Zika Virus, IgM, Serum

CPT: 86790
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Test Details

Use

Presumptive (not definitive) evidence of Zika virus infection

Limitations

Interpretation of Zika IgM results must account for the possibility of false-negative and false-positive results. False-negative results can arise from:

a) Specimen collection conducted before IgM has reached detectable levels (typically around 4 days postonset of symptoms).

b) Specimen collection conducted after IgM levels have decreased below detectable levels (typically around 12 weeks postonset of symptoms).

c) Failure to follow the authorized assay procedures.

The most common cause of false-positive results is cross-reactivity with IgM specific for other flaviviruses such as dengue virus. Only limited evaluation of cross-reactivity with flaviviruses or arboviruses has been conducted. No evaluation of cross-reactivity with rheumatoid factor has been conducted. Clinical data indicate cross-reactivity with antidengue virus antibodies is likely. Follow-up testing is necessary to rule out a false-positive result. Confirmation of the presence of anti-Zika IgM requires testing by CDC or a CDC-designated laboratory. The gold-standard method for confirmation of the presence of anti-Zika antibodies is the plaque reduction neutralization test (PRNT). Specimens are sent to CDC or a CDC designated State Laboratory for PRNT when results indicate the need based on the most recent algorithm(s).

The CDC may refuse to accept specimens for PRNT that do not meet their epidemiologic criteria for PRNT testing. If this occurs you will be notified by the report. Follow up may occur from your state public health laboratory.

All Zika testing should be conducted following the CDC-issued Zika laboratory guidance and testing algorithms: http://www.cdc.gov/zika/state-labs/index.html

Negative results do not preclude infection with Zika virus and should not be used as the sole basis of a patient treatment/management decision. All results should be interpreted by a trained professional in conjunction with review of the patient's history and clinical signs and symptoms.

This assay is for in vitro diagnostic use under FDA Emergency Use Authorization only and is limited to qualified laboratories.

All specimens should be handled as if infectious. Proper biosafety precautions, including personal protective equipment, must be used when handling specimen materials.

Proper collection, storage and transport of specimens are essential for correct results.

Performance has only been established with the specimen types listed in the Intended Use. Other specimen types are not acceptable for use with this assay.

It should be noted that as of April 2016, any patient whose sample yields positive PRNT results (ie, ≥10) for both Zika and dengue virus is now classified as having a flavivirus infection. This virus infection is only specified if one result is positive and the other negative. The former fourfold difference to identify the infection has been shown to be incorrect in a number of instances and has now been abandoned for Zika diagnosis only.

Methodology

IgM antibody capture ELISA

Additional Information

• This test has not been FDA cleared or approved;

• This test has been authorized by FDA under an Emergency Use Authorization (EUA) for use by authorized laboratories;

• This test has been authorized only for the diagnosis of Zika virus infection and not for any other viruses or pathogens; and

• This test is only authorized for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of in vitro diagnostic tests for detection of Zika virus and/or diagnosis of Zika virus infection under section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.

Specimen Requirements

Specimen

Serum

Volume

2 mL

Minimum Volume

1 mL

Container

Gel-barrier tube is preferred. Red top tube is acceptable.

Collection

Usual phlebotomy collection. Spin as quickly as possible after clot formation, remove serum, and refrigerate.

Storage Instructions

Refrigerate

Stability Requirements

Temperature

Period

Room temperature

Unstable

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Specimen submitted at room temperature; overly hemolyzed specimen; lipemia; gross bacterial contamination; mislabeled specimen

Clinical Information

Special Instructions

Pregnancy status must be captured as part of the EUA and agreement with the CDC to offer the Zika virus IgM test. See the CDC website for updates to recommendations for Zika virus testing.

References

AABB. Updated Recommendations for Zika, Dengue, and Chikungunya Viruses. AABB Association Bulletin No. 16-07. September 28, 2016.
Bingham AM, Cone M, Mock V, et al. Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from persons with Travel-Associated Zika Virus Disease - Florida, 2016. MMWR / May 10, 2016 / Vol. 65 / No. 18.
Centers for Disease Control and Prevention. Zika MAC-ELISA Assay Instructions for Use. Version: 6/29/2016
InBios Zika Detect IgM Capture ELISA Instructions for Use. August 17, 2016.
Petersen EE, Polen KN, Meaney-Delman D, et al. US Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure - United States, 2016. MMWR / April 1, 2016 / Vol. 65 / No. 12.
Rabe IB, Staple E, Villanueva J, et al. Interim guidance for interpretation of Zika virus antibody test results. MMWR / June 3, 2016 / Vol. 65 / No. 21.
World Health Organization. Laboratory testing for Zika virus infection. Interim guidance. 23 March 2016. WHO/ZIKV/LAB/16.1.
World Health Organization, Pan American Health Organization. Zika virus (ZIKV) Surveillance in the Americas: Laboratory detection and diagnosis. Algorithm for detecting Zika Virus (ZIKV). Available at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=30176&lang=en

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
163049 Zika Virus IgM (EUA) 80824-6 163047 Zika Virus IgM (EUA) 80824-6
Reflex Table for Zika Virus IgM (EUA)
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 163039 Zika Tracking 163039 Zika Tracking N/A
Reflex Table for Zika Virus IgM (EUA)
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 163039 Zika Tracking 163039 Zika Tracking N/A

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