Page 1 of 2Document No: INS-SE-52 Version No: 12

RS38-FVDenguePrinted: 15-Jan-19, 9:59 AM

Flavivirus – Dengue Fever SerologyPlease print the document labelled ‘Clinical Notes & Test Instructions’ and enter your results via myQAP.

Kit Information Please supply kit lot number and expiry date If you have changed kits since the last RCPAQAP Serology survey, OR have not previously supplied your

kit details to the RCPAQAP Serology, please provide us with your new kit details

DO NOT FILL IN DETAILS FOR TESTS IF RESULTS ARE NOT INCLUDEDTest for example, IgG, IgM, Total Ab, NS1 Ag, NS1/IgG/IgM CombinedMethod for example, EIA, HAI, IFA, ICT

Please write expiry date as Mmm/yy example, Nov 19Test Method Lot Number Expiry Date

Test Results Units – for example, S/CO, titre Cut-off value is the absolute value that designates the cut-off point below which is negative or equivocal

and equal to or above is positive. Do not use >, ≥, , < for cut-off value. Test value – for the purposes of the QAP, titre is defined as the inverse of the end-point dilution – for

example, a dilution of 1/64 or 1:64, is a titre of 64. Please express the titre in this manner and do not write the dilution.

Test result - (Neg = negative, Equ = equivocal, Pos = positive). Enter Not Tested if Not Tested. Enter N/A (not applicable) if any of the above do not relate to your test

Specimen No. ___A Specimen No. ___BTest Units Cut-off Value Result Value Result

Participant No: _ _ _ _ _

Survey No: V___:20___

Page 2 of 2Document No: INS-SE-52 Version No: 12

RS38-FVDenguePrinted: 15-Jan-19, 9:59 AM

Interpretative CommentFor the purposes of data management, please use the comments provided. It is acceptable to tick more than one comment per specimen.

Interpretative Comment for Dengue Fever ___A ___B1 No serological evidence of recent dengue infection.

2 Serological evidence of past infection with dengue.

3 Suggestive of recent or current dengue infection.

4 Suggestive of recent or current primary dengue infection.

5 Suggestive of recent or current secondary dengue infection.

6 In order to confirm or exclude recent infection, please send a second specimen in 10-14 days for parallel testing.

7 Refer to a reference laboratory for further testing.

8 Possible cross-reactivity with other Flavivirus.

9 No comment.

10 Not tested.