Approach to diagnostic testing for dengue and Zika virus infection in symptomatic nonpregnant individuals with risk for infection with both viruses

Specimen and test selection: Dengue and Zika virus NAATs, IgM antibody testing, and PRNTs should be performed on serum. Some NAATs also can be performed on plasma, whole blood, cerebrospinal fluid, or urine, and some antibody tests can be performed on plasma, whole blood, or cerebrospinal fluid. Laboratories might choose to perform dengue and Zika virus NAATs and IgM antibody testing simultaneously rather than sequentially, or to perform dengue virus nonstructural protein-1 testing instead of dengue virus NAAT.
Indications to repeat assay(s): If the patient's illness has epidemiologic or clinical significance (eg, first case of local transmission in area, new transmission mode, or unusual clinical syndrome), repeat a positive NAAT on newly extracted RNA from the same specimen. For indeterminate IgM antibody test results, repeat IgM antibody testing or perform PRNT on the same specimen. In areas where PRNTs are not performed, report the indeterminate results and request a second serum specimen for IgM antibody testing.
Interpretation of results: Dengue and Zika virus IgM antibodies can be detected in serum for months following infection. The specific timing of infection cannot be determined. 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 of serologic diagnostic testing.