Taiwan - Research on rapid laboratory diagnosis of dengue fever

Issues and Objectives

It is estimated that hundreds of millions of dengue virus infections occur annually in tropical and subtropical regions worldwide. Dengue infection is a threat, and recent evidence shows that infection rates are increasing year by year. Dengue virus infection leads to dengue fever and other severe dengue symptoms, with approximately 500,000 people requiring hospitalization each year due to severe dengue. The true number of dengue cases is likely far greater than the known number, possibly due to unreported cases or inaccurate clinical classification. Currently, there are no specific effective antiviral drugs to treat this viral infection. Therefore, accurate and early diagnosis, along with appropriate preventative measures, are crucial for the proper and rapid management and control of the disease in endemic areas.

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Improvement Measures Taken

The following are the detection capabilities of several commonly used detection methods:

1. Dengue fever rapid diagnostic test (RDT): Tuan Nur Akmalina Mat Jusoh and Rafidah Hanim Shueb tested 86 samples using an NS1 ELISA (Platelia™ Dengue NS1 antigen capture test (Bio-Rad Laboratories, France)). 36 samples were NS1 antigen positive, and the rest were negative. The results of the ProDetect Dengue Duo NS1 Antigen IgG/IgM rapid test (Mediven) and the SD BIOLINE Dengue Duo® rapid test were then compared with the results of the reference NS1 ELISA.
2. Real-time RT-PCR (qRT-PCR)：Tuan Nur Akmalina Mat Jusoh and Rafidah Hanim Shueb compared the results of three commercial real-time qRT-PCR kits (RealStar Dengue RT-PCR, GenoAmp Trioplex Real-Time RT-PCR Zika/Den/Chiku, and GenoAmp Real-Time RT-PCR Dengue) with NS1 ELISA test results. A total of 31 NS1 ELISA-positive samples and 5 negative samples were used in the study.
3. Dengue virus qRT-PCR Serotyping：Tuan Nur Akmalina Mat Jusoh and Rafidah Hanim Shueb detected 26 dengue-positive samples using GenoAmp Real-Time RT-PCR Dengue (Serotyping of Dengue 1-Dengue 4).

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Results

1. Rapid diagnostic test (RDT) for dengue fever: This RDT showed excellent concordance with the NS1 ELISA test, with a kappa value of 0.904 (95% CI: 0.813–0.996). For the SD BIOLINE Dengue Duo® rapid test, the sensitivity and specificity were 88.9% and 100%, respectively. This rapid test also showed very high concordance with the NS1 ELISA test, with a kappa value of 0.903 (95% CI: 0.810–0.995). This confirms that both the SD BIOLINE and ProDetect rapid dengue tests are excellent rapid diagnostic tools for dengue fever.
2. Real-time RT-PCR (qRT-PCR): All Real-time qRT-PCR assays performed in this study demonstrated high sensitivity (90.3%, 90.3%, and 83.9%). All kits showed 100% specificity when tested with negative samples. Real Star Dengue RT-PCR and GenoAmpTrioplex Real-time RT-PCR Zika/Den/Chiku showed good concordance with the NS1 ELISA, with a kappa value of 0.722 (95% CI: 0.432–1.000). The performance of GenoAmpTrioplex Real-time RT-PCR Zika/Den/Chiku was comparable to that of Real Star Dengue RT-PCR.
3. Dengue virus qRT-PCR Serotyping : Fourteen samples were infected with dengue virus type 1, eight with dengue virus type 2, two with dengue virus type 3, and one with dengue virus type 4. Another sample showed co-infection with both type 1 and type 2.

Due to climate change, the future climate will be more favorable for the survival of disease-carrying mosquitoes, which may increase the scale and severity of dengue fever outbreaks in Taiwan. The rapid diagnosis proposed in this case can accelerate the dengue fever monitoring and prevention process and can be regarded as an adaptation strategy to strengthen the public health and epidemic prevention system in response to future climate change.

Glossary

Climate change risk assessment: Using effective assessment tools to understand the medium- and long-term impacts of climate change on various sectors, and to propose corresponding adaptation strategies and actions to reduce the risks brought about by climate change.

Case type:

Structural and physical options: engineering techniques or reinforcement of existing structures, integrated technology development

Social options: learning and exchanging disaster knowledge in the community, and developing and applying early warning information.

Institutional options: Establishing institutions at the economic, policy, and legal levels

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References

Rapid laboratory diagnosis and vaccine development for dengue fever, Chen Guangming, Journal of Infection Control, Vol. 29, No. 1, pp. 29-38.

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Reference Websites

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