{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T20:01:13Z","timestamp":1772740873918,"version":"3.50.1"},"reference-count":80,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    The BioFire\u00ae Global Fever Panel (GFP; BioFire Diagnostics, Salt Lake City, UT) is an assay designed for detecting multiple pathogens, including dengue virus (DENV;\n                    <jats:italic>Orthoflavivirus denguei<\/jats:italic>\n                    ). Although its performance has been primarily assessed using composite reference standards (CRS) or through direct comparisons with other tests, its real-world accuracy remains uncertain. The performance of the GFP in combination with real-time reverse transcriptase polymerase chain reaction (qRT-PCR) testing is evaluated in the present study using dengue surveillance data from 224 individuals with acute fever (\u22645 days) in a dengue-endemic area of the Peruvian Amazon. Dengue virus RNA was detected in serum and whole blood using qRT-PCR testing and the GFP, respectively. Two reference standards were developed: one based on CRS and another based on latent class analysis. The best latent class model (LCM) included a viral load surrogate. Using qRT-PCR testing or the LCM as a reference, the GFP exhibited a sensitivity of 94.5% (95% CI: 88.4\u201398.0%) and a specificity of 75.7% (95% CI: 66.8\u201383.2%). With CRS, the GFP displayed a sensitivity of 95.6% (95% CI: 90.7\u201398.4%) and 100% specificity. The simultaneous and sequential two-test algorithms for negative yielded comparable performance and exhibited high sensitivity compared with other two-test sequential algorithms. The sequential testing algorithm, which used qRT-PCR testing followed by the GFP for negative results, offered the best balance in cost, time, and performance (sensitivity: 99.3\u2013100%; specificity: 75.7\u2013100%). Although the GFP is more expensive than qRT-PCR testing, it offers a shorter turnaround time per sample. Overall, the findings suggest that the GFP is a reliable and high-performing tool for DENV testing, but its cost may restrict its use in resource-limited settings.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0395","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T16:51:08Z","timestamp":1767113468000},"page":"540-547","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Analysis of Molecular Detection Algorithms for Enhanced Dengue Surveillance: A Field Case Evaluation"],"prefix":"10.4269","volume":"114","author":[{"given":"Vidal","family":"Felices","sequence":"first","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steev","family":"Loyola","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH, Lima, Peru;"},{"name":"Vysnova Partners, Inc, Alexandria, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crystyan","family":"Siles","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger M.","family":"Castillo-Or\u00e9","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Silva","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia S.","family":"Ampuero","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit SOUTH, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"EClinicalMedicine","first-page":"100712","article-title":"Global, regional, and national dengue burden from 1990 to 2017: A systematic analysis based on the global burden of disease study 2017","volume":"32","author":"Zeng","year":"2021"},{"key":"b2","article-title":"Situation Report No 24 \u2013 Dengue Epidemiological Situation in the Region of the Americas \u2013 Epidemiological Week 24.","year":"2024"},{"key":"b3","series-title":"Nat Rev Microbiol","first-page":"S7","article-title":"Dengue: A continuing global threat","volume":"8","author":"Guzman","year":"2010"},{"key":"b4","series-title":"Nat Rev Microbiol","first-page":"S30","article-title":"Evaluation of diagnostic tests: Dengue","volume":"8","author":"Peeling","year":"2010"},{"key":"b5","series-title":"Cochrane Database Syst Rev","first-page":"CD011155","article-title":"NS1 antigen detecting assays for diagnosing acute dengue infection in people living in or returning from endemic countries","volume":"18","author":"Casenghi","year":"2018"},{"key":"b6","series-title":"Virus Res","first-page":"199018","article-title":"Dengue virus infection \u2013 A review of pathogenesis, vaccines, diagnosis and therapy","volume":"324","author":"Kok","year":"2023"},{"key":"b7","series-title":"Lancet","first-page":"1939","article-title":"Improving pathology and laboratory medicine in low-income and middle-income countries: Roadmap to solutions","volume":"391","author":"Sayed","year":"2018"},{"key":"b8","series-title":"PLoS One","first-page":"e80891","article-title":"The diagnostic and prognostic value of dengue non-structural 1 antigen detection in a hyper-endemic region in Indonesia","volume":"8","author":"Kosasih","year":"2013"},{"key":"b9","series-title":"PLoS One","first-page":"e0239710","article-title":"Evaluation of rapid diagnostic tests to detect dengue virus infections in Taiwan","volume":"15","author":"Liu","year":"2020"},{"key":"b10","series-title":"Virol J","first-page":"361","article-title":"Comparison of the diagnostic accuracy of commercial NS1-based diagnostic tests for early dengue infection","volume":"7","author":"Osorio","year":"2010"},{"key":"b11","series-title":"PLoS One","first-page":"e90037","article-title":"Diagnosing dengue at the point-of-care: Utility of a rapid combined diagnostic kit in Singapore","volume":"9","author":"Gan","year":"2014"},{"key":"b12","series-title":"Clin Vaccine Immunol","first-page":"2095","article-title":"Evaluation of six commercial point-of-care tests for diagnosis of acute dengue infections: The need for combining NS1 antigen and IgM\/IgG antibody detection to achieve acceptable levels of accuracy","volume":"18","author":"Blacksell","year":"2011"},{"key":"b13","series-title":"BMC Infect Dis","first-page":"210","article-title":"Diagnostic accuracy and utility of three dengue diagnostic tests for the diagnosis of acute dengue infection in Malaysia","volume":"20","author":"Chong","year":"2020"},{"key":"b14","series-title":"PLOS Glob Public Health","first-page":"e0000293","article-title":"Two-test algorithms for infectious disease diagnosis: Implications for COVID-19","volume":"2","author":"Pokharel","year":"2022"},{"key":"b15","series-title":"SAGE Open Med","first-page":"2050312118794589","article-title":"Dengue rapid diagnostic tests: Health professionals\u2019 practices and challenges in Burkina Faso","volume":"6","author":"Zongo","year":"2018"},{"key":"b16","series-title":"Enferm Infecc Microbiol Clin (Engl Ed)","first-page":"30","article-title":"Rapid diagnostic tests for dengue would reduce hospitalizations, healthcare costs and antibiotic prescriptions in Spain: A cost-effectiveness analysis","volume":"42","author":"Camprub\u00ed-Ferrer","year":"2024"},{"key":"b17","series-title":"J Biomed Biotechnol","first-page":"151967","article-title":"Commercial dengue rapid diagnostic tests for point-of-care application: Recent evaluations and future needs?","volume":"2012","author":"Blacksell","year":"2012"},{"key":"b18","series-title":"Health Technol Assess","first-page":"iii","article-title":"Evaluation of diagnostic tests when there is no gold standard. A review of methods","volume":"11","author":"Rutjes","year":"2007"},{"key":"b19","series-title":"PLoS One","first-page":"e0223832","article-title":"Diagnostic test evaluation methodology: A systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard \u2013 An update","volume":"14","author":"Umemneku Chikere","year":"2019"},{"key":"b20","series-title":"Nat Rev Microbiol","first-page":"S2","article-title":"A guide for diagnostic evaluations","volume":"4","author":"Peeling","year":"2006"},{"key":"b21","series-title":"Lancet Infect Dis","first-page":"1356","article-title":"Clinical evaluation of the BioFire Global Fever Panel for the identification of malaria, leptospirosis, chikungunya, and dengue from whole blood: A prospective, multicentre, cross-sectional diagnostic accuracy study","volume":"22","author":"Manabe","year":"2022"},{"key":"b22","series-title":"J Travel Med","first-page":"taad041","article-title":"Clinical evaluation of BioFire\u00ae multiplex-PCR panel for acute undifferentiated febrile illnesses in travellers: A prospective multicentre study","volume":"30","author":"Camprub\u00ed-Ferrer","year":"2023"},{"key":"b23","series-title":"J Clin Microbiol","first-page":"4977","article-title":"Serotype-specific detection of dengue viruses in a fourplex real-time reverse transcriptase PCR assay","volume":"43","author":"Johnson","year":"2005"},{"key":"b24","series-title":"Microelectron Eng","first-page":"26","article-title":"Diagnostic tools for tackling febrile illness and enhancing patient management","volume":"201","author":"Mitsakakis","year":"2018"},{"key":"b25","article-title":"510(k) Substantial Equivalence Determination Decision Summary \u2013 BioFire\u00ae Global Fever Panel \u2013 BioFire Defense."},{"key":"b26","series-title":"BMJ","first-page":"j5779","article-title":"Concerns about composite reference standards in diagnostic 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patients","volume":"18","author":"Nainggolan","year":"2023"},{"key":"b31","series-title":"PLoS Negl Trop Dis","first-page":"e0010365","article-title":"Combining rapid diagnostic tests to estimate primary and post-primary dengue immune status at the point of care","volume":"16","author":"Biggs","year":"2022"},{"key":"b32","series-title":"Int J Infect Dis","first-page":"90","article-title":"Dengue viremia kinetics in asymptomatic and symptomatic infection","volume":"101","author":"Matangkasombut","year":"2020"},{"key":"b33","series-title":"Turk J Emerg Med","first-page":"177","article-title":"User\u2019s guide to sample size estimation in diagnostic accuracy studies","volume":"22","author":"Akoglu","year":"2022"},{"key":"b34","series-title":"Sci Rep","first-page":"4232","article-title":"Latent class modeling to compare testing platforms for detection of antibodies against the Chlamydia trachomatis antigen Pgp3","volume":"8","author":"Wiegand","year":"2018"},{"key":"b35","series-title":"PLoS Negl Trop Dis","first-page":"e0004333","article-title":"The rapid test based on Leishmania infantum chimeric rK28 protein improves the diagnosis of canine visceral Leishmaniasis by reducing the detection of false-positive dogs","volume":"10","author":"Fraga","year":"2016"},{"key":"b36","series-title":"Biosensors (Basel)","first-page":"206","article-title":"Dengue detection: Advances in diagnostic tools from conventional technology to point of care","volume":"11","author":"Kabir","year":"2021"},{"key":"b37","series-title":"J Travel Med","first-page":"taab146","article-title":"Global burden for dengue and the evolving pattern in the past 30 years","volume":"28","author":"Yang","year":"2021"},{"key":"b38","article-title":"Epidemiological Alert \u2013 Increase in Dengue Cases in the Region of the Americas \u2013 16 February 2024.","year":"2024"},{"key":"b39","series-title":"Clin Infect Dis","first-page":"2262","article-title":"Algorithm in the diagnosis of febrile illness using pathogen-specific rapid diagnostic tests","volume":"70","author":"Pokharel","year":"2020"},{"key":"b40","series-title":"PLoS Negl Trop Dis","first-page":"e0007785","article-title":"Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study","volume":"13","author":"Utama","year":"2019"},{"key":"b1","series-title":"EClinicalMedicine","first-page":"100712","article-title":"Global, regional, and national dengue burden from 1990 to 2017: A systematic analysis based on the global burden of disease study 2017","volume":"32","author":"Zeng","year":"2021"},{"key":"b2","article-title":"Situation Report No 24 \u2013 Dengue Epidemiological Situation in the Region of the Americas \u2013 Epidemiological Week 24.","year":"2024"},{"key":"b3","series-title":"Nat Rev Microbiol","first-page":"S7","article-title":"Dengue: A continuing global threat","volume":"8","author":"Guzman","year":"2010"},{"key":"b4","series-title":"Nat Rev Microbiol","first-page":"S30","article-title":"Evaluation of diagnostic tests: Dengue","volume":"8","author":"Peeling","year":"2010"},{"key":"b5","series-title":"Cochrane Database Syst Rev","first-page":"CD011155","article-title":"NS1 antigen detecting assays for diagnosing acute dengue infection in people living in or returning from endemic countries","volume":"18","author":"Casenghi","year":"2018"},{"key":"b6","series-title":"Virus Res","first-page":"199018","article-title":"Dengue virus infection \u2013 A review of pathogenesis, vaccines, diagnosis and therapy","volume":"324","author":"Kok","year":"2023"},{"key":"b7","series-title":"Lancet","first-page":"1939","article-title":"Improving pathology and laboratory medicine in low-income and middle-income countries: Roadmap to solutions","volume":"391","author":"Sayed","year":"2018"},{"key":"b8","series-title":"PLoS One","first-page":"e80891","article-title":"The diagnostic and prognostic value of dengue non-structural 1 antigen detection in a hyper-endemic region in Indonesia","volume":"8","author":"Kosasih","year":"2013"},{"key":"b9","series-title":"PLoS One","first-page":"e0239710","article-title":"Evaluation of rapid diagnostic tests to detect dengue virus infections in Taiwan","volume":"15","author":"Liu","year":"2020"},{"key":"b10","series-title":"Virol J","first-page":"361","article-title":"Comparison of the diagnostic accuracy of commercial NS1-based diagnostic tests for early dengue infection","volume":"7","author":"Osorio","year":"2010"},{"key":"b11","series-title":"PLoS One","first-page":"e90037","article-title":"Diagnosing dengue at the point-of-care: Utility of a rapid combined diagnostic kit in Singapore","volume":"9","author":"Gan","year":"2014"},{"key":"b12","series-title":"Clin Vaccine Immunol","first-page":"2095","article-title":"Evaluation of six commercial point-of-care tests for diagnosis of acute dengue infections: The need for combining NS1 antigen and IgM\/IgG antibody detection to achieve acceptable levels of accuracy","volume":"18","author":"Blacksell","year":"2011"},{"key":"b13","series-title":"BMC Infect Dis","first-page":"210","article-title":"Diagnostic accuracy and utility of three dengue diagnostic tests for the diagnosis of acute dengue infection in Malaysia","volume":"20","author":"Chong","year":"2020"},{"key":"b14","series-title":"PLOS Glob Public Health","first-page":"e0000293","article-title":"Two-test algorithms for infectious disease diagnosis: Implications for COVID-19","volume":"2","author":"Pokharel","year":"2022"},{"key":"b15","series-title":"SAGE Open Med","first-page":"2050312118794589","article-title":"Dengue rapid diagnostic tests: Health professionals\u2019 practices and challenges in Burkina Faso","volume":"6","author":"Zongo","year":"2018"},{"key":"b16","series-title":"Enferm Infecc Microbiol Clin (Engl Ed)","first-page":"30","article-title":"Rapid diagnostic tests for dengue would reduce hospitalizations, healthcare costs and antibiotic prescriptions in Spain: A cost-effectiveness analysis","volume":"42","author":"Camprub\u00ed-Ferrer","year":"2024"},{"key":"b17","series-title":"J Biomed Biotechnol","first-page":"151967","article-title":"Commercial dengue rapid diagnostic tests for point-of-care application: Recent evaluations and future needs?","volume":"2012","author":"Blacksell","year":"2012"},{"key":"b18","series-title":"Health Technol Assess","first-page":"iii","article-title":"Evaluation of diagnostic tests when there is no gold standard. A review of methods","volume":"11","author":"Rutjes","year":"2007"},{"key":"b19","series-title":"PLoS One","first-page":"e0223832","article-title":"Diagnostic test evaluation methodology: A systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard \u2013 An update","volume":"14","author":"Umemneku Chikere","year":"2019"},{"key":"b20","series-title":"Nat Rev Microbiol","first-page":"S2","article-title":"A guide for diagnostic evaluations","volume":"4","author":"Peeling","year":"2006"},{"key":"b21","series-title":"Lancet Infect Dis","first-page":"1356","article-title":"Clinical evaluation of the BioFire Global Fever Panel for the identification of malaria, leptospirosis, chikungunya, and dengue from whole blood: A prospective, multicentre, cross-sectional diagnostic accuracy study","volume":"22","author":"Manabe","year":"2022"},{"key":"b22","series-title":"J Travel Med","first-page":"taad041","article-title":"Clinical evaluation of BioFire\u00ae multiplex-PCR panel for acute undifferentiated febrile illnesses in travellers: A prospective multicentre study","volume":"30","author":"Camprub\u00ed-Ferrer","year":"2023"},{"key":"b23","series-title":"J Clin Microbiol","first-page":"4977","article-title":"Serotype-specific detection of dengue viruses in a fourplex real-time reverse transcriptase PCR assay","volume":"43","author":"Johnson","year":"2005"},{"key":"b24","series-title":"Microelectron Eng","first-page":"26","article-title":"Diagnostic tools for tackling febrile illness and enhancing patient management","volume":"201","author":"Mitsakakis","year":"2018"},{"key":"b25","article-title":"510(k) Substantial Equivalence Determination Decision Summary \u2013 BioFire\u00ae Global Fever Panel \u2013 BioFire Defense."},{"key":"b26","series-title":"BMJ","first-page":"j5779","article-title":"Concerns about composite reference standards in diagnostic 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patients","volume":"18","author":"Nainggolan","year":"2023"},{"key":"b31","series-title":"PLoS Negl Trop Dis","first-page":"e0010365","article-title":"Combining rapid diagnostic tests to estimate primary and post-primary dengue immune status at the point of care","volume":"16","author":"Biggs","year":"2022"},{"key":"b32","series-title":"Int J Infect Dis","first-page":"90","article-title":"Dengue viremia kinetics in asymptomatic and symptomatic infection","volume":"101","author":"Matangkasombut","year":"2020"},{"key":"b33","series-title":"Turk J Emerg Med","first-page":"177","article-title":"User\u2019s guide to sample size estimation in diagnostic accuracy studies","volume":"22","author":"Akoglu","year":"2022"},{"key":"b34","series-title":"Sci Rep","first-page":"4232","article-title":"Latent class modeling to compare testing platforms for detection of antibodies against the Chlamydia trachomatis antigen Pgp3","volume":"8","author":"Wiegand","year":"2018"},{"key":"b35","series-title":"PLoS Negl Trop Dis","first-page":"e0004333","article-title":"The rapid test based on Leishmania infantum chimeric rK28 protein improves the diagnosis of canine visceral Leishmaniasis by reducing the detection of false-positive dogs","volume":"10","author":"Fraga","year":"2016"},{"key":"b36","series-title":"Biosensors (Basel)","first-page":"206","article-title":"Dengue detection: Advances in diagnostic tools from conventional technology to point of care","volume":"11","author":"Kabir","year":"2021"},{"key":"b37","series-title":"J Travel Med","first-page":"taab146","article-title":"Global burden for dengue and the evolving pattern in the past 30 years","volume":"28","author":"Yang","year":"2021"},{"key":"b38","article-title":"Epidemiological Alert \u2013 Increase in Dengue Cases in the Region of the Americas \u2013 16 February 2024.","year":"2024"},{"key":"b39","series-title":"Clin Infect 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