Interpretation of dengue and Zika virus diagnostic test results

Dengue and Zika virus NAATs			Interpretation
Positive dengue virus assay, negative Zika virus assay			Acute dengue virus infection
Positive Zika virus assay, negative dengue virus assay			Acute Zika virus infection
Positive (both assays)			Acute dengue and Zika virus coinfection
Negative (both assays)			No evidence of dengue or Zika virus infection*
Dengue and Zika virus IgM antibodies	Dengue virus PRNT	Zika virus PRNT	Nonpregnant patients	Pregnant women
Positive (either assay)^¶^Δ	≥10	<10	Recent dengue virus infection	Dengue virus infection, timing cannot be determined
Positive (either assay)^¶^Δ	<10	≥10	Recent Zika virus infection	Zika virus infection, timing cannot be determined
Positive (either assay)^¶	≥10	≥10	Recent flavivirus infection^◊	Flavivirus infection, timing cannot be determined
Any result	<10	<10	No evidence of dengue or Zika virus infection^§	No evidence of dengue or Zika virus infection^§
Positive dengue virus assay, negative Zika virus assay	Not performed		Presumptive recent dengue virus infection	Presumptive dengue virus infection, timing cannot be determined
Positive Zika virus assay, negative dengue virus assay	Not performed		Presumptive recent Zika virus infection	Presumptive Zika virus infection, timing cannot be determined
Positive (both assays)	Not performed		Presumptive recent flavivirus infection^◊	Presumptive flavivirus infection, timing cannot be determined
Positive dengue virus assay, Zika virus assay not performed	Not performed		Presumptive recent flavivirus infection^◊	Presumptive flavivirus infection, timing cannot be determined
Positive Zika virus assay, dengue virus assay not performed	Not performed		Presumptive recent flavivirus infection^◊	Presumptive flavivirus infection, timing cannot be determined
Negative (both assays)	Not performed		No evidence of dengue or Zika virus infection^§	No evidence of dengue or Zika virus infection^§
Negative dengue virus assay, Zika virus assay not performed	Not performed		No evidence of dengue virus infection^§	No evidence of dengue virus infection^§
Negative Zika virus assay, dengue virus assay not performed	Not performed		No evidence of Zika virus infection^§	No evidence of Zika virus infection^§

NAAT: nucleic acid amplification test; IgM: immunoglobulin M; PRNT: plaque reduction neutralization test.
* In the absence of testing to detect IgM antibodies, negative NAAT results might reflect collection after clearance of detectable viral RNA and does not rule out infection.
¶ Includes presumptive positive, indeterminate, and equivocal IgM antibody results that are not resolved by retesting.
Δ IgM and PRNT antibody testing infrequently provide discordant results (eg, dengue virus IgM positive, Zika virus IgM negative with dengue virus PRNT titer <10, Zika virus PRNT titer ≥10; or dengue virus IgM negative, Zika virus IgM positive with dengue virus PRNT titer ≥10, Zika virus PRNT titer <10). In such cases, report results as "presumptive flavivirus infection" and request a second specimen for retesting.
◊ The patient should be clinically managed for possible dengue and Zika virus infection because they might have been infected with either or both viruses. Data on the epidemiology of viruses known to be circulating at the location of exposure and clinical findings should be considered when interpreting the results.
§ In the absence of NAAT, negative IgM or neutralizing antibody testing in specimens collected ≤7 days after illness onset might reflect collection before the development of a detectable antibody response and does not rule out infection.

Reproduced from: Sharp TM, Fischer M, Muñoz-Jordán JL, et al. Dengue and Zika virus diagnostic testing for patients with a clinically compatible illness and risk for infection with both viruses. MMWR Recomm Rep 2019; 68:1.

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Interpretation of dengue and Zika virus diagnostic test results