Arbovirus Epidemiology and Diagnosis Educational Session Curacao 2016 R. Steingrover Clinical Microbiologist ADC
Contents Serology Epidemiology arboviruses Brazil microcephaly Regional epidemiology Curacao data Serological testing for Zika PCR testing for Zika Take home messages
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 10000 to 11000 bp Dengue virus West Nile virus Japanese Encephalitis virus https://en.wikipedia.org/wiki/zika_virus
Serology https://www.cdc.gov/dengue/clinicallab/laboratory.html
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
Serology https://www.cdc.gov/dengue/clinicallab/laboratory.html
Serology True? A B C IgM always comes before IgG B-cells make only IgG IgG is more cross reactive than IgM
Serology http://www.slideshare.net/allergychula/immunoglobulin
Serology http://course1.winona.edu/kbates/bio241/immunolo.htm
Serology http://www.euroimmunblog.com/recognizing-dengue/
Serology https://www.ncbi.nlm.nih.gov/books/nbk143156/
Serology https://www.cdc.gov/dengue/clinicallab/diagnosticprocess.html
Serology https://www.ncbi.nlm.nih.gov/books/nbk143156/
Serology https://www.ncbi.nlm.nih.gov/books/nbk143156/
Serology http://
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
Epidemiology http://indianexpress.com/article/india/india-news-india/chikungunya-dengue-rise-hospitals-symptoms-medicine- 3013730/
Epidemiology http://indianexpress.com/article/india/india-news-india/chikungunya-dengue-rise-hospitals-symptoms-medicine- 3013730/
Epidemiology http://indianexpress.com/article/india/india-news-india/chikungunya-dengue-rise-hospitals-symptoms-medicine- 3013730/
Epidemiology http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
Epidemiology http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
Epidemiology http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
Serology Zika causes microcephaly A is a conspiracy B no, pesticides causes microcephaly C is a fact D is supported by evidence
Zika and the microcephaly ID week 2016
Epidemiology http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
Sources of data http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
Sources of data If I want to know how much Zika infections there are, I go to: A Facebook B www.outbreaknews.com C the newspaper D WHO/PAHO http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
Epidemiology http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
Epidemiology http://www.paho.org/hq/index.php?option=com_content&view=article&id=11603&itemid=41696&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_content&view=article&id=11603&itemid=41696&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_content&view=article&id=11603&itemid=41696&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_content&view=article&id=11603&itemid=41696&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_content&view=article&id=11603&itemid=41696&lang=en
Epidemiology Curacao?
Epidemiology http://www.paho.org/hq/index.php?option=com_content&view=article&id=11603&itemid=41696&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_topics&view=rdmore&cid=6290&itemid=40734
Epidemiology www.paho.org/hq/index.php?option=com_docman&task=doc_download&itemid=270&gid=37257&lang=en
Virology www.paho.org/hq/index.php?option=com_docman&task=doc_download&itemid=270&gid=37257&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&itemid=270&gid=32910&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&itemid=270&gid=28795&lang=en
Epidemiology http://www.paho.org/hq/index.php?option=com_topics&view=article&id=343&itemid=40931
Epidemiology http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&itemid=&gid=37226&lang=en
CHIKV CUR 2014 http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&itemid=270&gid=30198&lang=en
CHIKV CUR 2015 http://http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&itemid=270&gid=33091&lang=e n=&gid=37226&lang=en
Virology Source: GGz Curacao
CHIKV 2014 tests Source: ADC Curacao
CHIKV 2015 tests Source: ADC Curacao
DENV 2014 tests Source: ADC Curacao
DENV 2015 tests Source: ADC Curacao
DENV 2016 tests Source: ADC Curacao
CHIKV 2016 tests Source: ADC Curacao
ZIKV 2016 tests Source: ADC Curacao
CUR 2016 tests Curacao PCR tests for Zika 2016 up to wk 47 3000+ tested 1000+ 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
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 http://www.slideshare.net/conass/ct-conjunta-220316-dengue-chikungunya-e-zika-situao-epidemiolgica-e-vigilncia
ZIKV tests making money http://chembio.com/dpp-zika-igmigg-system-ce-marked/
ZIKV tests http://chembio.com/dpp-zika-igmigg-system-ce-marked/
ZIKV tests North Mexico and US: no DENV/CHIKV coinfection http://chembio.com/dpp-zika-igmigg-system-ce-marked/
ZIKV tests ~50% cross-reactivity IgG but IgM 0%: Logical? http://chembio.com/dpp-zika-igmigg-system-ce-marked/
ZIKV tests ~50% cross-reactivity IgG but IgM 0%: Logical? Only in IgM negative patients! http://chembio.com/dpp-zika-igmigg-system-ce-marked/
ZIKV tests ~50% cross-reactivity IgG IgM 0%: only in IgM negative patients/samples Logical? http://chembio.com/dpp-zika-igmigg-system-ce-marked/
ZIKV tests Preliminary results, need confirmation testing http://chembio.com/dpp-zika-igmigg-system-ce-marked/
ZIKV tests Serological specificity 2016 Eurosurveillance https://www.euroimmun.com/fileadmin/euroimmun/pdf/autoimmunity/infections/zika/huzly_et_al.pdf
ZIKV tests Serological sensitivity Source: Euroimmun, Dr Jens Warnecke
ZIKV ELISA IgG (RU/ml) ZIKV tests ZIKV IgG repeated 350 300 250 200 150 100 50 0 Source: ADC
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 http://
PCR Testing http://trstmh.oxfordjournals.org/content/50/5/442.full.pdf+html
ZIKV PCR Testing PCR in urine Source: ADC
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? http://
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 http://
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 http://
Questions? http://
Questions? Thank you for participating Please review this session Any suggestions for future topics are welcome! http://