Dengue diagnostic test use to identify Aedes-borne disease hotspots
Authors: Audrey Dubot-Pérès, Manivanh Vongsouvath, Vilayouth Phimolsarnnousith, Elizabeth A Ashley, Paul N Newton
Journal: The Lancet Planetary Health (2021)

We were very interested to read the discussion of Felipe Dzul-Manzanilla and colleagues1Dzul-Manzanilla F Correa-Morales F Che-Mendoza A et al.Identifying urban hotspots of dengue, chikungunya, and Zika transmission in Mexico to support risk stratification efforts: a spatial analysis.Lancet Planet Health. 2021; 5: e277-e285Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar on the importance of identifying hotspots of Aedes mosquito-borne virus transmission for establishing efficient disease control. Identification of high risk transmission areas is based on the spatiotemporal epidemiology of patients with confirmed dengue virus, chikungunya virus, and Zika virus infection over a substantial period of time. However, much of the global rural population live in areas beyond surveillance, with hotspots of data focused around research institutions and urban areas and vast areas of the world that are surveillance terra incognita. With the enormous infrastructural and financial challenges for building appropriate formal laboratory systems in rural Africa, Asia, and the Americas, innovation is needed to build ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free and Deliverable to end-users) surveillance systems to collect reliable data on Aedes-borne disease transmission. Effective widespread planetary expansion of formal laboratory systems will take decades and, in the meantime, one potential method would be to add diagnostic value to rapid diagnostic tests (RDTs) as substrates for detection of pathogens presenting with similar clinical syndromes and epidemiology. Dengue immunoglobulin (Ig)M and IgG and non-structural protein 1 RDTs are widely used for dengue surveillance in Asia, but there are no equivalent tests for Zika virus and chikungunya virus. We have shown that in Laos, dengue virus, Zika virus, and chikungunya virus RNA can be simply extracted from dengue RDTs up to 2 months after use, for doing RT-PCR for all three viruses.2Vongsouvath M Phommasone K Sengvilaipaseuth O et al.Using rapid diagnostic tests as a source of viral RNA for dengue serotyping by RT-PCR—a novel epidemiological tool.PLoS Negl Trop Dis. 2016; 10e0004704Crossref PubMed Scopus (8) Google Scholar, 3Cassidy-Seyoum S Vongsouvath M Sengvilaipaseuth O et al.Rapid diagnostic tests as a source of dengue virus RNA for envelope gene amplification: a proof of concept.Am J Trop Med Hyg. 2019; 101: 451-455Crossref PubMed Scopus (1) Google Scholar, 4Vongsouvath M Bharucha T Seephonelee M et al.Harnessing dengue rapid diagnostic tests for the combined surveillance of dengue, Zika, and chikungunya viruses in Laos.Am J Trop Med Hyg. 2020; 102: 1244-1248Crossref PubMed Scopus (2) Google Scholar In pilot work, extracts from RDTs could also be used for dengue virus serotyping and amplification of the envelope gene. Although filter paper blood spots would also give this information for less expense, antigen and antibody rapid diagnostic testing has the additional advantage of permitting point of care diagnosis of dengue virus infection. Broadening the spectrum of add-on uses of RDTs as useful, inexpensive, and transportable matrices for enhancing cost-effective patient diagnosis and surveillance is a neglected opportunity.5Fhogartaigh NC Dance DAB Davong V et al.A novel technique for detecting antibiotic-resistant typhoid from rapid diagnostic tests.J Clin Micro. 2015; 53: 1758-1760Crossref PubMed Scopus (5) Google Scholar The shipping of used dengue RDTs to a central laboratory for rapid differential diagnosis using PCR assays of pathogens presenting with similar clinical syndromes holds promise as a practical and cost-effective solution for doing surveillance in the world's vast remote areas with cocirculation of dengue virus, Zika virus, and chikungunya virus. This approach could enhance field tri-viral surveillance and identify hotspots, and hence enable implementation of targeted preventive interventions. We declare no competing interests. Identifying urban hotspots of dengue, chikungunya, and Zika transmission in Mexico to support risk stratification efforts: a spatial analysisThis study provides evidence of the overlap of Aedes-borne diseases within geographical hotspots and a methodological framework for the stratification of arbovirus transmission risk within urban areas, which can guide the implementation of surveillance and vector control. Full-Text PDF Open Access