Landry Marie Louise, St George Kirsten
From the Departments of Laboratory Medicine and Medicine, Yale University School of Medicine, New Haven, Connecticut (Dr Landry); and the Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany (Dr St. George).
Arch Pathol Lab Med. 2017 Jan;141(1):60-67. doi: 10.5858/arpa.2016-0406-SA. Epub 2016 Oct 20.
-The rapid and accurate diagnosis of Zika virus infection is an international priority.
-To review current recommendations, methods, limitations, and priorities for Zika virus testing.
-Sources include published literature, public health recommendations, laboratory procedures, and testing experience.
-Until recently, the laboratory diagnosis of Zika infection was confined to public health or research laboratories that prepared their own reagents, and test capacity has been limited. Furthermore, Zika cross-reacts serologically with other flaviviruses, such as dengue, West Nile, and yellow fever. Current or past infection, or even vaccination with another flavivirus, will often cause false-positive or uninterpretable Zika serology results. Detection of viral RNA during acute infection using nucleic acid amplification tests provides more specific results, and a number of commercial nucleic acid amplification tests have received emergency use authorization. In addition to serum, testing of whole blood and urine is recommended because of the higher vial loads and longer duration of shedding. However, nucleic acid amplification testing has limited utility because many patients are asymptomatic or present for testing after the brief period of Zika shedding has passed. Thus, the greatest need and most difficult challenge is development of accurate antibody tests for the diagnosis of recent Zika infection. Research is urgently needed to identify Zika virus epitopes that do not cross-react with other flavivirus antigens. New information is emerging at a rapid pace and, with ongoing public-private and international collaborations and government support, it is hoped that rapid progress will be made in developing robust and widely applicable diagnostic tools.
寨卡病毒感染的快速准确诊断是一项国际重点工作。
回顾寨卡病毒检测的当前建议、方法、局限性及重点事项。
资料来源包括已发表的文献、公共卫生建议、实验室程序及检测经验。
直到最近，寨卡感染的实验室诊断还局限于自行制备试剂的公共卫生或研究实验室，检测能力有限。此外，寨卡病毒在血清学上与其他黄病毒发生交叉反应，如登革热、西尼罗河病毒和黄热病病毒。当前或既往感染，甚至接种过另一种黄病毒疫苗，常常会导致寨卡病毒血清学检测结果出现假阳性或无法解读的情况。在急性感染期间使用核酸扩增试验检测病毒RNA可提供更具特异性的结果，一些商用核酸扩增试验已获得紧急使用授权。除血清外，建议对全血和尿液进行检测，因为病毒载量更高且排毒持续时间更长。然而，核酸扩增试验的效用有限，因为许多患者无症状，或在寨卡病毒短暂排毒期过后才前来检测。因此，最迫切的需求和最艰巨的挑战是开发用于诊断近期寨卡感染的准确抗体检测方法。迫切需要开展研究以确定不与其他黄病毒抗原发生交叉反应的寨卡病毒表位。新信息正在迅速涌现，通过持续的公私合作、国际合作及政府支持，有望在开发强大且广泛适用的诊断工具方面取得快速进展。
