Test: Zika Virus Antibody IgM  
  Synonym: Arbovirus, Arbo-Serology, Zika virus serology 
  Method: ELISA 
  Availability: Test performed Monday-Friday; Turn-around time 1-3 weeks 
  Specimen: Serum and cerebrospinal fluid (CSF) 
  Collection Device: Clot (Red) or SST(Gold) tube
CSF collection tube

Specimen Labeling: Test subject to CLIA regulations and require 2 patient identifiers on specimen container and requisition forms. 
  Volume: Serum: 1 mL (minimum:0.5 mL). Additional testing for Chikungunya and dengue requires separate containers.
CSF: 1.0 mL 
  Storage/Transport: Centrifuge and aliquot serum into sterile leak-proof tube, ASAP. Place both CSF and serum at 4°C.

Shipping instructions, including specimen handling requirements during transport: Sender should contact the NPHL by email or phone before shipping. Ship specimen Monday -Thursday overnight to avoid weekend deliveries. Refrigerated, specimen should be shipped on cold packs. Package and ship as Category B, Biological Substance, UN3373. See instructions and shipping address: http://nphl.org/. Do not send directly to CDC. 
  Unacceptable: Severely lipemic, icteric or hemolyzed samples; heat-inactivated serum; multiple freeze thaw cycles 
  Specimen Stability: 2-8 °C for 72 hours, if > 3 days, freeze 
  Reference Interval: Negative – No significant level of detectable Zika IgM antibody.
Equivocal – Borderline levels of IgM antibody to Zika virus. (Repeat testing in 10-14 days recommended).
Positive – IgM antibody to Zika virus detected, reflexed for confirmation testing. 
  Reportable Disease: A positive result is reportable as Arbovirus infection under Title 173, report within 7 days 
  Comments: Pre-approval needed from state or local health department. Local or State Health Department. Send approval to NPHL@unmc.edu or call (402) 559-9444.

Supplemental Forms Required - NPHL Special Microbiology Requisition must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history.

Substantial serological cross-reactivity exists among the flaviviruses (dengue virus, St. Louis encephalitis virus and West Nile virus) and current IgM antibody assays cannot reliable distinguish among them. Therefore an IgM positive result in a Zika IgM ELISA test will be reflexed for confirmation testing using plaque-reduction neutralization testing which will result in a delay in the reporting of final results.

Molecular detection of Zika virus RNA can be performed on specimens collected at <7days of symptom onset. Refer to the Zika Virus RNA Detection test directory for additional information.  
  Revised: 2/5/2016