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Varicella-Zoster Virus Testing in Clinical Practice in the U.S., 2016-2023.

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Varicella-zoster virus (VZV) serologic testing is common for immunity assessment, while diagnostic PCR testing is less frequent. Inappropriate immunoglobulin M (IgM) testing for VZV was noted despite recommendations.

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Area of Science:

  • Virology
  • Immunology
  • Public Health

Background:

  • Varicella-zoster virus (VZV) testing is crucial for immunity assessment and diagnosis, especially in the context of widespread varicella vaccination.
  • Immunoglobulin G (IgG) testing is recommended for immunity assessment, while real-time polymerase chain reaction (PCR) is advised for diagnosing varicella or herpes zoster.

Purpose of the Study:

  • To characterize the patterns of VZV serologic and virologic testing within U.S. clinical practice.
  • To analyze the frequency, patient demographics, and reasons for VZV testing across different test types.

Main Methods:

  • Utilized five administrative data sources (covering 11-100 million enrollees from 2016-2023) to identify patients undergoing VZV serologic (IgG, IgM) or virologic (PCR, culture) testing.
  • Conducted descriptive analyses to determine testing frequency, patient characteristics, and rates stratified by test type.
  • Employed the top 20 diagnostic codes associated with each test type as a proxy for the indication of testing.

Main Results:

  • Serologic IgG testing constituted the largest proportion (43%-92%) of VZV tests, predominantly in females (79%-82%) and young adults aged 20-39 years (62%-70%).
  • Serologic testing rates were significantly higher (50-60 per 10,000 persons) compared to virologic testing, with PCR rates around 1 per 10,000 persons.
  • Immunoglobulin M (IgM) testing accounted for up to 11% of tests, despite not being recommended for screening or diagnosis.

Conclusions:

  • VZV serologic testing rates were 50-60 times higher than PCR testing rates, with higher utilization in females and young adults, likely for screening purposes.
  • While most VZV testing appeared clinically relevant, the study identified inappropriate use of IgM testing.
  • Emphasized the importance of appropriate VZV testing strategies to guide effective clinical and public health management of varicella and herpes zoster.