Clinical Scorecard: Assessing Seroprevalence of Zika Virus in a Dengue-Endemic Community: Utilizing Blood Donor Samples and Multiplex Serology for Arbovirus Surveillance in the Dutch Caribbean

At a Glance

Key Highlights

• ZIKV seroprevalence was 25% in Curaçao and 8% in Aruba during and after outbreaks (2016–2017).
• Multiplex NS1 protein microarray combined with VNT allowed differentiation of ZIKV from other flavivirus exposures despite antibody cross-reactivity.
• Flavivirus IgG antibody titers increased with age, highlighting the importance of age adjustment in seroprevalence interpretation.

Guideline-Based Recommendations

Diagnosis

• Use virus neutralization tests (VNT) as the gold standard for flavivirus serology due to highest specificity.
• Employ multiplex serology targeting NS1 proteins for large-scale seroprevalence studies to improve specificity and feasibility.
• Consider timing of sample collection as early post-infection phases may show transient cross-neutralizing antibodies.

Management

• Utilize seroprevalence data from blood donors to estimate outbreak magnitude and inform public health responses.
• Incorporate age stratification in serological data analysis to account for antibody background patterns.

Monitoring & Follow-up

• Leverage existing voluntary blood donor programs for ongoing arbovirus surveillance in endemic regions.
• Combine multiplex serology with confirmatory VNT to monitor flavivirus circulation and outbreak dynamics.

Risks

• Cross-reactive antibodies due to original antigenic sin may complicate serological interpretation in endemic areas.
• Underreporting of ZIKV cases is likely due to asymptomatic infections and short molecular detection windows.

Patient & Prescribing Data

Healthy adult blood donors from dengue and Zika endemic Caribbean islands

Not applicable; study focuses on seroprevalence and surveillance rather than treatment

Clinical Best Practices

• Use multiplex NS1 protein assays combined with VNT confirmation to accurately determine flavivirus exposure in endemic settings.
• Include age as a covariate when interpreting flavivirus serology results to adjust for cumulative antibody exposure.
• Employ blood donor samples as a practical and representative source for arbovirus serosurveillance.
• Recognize limitations of molecular diagnostics due to short detection windows and asymptomatic infections in outbreak assessment.

References

• Flavivirus emergence and Zika virus spread
• Zika virus associated severe disease
• Zika virus outbreaks in Aruba and Curaçao
• Cross-reactivity and original antigenic sin in flavivirus serology
• NS1 protein as specific serological target