CDC Recommends Urine Testing of Patients Suspected of Acute Zika Infection Interview with:
Andrea M. Bingham, PhD
Vector-Borne Disease Surveillance Coordinator
Florida Department of Health What is the background for this study? What are the main findings?

Dr. Bingham: Since its introduction to Brazil in 2015, Zika virus has spread throughout the Caribbean and South and Central America. We are constantly learning new things about Zika virus, including its potential for sexual transmission and its ability to cause certain birth defects such as microcephaly. Because many states, including Florida, have mosquito vectors that can potentially be infected with Zika virus, being able to identify infected people is important to ensure proper response and control measures are put in place to prevent local introductions. Improving testing capacity helps ensure that we have the ability to rapidly detect local Zika virus introductions if they occur.

On the basis of previous small Zika fever case studies that reported positive testing of patient urine and/or saliva samples, the Florida Department of Health made the decision to collect multiple specimen types from persons with suspected acute travel-related Zika fever in order to determine the most sensitive and efficient testing algorithm. Testing performed at our state public health laboratories in Tampa and Jacksonville suggested that urine was the most useful specimen for identifying acute Zika fever infections. Zika virus real time reverse-transcriptase polymerase chain reaction (RT-PCR) testing conducted on urine and serum samples collected the same day from 66 travel-associated Zika fever patients, detected Zika virus in nearly twice as many urine samples (61) as serum samples (31). Viral RNA was also detectable in urine longer than in serum. Although a high percentage of saliva samples also tested positive, no additional cases were identified through saliva testing alone. Based on these results and those of the small case studies, CDC updated their guidance to include urine as a recommended specimen type for testing of patients with suspected acute Zika fever. What should readers take away from your report?

Dr. Bingham: These results suggest urine is a useful specimen for identifying acute Zika fever infections. Urine samples tested positive by RT-PCR more frequently and longer after symptom onset than RT-PCR testing using serum alone. Increased sensitivity of Zika RT-PCR testing helps reduce the number of cases that are identified using only antibody-based testing, which can be challenging due to significant cross-reactivity between similar flaviviruses such as dengue and West Nile virus. What recommendations do you have for future research as a result of this study?

Dr. Bingham: Studies should be conducted in order to further evaluate the utility of urine Zika RT-PCR testing on specimens collected more than two weeks after symptom onset. Is there anything else you would like to add?

Dr. Bingham: We would like to acknowledge the support of the Centers of Disease Control and Prevention (CDC) and thank them for rapidly providing the reagents and protocols that allowed us to conduct this testing. Thank you for your contribution to the community.


Bingham AM, Cone M, Mock V, et al. Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016. MMWR Morb Mortal Wkly Rep 2016;65.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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