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Peer-reviewedCC BY 4.0Frontiers in Microbiology

Comparison of two Crimean-Congo haemorrhagic fever virus serological tests in Tanzanian febrile patients using a Bayesian latent class approach

  • Elichilia R. Shao1,2,3
  • Rebecca F. Bodenham2
  • Jaffu Chilongola4
  • Sarah Cleaveland5
  • Venance P. Maro1,3
  • Buliga Mujaga2
  • Eliaichi A. Mlay6
  • Laura J. Shirima7
  • Jeremia J. Pyuza8
  • Judith Njau2
  • Felix Lankester9,10
  • Ray Kayaga11,12
6 more authors
  • Matthew P. Rubach1,13,14
  • John A. Crump1,3,13,14,15
  • Chee Wah Tan16
  • Lin-Fa Wang16
  • Melinda K. Rostal17,18
  • Blandina T Mmbaga2,19
19 affiliations
  1. 1Internal Medicine Department, Kilimanjaro Christian Medical Center
  2. 2Kilimanjaro Clinical Research Institute
  3. 3Internal Medicine Department, School of Medicine, KCMC University
  4. 4Department of Medical Biochemistry and Molecular Biology, School of Medicine KCMC University
  5. 5School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow
  6. 6Department of Prosthetics and Orthotics, School of Rehabilitation Medicine, KCMC University
  7. 7Department of Epidemiology and Biostatistics, School of Public Health, KCMC University
  8. 8Pathology Department, School of Medicine, KCMC University
  9. 9Global Health Tanzania
  10. 10Paul G. Allen School for Global Health, Washington State University
  11. 11Department of Life Sciences and Bio-Engineering, Nelson Mandela African Institution for Science and Technology
  12. 12Tanzania Veterinary Laboratory Agency
  13. 13Duke Global Health Institute, Duke University
  14. 14Division of Infectious Diseases and International Health, Duke University Medical Center
  15. 15Centre for International Health, University of Otago
  16. 16Programme in Emerging Infectious Diseases, Duke-National University of Singapore Medical School
  17. 17One Health Research Consulting
  18. 18Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria
  19. 19Pediatric and Child Health Department, School of Medicine, KCMC University
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Abstract

Background: Crimean-Congo haemorrhagic fever virus (CCHFV) is a tick-borne zoonotic disease that can cause severe disease in humans, has a high fatality ratio, and is present in many African countries. Accurate diagnosis of CCHF remains difficult. Serological and molecular tests are frequently used to detect exposure or infection, but their accuracy varies with viral strain, infection stage, and population factors. Notably, there is no universally recognised gold standard test for CCHFV serological diagnosis. The reference standard for antibody detection requires neutralisation assays, which must be performed in biosafety level 4 (BSL-4) laboratories. These facilities are scarce and largely unavailable in sub-Saharan Africa, including Tanzania, where CCHFV is endemic. This study aimed to evaluate the diagnostic performance of the IDvet ELISA and Luminex serological assays for detecting prior CCHFV exposure in humans using Bayesian latent class modelling in the absence of a reference standard.

Methodology: This was a secondary analysis of archived serum samples from a prospective febrile illness surveillance cohort conducted between 2012–2014 in Moshi, Tanzania, at Kilimanjaro Christian Medical Center and Mawenzi Regional Referral Hospital. Bayesian latent class analysis was used to evaluate the performance of IDvet and Luminex assays in detecting CCHFV exposure in the samples collected.

Results: Of the 870 febrile admissions enrolled across both sites, serum samples were available for 427 participants (49%). The median posterior estimate for IDvet sensitivity was 0.893 (95% Bayesian credibility interval (BCI) = 0.555–0.996) and specificity was 0.972 (95% BCI = 0.936–0.996). For the Luminex assay, the median posterior estimate for sensitivity was 0.884 (95% BCI = 0.541, 0.995) and specificity was 0.987 (95% BCI = 0.947, 1.00). The model generated seroprevalence estimates for two subpopulations, livestock owners and non-livestock owners. The livestock owner seroprevalence estimate was 0.027 (95% BCI = 0.002, 0.069), and for non-livestock owners, 0.017 (95% BCI = 0.001, 0.044).

Conclusion: In the absence of a reference standard and access to BSL-4 neutralisation testing, both the IDvet ELISA and the Luminex assay demonstrated high diagnostic performance with comparable sensitivity in detecting prior exposure to CCHFV among febrile patients in northern Tanzania. Furthermore, the IDvet may offer operational advantages because of its simplicity and suitability for decentralised laboratories.

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Cite

BibTeXRIS
BibTeX
@article{shao2026comparison,
  title = {{Comparison of two Crimean-Congo haemorrhagic fever virus serological tests in Tanzanian febrile patients using a Bayesian latent class approach}},
  author = {Elichilia R. Shao and Rebecca F. Bodenham and Jaffu Chilongola and Sarah Cleaveland and Venance P. Maro and Buliga Mujaga and Eliaichi A. Mlay and Laura J. Shirima and Jeremia J. Pyuza and Judith Njau and Felix Lankester and Ray Kayaga and Matthew P. Rubach and John A. Crump and Chee Wah Tan and Lin-Fa Wang and Melinda K. Rostal and Blandina T Mmbaga},
  journal = {Frontiers in Microbiology},
  year = {2026},
  month = oct,
  doi = {10.3389/fmicb.2026.1894712},
  url = {https://www.frontiersin.org/articles/10.3389/fmicb.2026.1894712/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Comparison of two Crimean-Congo haemorrhagic fever virus serological tests in Tanzanian febrile patients using a Bayesian latent class approach
AU  - Elichilia R. Shao
AU  - Rebecca F. Bodenham
AU  - Jaffu Chilongola
AU  - Sarah Cleaveland
AU  - Venance P. Maro
AU  - Buliga Mujaga
AU  - Eliaichi A. Mlay
AU  - Laura J. Shirima
AU  - Jeremia J. Pyuza
AU  - Judith Njau
AU  - Felix Lankester
AU  - Ray Kayaga
AU  - Matthew P. Rubach
AU  - John A. Crump
AU  - Chee Wah Tan
AU  - Lin-Fa Wang
AU  - Melinda K. Rostal
AU  - Blandina T Mmbaga
PY  - 2026
DA  - 2026/10/16
JO  - Frontiers in Microbiology
DO  - 10.3389/fmicb.2026.1894712
UR  - https://www.frontiersin.org/articles/10.3389/fmicb.2026.1894712/full
AB  - Background: Crimean-Congo haemorrhagic fever virus (CCHFV) is a tick-borne zoonotic disease that can cause severe disease in humans, has a high fatality ratio, and is present in many African countries. Accurate diagnosis of CCHF remains difficult. Serological and molecular tests are frequently used to detect exposure or infection, but their accuracy varies with viral strain, infection stage, and population factors. Notably, there is no universally recognised gold standard test for CCHFV serological diagnosis. The reference standard for antibody detection requires neutralisation assays, which must be performed in biosafety level 4 (BSL-4) laboratories. These facilities are scarce and largely unavailable in sub-Saharan Africa, including Tanzania, where CCHFV is endemic. This study aimed to evaluate the diagnostic performance of the IDvet ELISA and Luminex serological assays for detecting prior CCHFV exposure in humans using Bayesian latent class modelling in the absence of a reference standard.  Methodology: This was a secondary analysis of archived serum samples from a prospective febrile illness surveillance cohort conducted between 2012–2014 in Moshi, Tanzania, at Kilimanjaro Christian Medical Center and Mawenzi Regional Referral Hospital. Bayesian latent class analysis was used to evaluate the performance of IDvet and Luminex assays in detecting CCHFV exposure in the samples collected.  Results: Of the 870 febrile admissions enrolled across both sites, serum samples were available for 427 participants (49%). The median posterior estimate for IDvet sensitivity was 0.893 (95% Bayesian credibility interval (BCI) = 0.555–0.996) and specificity was 0.972 (95% BCI = 0.936–0.996). For the Luminex assay, the median posterior estimate for sensitivity was 0.884 (95% BCI = 0.541, 0.995) and specificity was 0.987 (95% BCI = 0.947, 1.00). The model generated seroprevalence estimates for two subpopulations, livestock owners and non-livestock owners. The livestock owner seroprevalence estimate was 0.027 (95% BCI = 0.002, 0.069), and for non-livestock owners, 0.017 (95% BCI = 0.001, 0.044).  Conclusion: In the absence of a reference standard and access to BSL-4 neutralisation testing, both the IDvet ELISA and the Luminex assay demonstrated high diagnostic performance with comparable sensitivity in detecting prior exposure to CCHFV among febrile patients in northern Tanzania. Furthermore, the IDvet may offer operational advantages because of its simplicity and suitability for decentralised laboratories.
SN  - 1664-302X
ER  -