Test Catalog

Test ID: MZIKV    
Zika Virus IgM Antibody Capture ELISA, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Screening for the presence of IgM-class antibodies to Zika virus

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

The following algorithms are available in Special Instructions:

-Assessment for Zika Virus Infection

-Mosquito-borne Disease Laboratory Testing

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Zika virus is an RNA virus in the genus Flavivirus and is primarily transmitted through the bite of an infected Aedes species mosquito. Other means of transmission include through transfusion of blood and blood products, sexually through genital secretions, perinatally, vertically from mother to fetus, and potentially through contact with other body secretions such as tears and sweat.


Historically, most cases of Zika virus infection have occurred in parts of Africa and South-East Asia. However, Zika virus emerged in South America in early 2015 and is now endemic in over 50 countries in South, Central, and North America, including in several US territories and focal regions of the southern United States.


The majority (approximately 80%) of individuals infected with Zika virus are asymptomatic. Among symptomatic patients, fever, headache, retro-orbital pain, conjunctivitis, maculopapular rash, myalgias, and arthralgias are commonly reported. Notably, these symptoms are not distinct and can be seen with other emerging arboviruses, including dengue and chikungunya. Therefore, diagnostic testing for each of these viruses is recommended in patients returning for areas where these viruses cocirculate. Intrauterine or prenatal infection with Zika virus has been causally linked to development of microcephaly, with the greatest risk for fetal abnormality occurring if the infection is acquired during the first trimester. Finally, Zika virus has also been associated with development of Guillain-Barre syndrome.


A number of Zika virus serologic and nucleic acid amplification tests (NAAT) have received emergency use authorization (EUA) through the Food and Drug Administration (FDA). The recommended tests vary by the patient's symptoms, course of illness, and whether or not the patient is pregnant.


For the most up-to-date information regarding Centers for Disease Control and Prevention (CDC) testing guidelines visit www.cdc.gov/zika/.


These guidelines are reflected in Assessment for Zika Virus Infection Special Instructions:


Zika virus testing is not recommended for asymptomatic couples attempting conception, given the potential for false-positive and false-negative results. Additionally, it is well established the Zika virus may remain in reproductive fluids, despite negative serologic and molecular test results in blood and urine.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.


Interpretation Provides information to assist in interpretation of the test results

See Assessment for Zika Virus Infection in Special Instructions for a review of the recommended testing and interpretation of results. For the most recent Centers for Disease Control and Prevention (CDC) guidelines for Zika virus testing visit www.cdc.gov/zika/.


Presumptive Zika Positive:

IgM-class antibodies to Zika virus (ZIKV) detected. This is a preliminary result and does not confirm evidence of ZIKV infection. Confirmatory testing may be required as determined by your local health department.  False-positive results may occur in patients with other current or prior flavivirus infections (eg, dengue virus). For patients with less than 7 days of symptoms or last possible exposure to ZIKV, reverse transcription-polymerase chain reaction (RT-PCR) for ZIKV on serum and urine is recommended. A positive ZIKV RT-PCR result on either specimen is confirmatory for ZIKV infection.


Other Flavivirus Positive:

Antibodies to a flavivirus, not ZIKV, were detected. Consider targeted testing for IgM-class antibodies to dengue and/or West Nile viruses as appropriate, taking into consideration patient exposure and presentation.



No evidence of IgM-class antibodies to ZIKV. For specimens collected less than 7 days post symptom onset or possible ZIKV exposure, RT-PCR for ZIKV on serum and urine to exclude a false-negative ZIKV IgM result is recommended. For symptomatic patients with travel to dengue endemic areas, testing for IgM antibodies to dengue virus is also recommended.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

A presumptive positive result by this test only suggests infection with Zika virus. This result should not be considered as diagnostic for Zika virus infection. False-positive results may occur in patients infected with other, closely related flaviviruses, including dengue virus, or in patients who have been vaccinated against yellow fever virus. Only limited evaluation of cross-reactivity with flaviviruses or arboviruses has been conducted. Therefore, confirmatory testing of presumptive or possible positive samples may be required and should be performed as determined by the local health department. Evaluation of sample by real-time polymerase chain reaction (PCR) for Zika virus may also be warranted.


False-negative results can arise from specimen collection prior to development of an IgM antibody response (less than 4 days postsymptom onset) or after IgM levels have decreased below detectable levels. Negative results from at-risk individuals who are immunosuppressed should be interpreted with caution.


Negative results do not preclude infection with Zika virus and should not be used as the sole basis of patient treatment or management decisions. All results should be interpreted by a trained professional in conjunction with review of the patient's exposure history and clinical signs and symptoms.


Zika and dengue virus infections presents with symptoms similar to other arboviruses that cocirculate in areas where Zika virus is currently endemic. Diagnostic testing to rule out these infections (eg, chikungunya) and other similar presenting infection should be considered.


Testing of asymptomatic pregnant women with possible exposure, but without ongoing exposure to Zika virus, is not routinely recommended.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Oduyebo T, Polen KD, Walke HT, et al: Update: Interim guidance for health care providers caring for pregnant women with possible Zika virus exposure - United States (Including U.S. Territories), July 2017. MMWR Morb Mortal Wkly Rep. 2017;66:781-793

2. Waggoner JJ, Pinsky BA: Zika virus: Diagnostics for an emerging pandemic threat. J Clin Microbiol. 2016;54(4):860-867

3. Theel ES, Hata DJ: Diagnostic testing for Zika virus: A post outbreak update. J Clin Microbiol. 2018;56(4) pii: e01972-17. doi: 10.1128/JCM.01972-17

Special Instructions Library of PDFs including pertinent information and forms related to the test