A new blood test can cheaply and quickly distinguish between the mosquito-borne Zika and dengue viruses, researchers reported Wednesday, giving public health officials a valuable tool to track the spread of outbreaks and prepare for the possible consequences of the different infections.
The test, which was described in the journal Science Translational Medicine, relies on a simple paper strip, and researchers hope it can eventually be purchased for less than $1. The scientists who developed the test are at work to commercialize it and production would need to be scaled up before it could be deployed widely.
Knowing which disease is spreading in an area is crucial for public health responses and research. But the Zika-dengue distinction is all the more important because Zika, unlike dengue, can cause severe birth defects and can be transmitted through sex, meaning it is vital for pregnant women to know which virus they have and for their sexual partners to identify their infections as well.
The problem is that Zika and dengue are similar; with some tests, the viruses “cross-react,” meaning that a dengue sample might produce a positive Zika test. They also trigger similar symptoms, including fever, headaches, and body pain. Samples often need to be sent to state labs to confirm the infection, which is expensive, time-consuming, and not realistic on a mass scale. That made it challenging to accurately track the recent Zika outbreak as it swept through South and Central America.
A 15-minute test
The new test exploits a quirk in how the viruses affect the body. Zika and the four strains of dengue each cause infected cells to release a slightly different version of a protein called NS1.
For the test, antibodies that can uniquely identify those specific Zika or dengue NS1 proteins are embedded onto a paper strip, along with gold nanoparticles. The end result is that if the virus is present in the sample, a red dot will appear on the strip.
The test works best when analyzing serum — a component of blood that can be easily separated out in health clinics — but the researchers said it should also work on blood samples.
“All you do is mix the serum with a solution and you dunk a paper strip into it,” said Kimberly Hamad-Schifferli, an engineer at the University of Massachusetts, Boston, and visiting scientist at the Massachusetts Institute of Technology, who helped lead the research. “You wait 15 minutes and you look for the appearance of a colored dot.”
The Zika test accurately identified infections in 81 percent of positive samples and incorrectly identified an infection in negative samples 14 percent of the time.
The test can also differentiate among the four strains of dengue. Getting infected with one strain, or serotype, doesn’t protect someone from contracting another strain later on, and those multiple infections increase the risk that the person will develop a much more severe illness called dengue hemorrhagic fever.
“Being able to distinguish the four serotypes is very important for epidemiology purposes and to know what viruses are circulating in an environment,” said Lee Gehrke, an engineer at MIT and one of the leaders of the research.
Currently, each paper strip is built to pick up on only one virus, so it would require five different versions to identify exactly what virus was causing an infection. But the researchers said they’re exploring how they could compile all five tests into one strip.
Nikos Vasilakis, a Zika expert at the University of Texas Medical Branch at Galveston who was not involved in developing the test, said the test’s cost and the simplicity could make it a widely used tool in the parts of the world where these viruses circulate. The cost per strip now is in the $5 range, but the researchers said they expect that to drop with scaled-up production.
“The test will be in a single dollar range, which is the biggest advantage in a resource-poor countries,” Vasilakis said. “The other advantage is that it’s very easy to use.”
The researchers traveled to places in Central and South America and India to validate their test on samples from patients with confirmed infections. The paper’s long list of authors includes many scientists from those countries who helped the researchers secure samples for testing.
The number of new Zika cases has dwindled since the major outbreak in the Americas in 2015 and 2016, but experts anticipate future outbreaks. The researchers also said they plan to apply the platform they used to build the Zika and dengue test to come up with diagnostic tests for other viruses.
SYRACUSE, N.Y. – Dr. Ross Sullivan used to tell heroin and painkiller overdose patients in Upstate University Hospital’s emergency room to stop using drugs and go to local addiction treatment programs for help.
Sullivan quickly learned that approach didn’t work because the wait to get into rehab took months, too long for people hooked on opioids to stay off drugs. Most patients would leave the ER and use heroin and other opioids again as soon as possible to ease the agony of withdrawal.
So last year Sullivan started his own clinic in the ER to provide addicts with short-term prescriptions of Suboxone, a brand-name version of the drug buprenorphine that eases cravings and withdrawal symptoms. The clinic tides patients over until they get into a rehab program or find a doctor in the community who prescribes Suboxone. The clinic has seen more than 175 patients so far and has steered about 80 percent of them to treatment in the community.
No other ER in Syracuse and few nationwide are doing this. Not many emergency medicine doctors are trained in addiction medicine like Sullivan, even though the growing opioid epidemic has become the worst drug crisis in U.S. history. Only 158 – less than 1 percent – of the nation’s 35,000 board-certified emergency medicine physicians are also certified in addiction medicine.
“The more you can engage them in the ER, the better chance we have to keep them alive and help them,” Sullivan says.
Frank Panico, 59, of Syracuse, was one of the clinic’s first patients. The painting contractor injected heroin for nearly 30 years and says he would be dead were it not for Sullivan. He overdosed twice and was revived both times with naloxone, the overdose-reversing drug, by ambulance crews.
Panico contacted rehab programs a few times, but did not follow through after learning he’d have to wait a month to get in.
‘Roller coaster ride through hell’
Panico went to Sullivan for help after another addict he met at the Syracuse Rescue Mission told him about the doctor. Panico had just lost his job, his wife and been evicted from his home.
“I was on the street with nothing and I had to get myself help or die,” he says. “I was at the point where I wasn’t doing it (heroin) to get high, I was doing it just to function. It was like a roller coaster ride through hell.”
After Sullivan got him started on Suboxone, Panico got addiction treatment through Syracuse Behavioral Healthcare.
He’s been clean since Aug. 2, 2016.
The only local program similar to Sullivan’s is ACR Health’s outpatient clinic for injection drug users at 627 W. Genesee St. That clinic recently began providing short-term Suboxone prescriptions to opioid addicts waiting to get into treatment.
Treating addiction like any other chronic disease
Few hospital emergency rooms offer this type of treatment because emergency medicine doctors under federal law cannot give Suboxone to patients for more than 72 hours to treat withdrawal. Sullivan is not subject to that limitation because in addition to being an emergency medicine doctor, he’s certified in addiction medicine and federally-licensed to prescribe Suboxone.
Dr. Gail D’Onofrio, head of emergency medicine at Yale Medical School and an advocate of using medication in ERs to start addiction treatment, says emergency physicians like Sullivan who are trained in addiction medicine are “rarer than hen’s teeth.”
D’Onofrio, who is also certified in addiction medicine, co-authored a study published earlier this year that found patients started on medication in the ER to reduce cravings are more likely to receive addiction treatment and reduce opioid use long term.
Doctors should be able to start people with opioid addictions on medication like Suboxone in ERs the same way they treat other patients who come in with high blood pressure, diabetes and other chronic diseases, D’Onofrio says.
“It’s not usually what we do as emergency physicians,” she says. “We are great at saving lives in overdose events, but then we don’t continue it.”
NY wants to replicate Upstate program
Programs like Sullivan’s are helping reinvent the way ER doctors treat patients with opioid addictions, she says.
The New York State Office of Alcoholism and Substance Abuse Services is enthusiastic about Sullivan’s clinic.
“We are interested in exploring ways to expand and replicate innovative concepts like this throughout the state,” the agency said in a prepared statement.
In order for ER-initiated addiction treatment to lead to long-term benefits, there has to be enough treatment programs available in the community to provide follow-up care for addiction patients.
Sullivan says there’s not enough drug treatment available in the Syracuse area. But the shortage has eased a bit as some programs have expanded and more doctors have been trained and licensed to prescribe Suboxone, he says.
Maria Sweeney, a peer engagement specialist, works with Sullivan to help patients find treatment, support groups, health insurance, jobs, food stamps and housing. Thirty percent of the clinic’s patients are homeless.
Meeting patients in Rescue Mission or jail
After patients leave the hospital, Sweeney meets them at the Rescue Mission, the Onondaga County Justice Center or wherever else they end up to help them on the road to recovery. She works closely with case managers from addiction treatment centers, shelters and other agencies.
Patients must come to Sullivan’s clinic weekly for urine drug tests. The clinic also requires patients to be evaluated by a treatment program.
Sullivan says the clinic is a place where patients “can take a deep breath and set themselves up in a treatment center.”
“All they need is a prescription and someone who cares so they don’t have to go out and get heroin,” he says.
Terry Green, 54, of Syracuse, ended up in Upstate’s ER after overdosing on heroin Sept. 4, 2016 in Rose Hill Cemetery on the city’s North Side.
Grandmother overdosed in cemetery
Green, who has seven children and six grandchildren, became an addict when she began taking her husband’s Oxycontin, a prescription painkiller. After her husband died, Green switched to heroin because she couldn’t afford to buy Oxycontin on the street. Before long she was snorting about 10 bags of heroin daily. She paid $5 a bag.
Green’s adult children cut her off because they feared she would steal from them and did not want her around their kids. She ended up homeless, sleeping in shelters and on park benches. To support her drug habit, she shoplifted sneakers and other items, then sold them on the street.
At Upstate’s ER, Green was given a dose of Suboxone and told about Sullivan’s clinic. She made an appointment and saw Sullivan two days later. He began prescribing Suboxone and the clinic helped her get treatment at Syracuse Behavioral Healthcare.
Green hasn’t used heroin, which she calls “the devil,” since the overdose.
She has mended fences with her family and now lives with her daughter and grandchild.
“Nobody wants to wait a month for help,” she says. “That’s why there are so many people dying and overdosing.”