Diagnostics EvaluationDiagnostics Serie Evaluation Series No.3 Evaluation of commercially available anti-dengue virus immunoglobulin M tests Special Programme for Research & Training in Tropical Diseases (TDR) sponsored by UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR) sponsored by UNICEF/UNDP/World Bank/WHO WHO Library Cataloguing-in-Publication Data : Evaluation of commercially available anti-dengue virus immunoglobulin M tests. (Diagnostics evaluation series, 3) 1.Dengue - diagnosis. 2.Dengue - immunology. 3.Dengue virus - immunology. 4.Immunoglobulin M - blood. 5.Immunoglobulin M - immunology. 5.Antibodies, Viral - blood. 6.Enzyme-linked immunosorbent assay. 7.Reagent kits, Diagnostic. I.UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. II.Pediatric Dengue Vaccine Initiative. 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Peeling TDR/World Health Organization Accessible Quality Assured Diagnostics 20, Avenue Appia UNICEF/UNDP/World Bank/WHO Special Programme 1211 Geneva 27 for Research & Training in Tropical Diseases (TDR) Switzerland World Health Organization 20, Avenue Appia Fax: (+41) 22 791-4854 1211, Geneva 27 [email protected] Switzerland www.who.int/tdr Tel: (+41) 22 791-3742 E-mail: [email protected] Evaluation of commercially available anti-dengue virus immunoglobulin M tests Acknowledgements TDR is indebted to the members of the Dengue diagnostics evaluations steering group, Drs Harvey Artsob, Duane Gubler, Maria Guzman, Elizabeth Hunsperger, Harold Margolis, Rosanna Peeling and Sutee Yoksan for their valuable input into the development of the dengue diag- nostics evaluation scheme. Without them, this work would not have been possible. TDR would like to acknowledge the excellent work of the principal investigators and staff at the evaluation laboratories, in particular, the staff of the reference laboratories for validating the qualification panels, repackaging and sending out the tests to all the sites and performing the reproducibility testing. The excellent assistance of Michael Drebot with the coordination of the proficiency testing, of Mary Cheang with data analysis, of Nidia Rizzo with technical coordination, and of Isabela Suder-Dayao with contract administration is much appreciated. This report was prepared by José Luis Pelegrino and Carl-Michael Nathanson. The main findings from this evalution has been published in Emerging Infectious Diseases. Hunsperger EA, Yoksan S, Buchy P, et al. Evaluation of commercially available anti–dengue virus immunoglobulin M tests. Emerg Infect Dis. 2009; 15:436-40. DOI: 10.3201/eid1503.080923 Evaluation of commercially available anti-dengue virus immunoglobulin M tests i Abbreviations AFRIMS Armed Forces Research Institute of Medical Sciences CDC Centers for Disease Control CI confidence interval DENV dengue virus EIA enzyme immunoassay ELISA enzyme-linked immunosorbent assay ERC ethical review committee GCLP good clinical laboratory practice HRP horse radish peroxidase IgG immunoglobulin G IgM immunoglobulin M MAb monoclonal antibody MAC-ELISA IgM antibody capture ELISA OD optical density PCR polymerase chain reaction PDVI Pediatric Dengue Vaccine Initiative QA quality assurance RDT rapid diagnostic test RFA request for application RNA ribonucleic acid SE sensitivity SPC specificity TDR Special Programme for Research and Training in Tropical Diseases WHO World Health Organization ii Evaluation of commercially available anti-dengue virus immunoglobulin M tests Table of contents Objectives ..................................................... 1 Background ................................................... 2 1. Evaluation plan .............................................. 3 1.1 Tests under evaluation ............................................ 3 1.2 Evaluation sites .................................................. 6 1.3 Evaluation panel.................................................. 7 2. Site preparation ............................................. 9 2.1 Proficiency ....................................................... 9 2.2 Ethical considerations ............................................. 9 3. Evaluation .................................................... 10 3.1 Before testing ...................................................10 3.2 Performing the tests – general procedures .......................... 10 3.3 Performing the tests – specific procedures ..........................11 Dengue Duo Cassette (DuoCassette) Panbio Diagnostics, Australia....................................12 Hapalyse Dengue-M PA Kit (HapalyseM) Pentax Corporation, Japan ......................................13 SD Bioline Dengue IgG/IgM (SD Bioline) Standard Diagnostics, Republic of Korea ..........................14 Dengucheck WB (Dengucheck) Zephyr Biomedicals, India ...................................... 15 Dengue Fever Virus IgM Capture DxSelect (DxSelect) Focus Diagnostics, United States of America ...................... 16 Evaluation of commercially available anti-dengue virus immunoglobulin M tests iii Dengue IgM Capture ELISA (Pb IgMCap) Panbio Diagnostics, Australia....................................18 Pathozyme–Dengue M (Pathozyme M) Omega Diagnostics Ltd., United Kingdom .........................19 Pathozyme–Dengue M Capture (Pathozyme MCap) Omega Diagnostics Ltd., United Kingdom .........................20 SD Dengue IgM Capture ELISA (SD IgMCap) Standard Diagnostics, Republic of Korea ..........................21 4. Results ........................................................ 24 4.1 ELISAs..........................................................26 4.2 Rapid Tests ..................................................... 28 4.3 Cross-reactions .................................................. 30 4.4 Test reproducibility and user-friendliness ...........................32 Conclusion ................................................... 34 References ...................................................36 Annexes . 37 iv Evaluation of commercially available anti-dengue virus immunoglobulin M tests Accessible Quality-Assured Diagnostics is a unit within the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) aimed at promoting and facilitating the development, evaluation and deployment of diagnostic tools appropriate for use in developing countries. Pediatric Dengue Vaccine Initiative (PDVI) was established to raise awareness and work with public and private part- ners in the North and South to accelerate the development and introduction of dengue vaccine(s) that are affordable and accessible to poor children in endemic countries. Evaluation