Journal of Clinical Microbiology, December 29, 2017

Premkumar L, Collins M, Graham S, Liou GA, Lopez CA, Jadi R, Balmaseda A, Brackbill JA, Dietze R, Camacho E, De Silva AD, Giuberti C, Dos Reis HL, Singh T, Heimsath H, Weiskopf D, Sette A, Osorio JE, Permar SR, Miley MJ, Lazear HM, Harris E, de Silva AM


Zika virus (ZIKV) is an emerging flavivirus that can cause birth defects and neurologic complications. Molecular tests are effective in diagnosing acute ZIKV infection, although the majority of infections produce no symptoms at all or present after the narrow window in which molecular diagnostics are dependable. Serology is a reliable method for detecting infections after the viremic period; however, most serological assays have limited specificity due to cross-reactive antibodies elicited by flavivirus infections. Since ZIKV and dengue virus (DENV) widely co-circulate, distinguishing ZIKV from DENV infection is particularly important for diagnosing individual cases or surveillance to coordinate public health response. Flaviviruses also elicit type-specific antibodies directed to non-cross-reactive epitopes of the infecting virus; such epitopes are attractive targets for designing antigens to develop serologic tests with greater specificity. Guided by comparative epitope modeling of ZIKV envelope protein, we designed two recombinant antigens displaying unique antigenic regions on domain I (Z-EDI) and domain III (Z-EDIII) of ZIKV envelope protein. Both Z-EDI and Z-EDIII antigens consistently detected ZIKV-specific IgG in ZIKV-immune sera but not cross-reactive IgG in DENV-immune sera in late convalescence (>12 weeks post-infection). In contrast, during early convalescence (2-12 weeks post-infection), secondary DENV-immune sera and some primary DENV-immune sera cross-reacted with Z-EDI and Z-EDIII antigens. Analysis of sequential samples from DENV-immune individuals demonstrated that Z-EDIII cross-reactivity peaked in the early convalescence and steeply declined over time. The Z-EDIII antigen has much potential as a diagnostic antigen for population level surveillance and for detecting past infections in patients.

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