Enhancing Japanese Encephalitis diagnosis with differential ELISA testing in India: A comparative evaluation of two JE IgM capture ELISA kits.

Background objectives: Japanese encephalitis (JE) remains a significant public health concern in India. IgM capture ELISA is widely used for laboratory confirmation, but cross-reactivity with other flaviviruses like Dengue virus (DEN) can lead to false positives in endemic countries like India. To overcome this problem, WHO recommends an IgM capture ELISA-based differential testing algorithm which includes JE IgM testing followed by DEN IgM testing. This study evaluates the performance of JE and DEN IgM capture ELISA kits from NIV, Pune in differentiating JE and DENV infections using ELISA-based differential testing algorithm in comparison with Inbios JE and DEN detect IgM capture ELISA kits.

Methods: A total of 131 serum samples from patients with suspected AES were tested initially using both NIV JE IgM ELISA kit and Inbios JE detect followed by NIV Dengue IgM and Inbios DEN detect kits, and results were compared.

Results: The NIV kit showed a higher JE IgM positivity rate (77.9%) than the Inbios kit (69.5%). Differential testing reclassified 21.5% (22/102) of NIV JE IgM positive cases and 16.4% (15/91) of Inbios JE IgM positive cases as DEN positive.

Interpretation conclusion: The results emphasise the presence of cross reactivity between the JE and DEN viruses. Despite limitations such as the absence of PRNT, the findings support differential testing as a cost-effective strategy to enhance JE diagnostic accuracy in resource limited settings and reinforce the need for improved diagnostic algorithms to prevent misclassification of flavivirus infections especially in endemic countries.