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Peer-reviewedCC BY 4.0PLOS Neglected Tropical Diseases

Zika virus serologic responses during pregnancy in a dengue-endemic setting: A prospective cohort study in Thailand

  • Salin Sirinam1
  • Dennopporn Sudjai2
  • Supawat Chatchen1
  • Watcharee Arunsodsai1
  • Weerawan Hattasingh1
  • Laura Pezzi3,4
  • Thomas Jaenisch5
  • May Chu5
  • Thitiya Yakasaem1
  • Kriengsak Limkittikul1
5 affiliations
  1. 1Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  2. 2Department of Obstetrics and Gynecology, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
  3. 3National Reference Center for Arboviruses, Inserm-IRBA, Marseille, France
  4. 4Unité des Virus Émergents, UVE, Aix-Marseille University, Università di Corsica, IRD 190, Inserm 1207, IRBA, Marseille, France
  5. 5Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States of America
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Abstract

Background: Zika virus (ZIKV) infection during pregnancy has been associated with adverse birth outcomes, including severe neurological abnormalities. Confirmation of infection remains challenging due to the disease’s predominantly asymptomatic or mild nature. While real-time reverse transcription polymerase chain reaction (RT-qPCR) is the gold standard, its use in clinical settings and surveillance is limited. Serological point-of-care tests offer alternatives but pose interpretation challenges in Flavivirus-endemic regions. Methods and Findings: We conducted a prospective cohort of 199 pregnant women attending the antenatal clinic at Rajavithi Hospital, Bangkok, Thailand, in 2021–2022 to describe the incidence of ZIKV serologic responses detected by a rapid test and associated pregnancy outcomes. Participants were monitored using the DPP ZCD IgM/IgG (Zika/Chikungunya/Dengue IgM/IgG) System rapid immunochromatography test (Chembio), with RT-qPCR and plaque reduction neutralization testing performed for further assessment. A ZIKV serologic response was defined as a reactive ZIKV immunoglobulin M (IgM) result at enrollment or seroconversion from non-reactive to reactive ZIKV IgM or IgG between study visits. The DPP ZCD rapid test revealed incident ZIKV-reactive serologic responses at 15.4 per 100 person-years, with all affected participants being asymptomatic. All RT-qPCR results were negative, and participants with ZIKV IgG seroconversion had neutralizing antibodies against ZIKV and all 4 Dengue virus (DENV) serotypes. A prior history of DENV infection was associated with increased odds of ZIKV-reactive serologic response (OR 3.53, P value 0.046). Conclusion: This prospective study identified serologic responses detected by a ZIKV-reactive rapid test among pregnant women in Thailand. In a highly dengue-immune setting, these responses could reflect true ZIKV exposure, DENV reinfection, flavivirus immune boosting, or serologic cross-reactivity, and therefore cannot be attributed specifically to ZIKV. Rapid serologic testing may support screening and surveillance but cannot establish ZIKV infection or ZIKV-specific exposure without careful interpretation and additional testing. Author summary: Zika virus infection during pregnancy is a major public health concern because it can cause severe brain defects in fetuses and fetal loss. Detecting this virus is difficult because most infected mothers do not show specific symptoms. Furthermore, standard blood tests often miss the short window when the virus is active in the blood, or takes too long to establish in clinical settings. In this study, we monitored pregnant women in Bangkok, Thailand, using a simple rapid blood test that detects antibodies reactive with Zika virus. We found new serologic responses during pregnancy, but all participants were asymptomatic and RT-qPCR results were negative. In addition, participants with Zika-reactive antibody responses also showed broad antibody responses to Dengue virus. Therefore, the observed responses could represent Zika virus exposure, Dengue reinfection, immune boosting, or cross-reactivity between related flaviviruses. These findings show that rapid serologic tests may be helpful for screening, but results must be interpreted cautiously in regions where Zika and Dengue viruses co-circulate.

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Cite

BibTeXRIS
BibTeX
@article{sirinam2026zika,
  title = {{Zika virus serologic responses during pregnancy in a dengue-endemic setting: A prospective cohort study in Thailand}},
  author = {Salin Sirinam and Dennopporn Sudjai and Supawat Chatchen and Watcharee Arunsodsai and Weerawan Hattasingh and Laura Pezzi and Thomas Jaenisch and May Chu and Thitiya Yakasaem and Kriengsak Limkittikul},
  journal = {PLOS Neglected Tropical Diseases},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pntd.0014805},
  url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014805},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Zika virus serologic responses during pregnancy in a dengue-endemic setting: A prospective cohort study in Thailand
AU  - Salin Sirinam
AU  - Dennopporn Sudjai
AU  - Supawat Chatchen
AU  - Watcharee Arunsodsai
AU  - Weerawan Hattasingh
AU  - Laura Pezzi
AU  - Thomas Jaenisch
AU  - May Chu
AU  - Thitiya Yakasaem
AU  - Kriengsak Limkittikul
PY  - 2026
DA  - 2026/10/15
JO  - PLOS Neglected Tropical Diseases
DO  - 10.1371/journal.pntd.0014805
UR  - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014805
AB  - Background: Zika virus (ZIKV) infection during pregnancy has been associated with adverse birth outcomes, including severe neurological abnormalities. Confirmation of infection remains challenging due to the disease’s predominantly asymptomatic or mild nature. While real-time reverse transcription polymerase chain reaction (RT-qPCR) is the gold standard, its use in clinical settings and surveillance is limited. Serological point-of-care tests offer alternatives but pose interpretation challenges in Flavivirus-endemic regions. Methods and Findings: We conducted a prospective cohort of 199 pregnant women attending the antenatal clinic at Rajavithi Hospital, Bangkok, Thailand, in 2021–2022 to describe the incidence of ZIKV serologic responses detected by a rapid test and associated pregnancy outcomes. Participants were monitored using the DPP ZCD IgM/IgG (Zika/Chikungunya/Dengue IgM/IgG) System rapid immunochromatography test (Chembio), with RT-qPCR and plaque reduction neutralization testing performed for further assessment. A ZIKV serologic response was defined as a reactive ZIKV immunoglobulin M (IgM) result at enrollment or seroconversion from non-reactive to reactive ZIKV IgM or IgG between study visits. The DPP ZCD rapid test revealed incident ZIKV-reactive serologic responses at 15.4 per 100 person-years, with all affected participants being asymptomatic. All RT-qPCR results were negative, and participants with ZIKV IgG seroconversion had neutralizing antibodies against ZIKV and all 4 Dengue virus (DENV) serotypes. A prior history of DENV infection was associated with increased odds of ZIKV-reactive serologic response (OR 3.53, P value 0.046). Conclusion: This prospective study identified serologic responses detected by a ZIKV-reactive rapid test among pregnant women in Thailand. In a highly dengue-immune setting, these responses could reflect true ZIKV exposure, DENV reinfection, flavivirus immune boosting, or serologic cross-reactivity, and therefore cannot be attributed specifically to ZIKV. Rapid serologic testing may support screening and surveillance but cannot establish ZIKV infection or ZIKV-specific exposure without careful interpretation and additional testing. Author summary: Zika virus infection during pregnancy is a major public health concern because it can cause severe brain defects in fetuses and fetal loss. Detecting this virus is difficult because most infected mothers do not show specific symptoms. Furthermore, standard blood tests often miss the short window when the virus is active in the blood, or takes too long to establish in clinical settings. In this study, we monitored pregnant women in Bangkok, Thailand, using a simple rapid blood test that detects antibodies reactive with Zika virus. We found new serologic responses during pregnancy, but all participants were asymptomatic and RT-qPCR results were negative. In addition, participants with Zika-reactive antibody responses also showed broad antibody responses to Dengue virus. Therefore, the observed responses could represent Zika virus exposure, Dengue reinfection, immune boosting, or cross-reactivity between related flaviviruses. These findings show that rapid serologic tests may be helpful for screening, but results must be interpreted cautiously in regions where Zika and Dengue viruses co-circulate.
SN  - 1935-2735
SN  - 1935-2727
ER  -