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Test Code VZPG Varicella-Zoster Antibody, IgG, Serum

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

Varicella-Zoster Ab, IgG, S

Specimen Type


Specimen Required


Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 0.5 mL

Reject Due To


Mild OK; Gross reject


Mild OK; Gross reject


Mild OK; Gross reject


Heat-inactivated specimen

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 14 days
  Frozen  14 days

Specimen Minimum Volume

0.4 mL

Day(s) and Time(s) Performed

Monday through Saturday, 9 a.m. 

Specimen Retention Time

14 days

Analytic Time

Same day/1 day

Reference Values

Vaccinated: Positive (≥1.1 AI)

Unvaccinated: Negative (≤0.8 AI)

Useful For

Determination of immune status of individuals to the varicella-zoster virus (VZV)


Documentation of previous infection with VZV in an individual without a previous record of immunization to VZV

Method Name

Multiplex Flow Immunoassay (MFI)

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
VZPG Varicella-Zoster Ab, IgG, S 5403-1


Result ID Test Result Name Result LOINC Value
VZG Varicella-Zoster Ab, IgG, S 15410-4
DEXG4 Varicella IgG Antibody Index 5403-1

Clinical Information

Varicella-zoster virus (VZV), a herpes virus, causes 2 distinct exanthematous (rash-associated) diseases: chickenpox (varicella) and herpes zoster (shingles). Chickenpox is a highly contagious, though typically benign disease, usually contracted during childhood. Chickenpox is characterized by a dermal vesiculopustular rash that develops in successive crops approximately 10 to 21 days following exposure.(1) Although primary infection with VZV results in immunity and protection from subsequent infection, VZV remains latent within sensory dorsal root ganglia and upon reactivation, manifests as herpes zoster or shingles. During reactivation, the virus migrates along neural pathways to the skin, producing a unilateral rash, usually limited to a single dermatome. Shingles is an extremely painful condition typically occurring in older nonimmune adults or those with waning immunity to VZV and in patients with impaired cellular immunity.(2)


Individuals at risk for severe complications following primary VZV infection include pregnant women, in whom the virus may spread through the placenta to the fetus, causing congenital disease in the infant. Additionally, immunosuppressed patients are at risk for developing severe VZV-related complications, which include cutaneous disseminated disease and visceral organ involvement.(2,3)


Serologic screening for IgG-class antibodies to VZV will aid in identifying nonimmune individuals.


Positive: Antibody index value (AI) of 1.1 or higher:

The reported AI value is for reference only. This is a qualitative test and the numeric value of the AI is not indicative of the amount of antibody present. AI values above the manufacturer recommended cutoff for this assay indicate that specific antibodies were detected, suggesting prior exposure or vaccination.The presence of detectable IgG-class antibodies indicates prior exposure to the varicella-zoster virus (VZV) through infection or immunization. Individuals testing positive are considered immune to varicella-zoster.


Equivocal: AI 0.9-1.0

Submit an additional specimen for testing in 10 to 14 days to demonstrate IgG seroconversion if recently vaccinated or if otherwise clinically indicated.


Negative: AI of 0.8 or lower

The absence of detectable IgG-class antibodies suggests no prior exposure to the VZV or the lack of a specific immune response to immunization.


IgG-class antibodies to varicella-zoster virus may be present in serum specimens from individuals who have received blood products within the past several months, but have not been immunized or experienced past infection with this virus.


Serum specimens drawn early during acute phase of infection may be negative for IgG-class antibodies to this virus.

Clinical Reference

1. Yankowitz J, Grose C: Congenital infections. In Essentials of Diagnostic Virology. Edited by GA Storch. Churchill Livingstone, New York, 2000, pp 187-201

2. Gnann JW, Whitley RJ: Herpes zoster. N Engl J Med 2002;347:340-346

3. Cvjetkovic D, Jovanovic J, Hrnjakovic-Cvjetkovic I, et al: Reactivation of herpes zoster infection by varicella-zoster virus. Med Pregl 1999;52(3):125-128

Method Description

The BioPlex 2200 Varicella-Zoster Virus (VZV) IgG assay uses multiplex flow immunoassay technology. Briefly, serum samples are mixed and incubated at 37° C with sample diluent and dyed beads coated with VZV antigen. After a wash cycle, antihuman IgG-antibody conjugated to phycoerythrin (PE) is added to the mixture and incubated at 37° C. Excess conjugate is removed in another wash cycle and the beads are resuspended in wash buffer. The bead mixture then passes through a detector that identifies the bead based on dye fluorescence and determines the amount of antibody captured by the antigen based on the fluorescence of the attached PE. Raw data is calculated in relative fluorescence intensity. 


Three additional dyed beads, an internal standard bead, a serum verification bead, and a reagent blank bead are present in each reaction mixture to verify detector response, the addition of serum to the reaction vessel and the absence of significant nonspecific binding in serum.(Package insert: BioPlex 2200 System MMRV IgG, Bio-Rad Laboratories Clinical Diagnostics Group, Hercules, CA)

Supportive Data

To evaluate the accuracy of the BioPlex Varicella-Zoster Virus (VZV) IgG multiplex flow immunoassay (MFI), 500 prospective serum specimens were analyzed in a blinded fashion by the Diamedix VZV IgG EIA (Diamedix, Miami, FL) and the BioPlex VZV IgG assay. Specimens with discordant results after initial testing were repeated by both assays during the same freeze/thaw cycle. Further discrepancies were evaluated by the SeraQuest VZV IgG EIA.(Quest Int., Doral, FL) The results are summarized below:



Diamedix VZV IgG EIA

BioPlex VZV IgG

















a. All 18 specimens tested positive by the SeraQuest VZV IgG EIA.

Sensitivity: 92.2% (436/473); 95% Confidence interval (95% CI): 89.4%-94.3%

Specificity: 100.0 (22/22); 95% CI: 82.5%-100.0%

Overall percent agreement: 91.8% (459/500); 95% CI: 89.0%-93.9%


If not ordering electronically, complete, print, and send a General Request Form (T239) with the specimen (