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Which serological tests commonly used to diagnosis dengue?

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dengue serological diagnosis

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WHO dengue laboratory testing serology IgM IgG NS1 diagnosis

Common serological tests for dengue detect antibodies to dengue virus in serum:
  1. Dengue-specific IgM antibody capture ELISA (MAC-ELISA)
    • Most commonly used serologic test for recent dengue infection.
    • IgM usually becomes detectable about 3-5 days after symptom onset and may remain detectable for 2-3 months or longer.
    • A positive result can cross-react with other flaviviruses, such as Zika, Japanese encephalitis, and West Nile virus.
  2. Dengue IgG ELISA
    • Detects IgG antibodies, which appear later in primary infection but rise early and strongly in secondary dengue infection.
    • A single positive IgG result usually indicates past exposure, not necessarily acute dengue.
    • Paired acute and convalescent sera showing seroconversion or a significant rise in IgG titre supports recent infection.
  3. Rapid diagnostic tests (immunochromatographic/card tests) for IgM, IgG, or both
    • Quick point-of-care tests, often reported as dengue IgM/IgG rapid tests.
    • Useful for screening, but accuracy varies by kit; positive results may need confirmation by ELISA or a reference laboratory.
  4. Plaque-reduction neutralization test (PRNT)
    • A more specific confirmatory antibody test.
    • Used when flavivirus cross-reactivity makes an IgM result uncertain, especially in regions where dengue and Zika or other flaviviruses circulate.
    • It is specialized and not usually a routine first-line test.
Important distinction: NS1 antigen detection is commonly used for early dengue diagnosis but is not an antibody serological test. In the first 0-7 days, NS1 antigen or RT-PCR is preferred; after about day 3-5 and particularly after day 7, IgM serology becomes more useful. The CDC testing guidance and WHO laboratory guidance recommend interpreting results according to the day of illness and local circulation of related flaviviruses.
Recent evidence supports using testing strategies that combine a direct test such as RT-PCR or NS1 with IgM testing rather than relying on a single assay alone (PMID: 40209729).
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