Acute- and convalescent-phase serum samples were tested by IgG ELISA with ZIKV antigen as described for detection of IgG to arboviruses (12 (link)). Samples were also tested by IgM ELISA as described with the following viral antigens: ZIKV, DENV 1–4 mixture, yellow fever virus (YFV), Japanese encephalitis virus, and Murray Valley encephalitis virus (13 (link)). Testing for IgM to West Nile virus (WNV) and St. Louis encephalitis virus was performed by using a microsphere immunoassay (14 (link)). Ratios of patient optical density values to negative control values (P/Ns) were calculated for IgG and IgM ELISAs. Values >3 were considered positive, and values 2–3 were considered equivocal. Neutralizing antibody titers were determined by using a PRNT with a 90% cut-off value (15 (link)).
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