epidemiology

32 Epidemiology

33 Epidemiology

34 Epidemiology Curacao?

35 Epidemiology

36 Epidemiology

37 Epidemiology

38 Virology

39 Epidemiology

40 Epidemiology

41 Epidemiology

42 Epidemiology

43 CHIKV CUR

44 CHIKV CUR n=&gid=37226&lang=en

45 Virology Source: GGz Curacao

46 CHIKV 2014 tests Source: ADC Curacao

47 CHIKV 2015 tests Source: ADC Curacao

48 DENV 2014 tests Source: ADC Curacao

49 DENV 2015 tests Source: ADC Curacao

50 DENV 2016 tests Source: ADC Curacao

51 CHIKV 2016 tests Source: ADC Curacao

52 ZIKV 2016 tests Source: ADC Curacao

53 CUR 2016 tests Curacao PCR tests for Zika 2016 up to wk tested positives Dengue: IgM positives indicate Dengue activity or Zika cross-reactivity No surveillance of Dengue serotypes (1-4) CHIKV Very little activity Source: ADC Curacao

54 Testing arboviruses True?: A Always test for DENV+CHIKV+ZIKV together B DENV IgG cross reacts in ZIKV IgG test C ZIKV IgG cross reacts in DENV IgG test D PCR testing is not necessary if you test serology

55 ZIKV tests making money

56 ZIKV tests

57 ZIKV tests North Mexico and US: no DENV/CHIKV coinfection

58 ZIKV tests ~50% cross-reactivity IgG but IgM 0%: Logical?

59 ZIKV tests ~50% cross-reactivity IgG but IgM 0%: Logical? Only in IgM negative patients!

60 ZIKV tests ~50% cross-reactivity IgG IgM 0%: only in IgM negative patients/samples Logical?

61 ZIKV tests Preliminary results, need confirmation testing

62 ZIKV tests Serological specificity 2016 Eurosurveillance

63 ZIKV tests Serological sensitivity Source: Euroimmun, Dr Jens Warnecke

64 ZIKV ELISA IgG (RU/ml) ZIKV tests ZIKV IgG repeated Source: ADC

65 ZIKV PCR Testing PCR in urine Adapted early in ADC Twice as sensitive as plasma in only published comparison Longer diagnostic window in urine than plasma Absolute sensitivity of PCR unknown

66 PCR Testing

67 ZIKV PCR Testing PCR in urine Source: ADC

68 ZIKV PCR Testing PCR in urine is best Curacao PCRs ~30% positive overall What about the other 70%? Out of window? No shedding of RNA/DNA in urine? Dengue infection?

69 ZIKV Testing Currently PCR + serological tests available ZIKV Anti-NS1 ELISA shows no cross-reactivity PCR for zika has limited diagnostic window Limited information regarding sensitivity of PCR Most (but not all) patients seroconvert for anti- ZIKV IgG

70 Testing Positive PCR establishes current infection Serologic testing additional value Specific regarding DENV and CHIKV IgG high/rise probably most sensitive test for (past) ZIKV infection IgM lacks sensitivity, probably also specificity Useful in PCR negative Zika-suspected cases Reimbursement from SVB for Gynaecology+Neurology+SEHOS Epidemiology of test results Useful monitoring for Curacao? Not all serological test perform equal

71 Questions?

72 Questions? Thank you for participating Please review this session Any suggestions for future topics are welcome!