Evaluation of Commercially Available Serologic Diagnostic Tests for Chikungunya Virus

Christine M. Prat

, Olivier Flusin, Amanda Panella, Bernard Tenebray, Robert Lanciotti, and Isabelle Leparc-Goffart

Author affiliations: French Armed Forces Biomedical Research Institute (IRBA), Marseille, France (C.M. Prat, O. Flusin, B. Tenebray, I. Leparc-Goffart); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A. Panella, R. Lanciotti)

Abstract

Chikungunya virus (CHIKV) is present or emerging in dengue virus–endemic areas. Infections caused by these viruses share some common signs/symptoms, but prognosis, patient care, and persistent symptoms differ. Thus, accurate diagnostic methods are essential for differentiating the infections. We evaluated 4 CHIKV serologic diagnostic tests, 2 of which showed poor sensitivity and specificity.

Disease caused by chikungunya virus (CHIKV), a mosquitoborne arbovirus (family Togaviridae family, genus Alphavirus), is clinically characterized by sudden-onset fever and severe arthralgia, which may persist for weeks, months, or years after the acute phase of the infection (1). Other symptoms of CHIKV infection (headache, fatigue, and rash) are common among many arboviral infections, including dengue.

CHIKV is endemic to some parts of Africa and causes recurrent epidemic waves in Asia and the Indian subcontinent. In 2005, CHIKV emerged in the Indian Ocean region (2), and at the end of 2013, the virus emerged in the Americas. The latter emergence occurred on St. Martin Island in the Caribbean, where autochthonous cases were confirmed in early December 2013; thereafter, the virus rapidly expanded to neighboring islands and territories (3). Aedesaegypti and Ae. albopictus mosquitoes, the vectors of CHIKV and dengue virus (DENV), are established in tropical and temperate regions of the world. The vulnerability of Europe to transmission of CHIKV and other arboviruses has been shown: autochthonous cases of CHIKV infection occurred in Italy in 2007 (4) and in France in 2010 (5), and cases of autochthonous dengue occurred in France in 2010 and 2013 (6,7).

The rate of CHIKV and DENV co-infections during the recent epidemic of CHIKV infections on St. Martin was 2.8% (8). It can be challenging to differentiate clinically between CHIKV and DENV infections, but it is crucial to do so because prognosis and patient care differ for these diseases.

The increasing threat of CHIKV emergence in temperate regions and the need to anticipate possible outbreaks of CHIKV infection are presenting a challenge to the current level of diagnostic preparedness. In France, a National Public Health plan for stopping the spread of CHIKV and DENV has been developed. The plan calls for detecting possible infections by obtaining clinical samples from patients with suspected cases and using vector control measures if needed. The diagnostic strategy (9) is twofold: for serum collected 1–7 days after the onset of symptoms, real-time PCR is used to detect viral genome; and for serum collected >5 days after onset of symptoms, serologic techniques are used to detect IgM and/or IgG responses to the virus. Real-time PCR testing can differentiate between DENV and CHIKV infections; however, a certain proportion of infected persons seek medical care at a time when real-time PCR is no longer effective for diagnosis. Thus, we evaluated commercially available serologic test kits that could be used widely.

One serologic testing method is the indirect fluorescent antibody (IFA) technique. Although IFA tests have good sensitivity and specificity (10) for CHIKV, this method requires specific material that may not be available in diagnostic laboratories worldwide. Furthermore, a previous study showed variability in IFA results between laboratories (11). Thus, we focused our analysis on 2 other serologic CHIKV detection methods: ELISA and immunochromatography test for rapid detection (RDT).

Dr Prat is deputy director of the French National Reference Center for Arboviruses at IRBA. Her research interests include arboviruses epidemiology and viral infections of the brain.

Acknowledgment

This work was financed by the French National Reference Center for Arboviruses.

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Tables

Suggested citation for this article: Prat CM, Flusin O, Panella A, Tenebray B, Lanciotti R, Leparc-Goffart I. Evaluation of commercially available serologic diagnostic tests for chikungunya virus. Emerg Infect Dis. 2014 Dec [date cited]. http://dx.doi.org/10.3201/eid2012.41269

DOI: 10.3201/eid2012.141269