Comparison of two dengue NS1 rapid tests for sensitivity, specificity and relationship to viraemia and antibody responses.
BACKGROUND
Dengue is a major public health problem in tropical and subtropical countries. Rapid and easy diagnosis of dengue can assist patient triage and care-management. The detection of DENV NS1 on rapid lateral flow tests offers a fast route to a presumptive dengue diagnosis but careful evaluations are urgently needed as more and more people use them.


METHODS
The sensitivity and specificity of the Bio-Rad NS1 Ag Strip and SD Dengue Duo (NS1/IgM/IgG) lateral flow rapid tests were evaluated in a panel of plasma samples from 245 Vietnamese patients with RT-PCR confirmed dengue and 47 with other febrile illnesses.


RESULTS
The NS1 rapid tests had similar diagnostic sensitivities (respectively 61.6% and 62.4%) in confirmed dengue cases but were 100% specific. When IgM/IgG results from the SD Dengue Duo were included in the test interpretation, the sensitivity improved significantly from 62.4% with NS1 alone to 75.5% when NS1 and/or IgM was positive and 83.7% when NS1 and/or IgM and/or IgG was positive. Both NS1 assays were significantly more sensitive for primary than secondary dengue. NS1 positivity was associated with the underlying viraemia as NS1-positive samples had a significantly higher viraemia than NS1-negative samples.


CONCLUSIONS
These data suggest that the NS1 test component of these assays are highly specific and have similar levels of sensitivity. The IgM parameter in the SD Duo test improved overall test sensitivity without compromising specificity. The SD Dengue Duo lateral flow rapid test deserves further prospective evaluation in dengue endemic settings.
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, District 5, Ho Chi Minh City, Viet Nam. vianney.tricou@kellogg.ox.ac.uk
Vianney
V
Tricou
Hang T T
HT
Vu
Nhu V N
NV
Quynh
Chau V V
CV
Nguyen
Hien T
HT
Tran
Jeremy
J
Farrar
Bridget
B
Wills
Cameron P
CP
Simmons
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007223:Infant; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012367:RNA, Viral / Q000097:blood; D011933:Reagent Kits, Diagnostic; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D014744:Vietnam; D017361:Viral Nonstructural Proteins / Q000097:blood*; D014766:Viremia; D055815:Young Adult
D000914:Antibodies, Viral; D012367:RNA, Viral; D011933:Reagent Kits, Diagnostic; D017361:Viral Nonstructural Proteins