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Author Notes:

Correspondence: Hana El Sahly, MD, One Baylor Plaza, BCM-MS280, Houston, TX 77030 (hanae@bcm.edu).

We thank our study subjects; Emmes staff including Andrew Hoy, Alison Kosel, and Carrie Brown; Baylor College of Medicine Vaccine and Treatment Evaluation Unit (VTEU) staff including Coni Cheesman and Rebecca Berry; Emory VTEU faculty, staff, and collaborators including Colleen Kelley, Varun Phadke, Yongxian Xu, Dongli Wang, Mary Bower, Rijalda Deovic, Sara Jo Johnson, Yerun Zu, Tiraje Lester, Mari Hart, Vinit Karmali, Joanne Altieri-Rivera, Pam Lankford-Turner, Dean Kleinhenz, Hannah Huston, Allison Beck, Amanda Feldpausch, and Sreelatha Aramgam; and the Division of Microbiology and Infectious Diseases at the National Institutes of Health including Robert Johnson, Seema Nayak, and Mary Smith.

For helpful scientific discussions, we thank Walla Dempsey, Kay Tomashek, and Daniel Hoft.

The authors report no conflict of interest as it pertains to the conduct and reporting of the study.


Research Funding:

The National Institutes of Allergy and Infectious Diseases at the National Institutes of Health provided contract funding for this project to the Vaccine and Treatment Evaluation Units at Baylor College of Medicine (HHSN272201300015I), Emory University (HHSN272201300018I), St. Louis University (HHSN27220130021I), and Emmes Corporation (HHSN272201500002C).

Additional support was provided to M.J.M. by the Georgia Research Alliance and to V.R. by T32AI074492 from the National Institute of Allergy and Infectious Diseases.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • Microbiology
  • Zika
  • diagnostics
  • serologic response
  • cell-mediated immune response
  • dengue
  • IGG

Clinical, Virologic, and Immunologic Characteristics of Zika Virus Infection in a Cohort of US Patients: Prolonged RNA Detection in Whole Blood

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Journal Title:

Open Forum Infectious Diseases


Volume 6, Number 1


, Pages ofy352-ofy352

Type of Work:

Article | Final Publisher PDF


Background. Clinical, virologic, and immunologic characteristics of Zika virus (ZIKV) infections in US patients are poorly defined. Methods. US subjects with suspected ZIKV infection were enrolled. Clinical data and specimens were prospectively collected for ZIKV RNA detection and serologic and cellular assays. Confirmed ZIKV infection (cases) and ZIKV-negative (controls) subjects were compared. Dengue-experienced and dengue-naive cases were also compared. Results. We enrolled 45 cases and 14 controls. Commonly reported symptoms among cases and controls were maculopapular rash (97.8% and 81.8%), fatigue (86.7% and 81.8%), and arthralgia (82.2% and 54.5%), respectively. The sensitivity (94%) and duration of infection detection (80% positivity at 65-79 days after disease onset) by polymerase chain reaction were highest in whole-blood specimens. ZIKV-neutralizing antibodies had a half-life of 105 days and were significantly higher in dengue virus- experienced cases than naive ones (P = .046). In intracellular cytokine staining assays, the ZIKV proteins targeted most often by peripheral blood mononuclear cells from cases were structural proteins C and E for CD4+ T cells and nonstructural proteins NS3, NS5, and NS4B for CD8+ T cells. Conclusions. ZIKV RNA detection was more frequent and prolonged in whole-blood specimens. Immunoglobulin G (IgG) and neutralizing antibodies, but not IgM, were influenced by prior dengue infection. Robust cellular responses to E and nonstructural proteins have potential vaccine development implications.

Copyright information:

© The Author(s) 2018.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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