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Madewell Z, Major C, Graff N, Adams C, Rodriguez D, Morales T, Medina Lopes N, Tosado R, Sánchez‐González L, Perez‐Padilla J, Volkman H, Bertrán‐Pasarell J, Sainz de la Peña D, Munoz‐Jordan J, Santiago G, Lorenzi O, Rivera‐Amill V, Rolfes M, Paz‐Bailey G, Adams L, Wong J. Diagnostic Accuracy of the Abbott BinaxNOW COVID-19 Antigen Card Test, Puerto Rico. Influenza Other Respir Viruses 2024; 18:e13305. [PMID: 39053895 PMCID: PMC11300111 DOI: 10.1111/irv.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/21/2024] [Accepted: 04/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic underscored the need for rapid and accurate diagnostic tools. In August 2020, the Abbott BinaxNOW COVID-19 Antigen Card test became available as a timely and affordable alternative for SARS-CoV-2 molecular testing, but its performance may vary due to factors including timing and symptomatology. This study evaluates BinaxNOW diagnostic performance in diverse epidemiological contexts. METHODS Using RT-PCR as reference, we assessed performance of the BinaxNOW COVID-19 test for SARS-CoV-2 detection in anterior nasal swabs from participants of two studies in Puerto Rico from December 2020 to May 2023. Test performance was assessed by days post symptom onset, collection strategy, vaccination status, symptomatology, repeated testing, and RT-PCR cycle threshold (Ct) values. RESULTS BinaxNOW demonstrated an overall sensitivity of 84.1% and specificity of 98.8%. Sensitivity peaked within 1-6 days after symptom onset (93.2%) and was higher for symptomatic (86.3%) than asymptomatic (67.3%) participants. Sensitivity declined over the course of infection, dropping from 96.3% in the initial test to 48.4% in testing performed 7-14 days later. BinaxNOW showed 99.5% sensitivity in participants with low Ct values (≤ 25) but lower sensitivity (18.2%) for participants with higher Cts (36-40). CONCLUSIONS BinaxNOW demonstrated high sensitivity and specificity, particularly in early-stage infections and symptomatic participants. In situations where test sensitivity is crucial for clinical decision-making, nucleic acid amplification tests are preferred. These findings highlight the importance of considering clinical and epidemiological context when interpreting test results and emphasize the need for ongoing research to adapt testing strategies to emerging SARS-CoV-2 variants.
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Affiliation(s)
- Zachary J. Madewell
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Chelsea G. Major
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Nathan Graff
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Cameron Adams
- Department of Microbiology and ImmunologyUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Dania M. Rodriguez
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Tatiana Morales
- Ponce Research InstitutePonce Health Sciences UniversityPoncePuerto Rico
| | - Nicole A. Medina Lopes
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Rafael Tosado
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | | | - Janice Perez‐Padilla
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Hannah R. Volkman
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | | | | | - Jorge Munoz‐Jordan
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Gilberto A. Santiago
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Olga Lorenzi
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | | | - Melissa A. Rolfes
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Gabriela Paz‐Bailey
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Laura E. Adams
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
| | - Joshua M. Wong
- Division of Vector‐Borne DiseasesCenters for Disease Control and PreventionSan JuanPuerto Rico
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Chang CK, Chen CS, Jian MJ, Chung HY, Chang FY, Lin JC, Hsieh SS, Tang SH, Perng CL, Chen CW, Chiu CH, Shang HS. Monitoring coronavirus disease progression and clinical impact through quantitative viral load testing. Clin Chim Acta 2024; 560:119731. [PMID: 38754576 DOI: 10.1016/j.cca.2024.119731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/13/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The viral load (VL) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals is critical for improving clinical treatment strategies, care, and decisions. Several studies have reported that the initial SARS-CoV-2 VL is associated with disease severity and mortality. Cycle threshold (Ct) values and/or copies/mL are often used to quantify VL. However, a multitude of platforms, primer/probe sets of different SARS-CoV-2 target genes, and reference material manufacturers may cause inconsistent interlaboratory interpretations. The first International Standard for SARS-CoV-2 RNA quantitative assays has allowed diagnostic laboratories to transition SARS-CoV-2 VL results into international units per milliliter (IU/mL). The Cobas SARS-CoV-2 Duo quantitative assay provides VL results expressed in IU/mL. MATERIALS AND METHODS We enrolled 145 and 50 SARS-CoV-2-positive, hospitalized and 50-negative individuals at the Tri-Service General Hospital, Taiwan from January to May 2022. Each participant's electronic medical record was reviewed to determine asymptomatic, mild, moderate, and severe cases. Nasopharyngeal swabs were collected using universal transport medium. We investigated the association of SARS-CoV-2 VL with disease severity using the Cobas SARS-CoV-2 Duo quantitative assay and its functionality in clinical assessment and decision making to further improve clinical treatment strategies. Limit of detection (LOD) was assessed. RESULTS All 50 SARS-CoV-2-negative samples confirmed negative for SARS-CoV-2, demonstrating 100 % specificity of the Cobas SARS-CoV-2 Duo assay. Patients with severe symptoms had longer hospital stays, and the length of hospital stay (30.56 days on average) positively correlated with the VL (8.22 ± 1.21 log10 IU/mL). Asymptomatic patients had the lowest VL (5.54 ± 2.06 log10 IU/mL) at admission and the shortest hospital stay (14.1 days on average). CONCLUSIONS VL is associated with disease severity and duration of hospitalization; therefore, its quantification should be considered when making clinical care decisions and treatment strategies. The Cobas SARS-CoV-2 Duo assay provides a commutable unitage IU/mL for interlaboratory interpretations.
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Affiliation(s)
- Chih-Kai Chang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chi-Sheng Chen
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ming-Jr Jian
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hsing-Yi Chung
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shan-Shan Hsieh
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Sheng-Hui Tang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Cherng-Lih Perng
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chien-Wen Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hung-Sheng Shang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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3
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Han C, Wang H, Wang Y, Hang C, Wang Y, Meng X. The silent reservoir? SARS-CoV-2 detection in the middle ear effusion of patients with Otitis media with effusion after omicron infection. Am J Otolaryngol 2024; 45:104229. [PMID: 38422555 DOI: 10.1016/j.amjoto.2024.104229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This multicenter, prospective study is designed to investigate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the Middle Ear Effusion (MEE) of patients developing Otitis Media with Effusion (OME) subsequent to an Omicron infection. The objective is to elucidate any potential association between the virus and the condition. METHODS This study, conducted from January to June 2023, spanned the Otolaryngology departments of two medical institutions in Eastern China. Patients manifesting OME subsequent to Omicron infection from both hospitals were subjected to comprehensive otolaryngological assessments, including pure-tone audiometry (PTA), tympanometry, otoscopic examination, and nasopharyngolaryngoscopy. Subsequently, MEE samples extracted from these patients were analyzed through RT-PCR to detect SARS-CoV-2. RESULTS In this study, 23 patients (32-84 years; 57.5 ± 14.8 mean age; 47.8 % male) presented OME in 25 ears post-Omicron infection, with 21 (91.3 %) exhibiting unilateral symptoms. The median duration from infection to MEE sampling was 21 days (IQR: 25-46; range: 11-150). Predominantly, 64.0 % exhibited Type B tympanograms, and fluid accumulation was observed in 88.0 % of ears. SARS-CoV-2 was detected in 3 MEE samples (12.0 %), with cycle threshold values ranging between 25.65 and 33.30. CONCLUSIONS Our study highlights the potential effects of COVID-19 on the middle ear, suggesting a link between SARS-CoV-2 and OME onset. The virus, a significant contributor to OME, is detectable in the MEE nearly a month post-Omicron infection, indicating a potential alteration in OME treatment strategies and a risk of recurrence, emphasizing the necessity for otolaryngologist vigilance.
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Affiliation(s)
- Chengzhou Han
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Huifang Wang
- Department of Clinical Laboratory, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Ying Wang
- Department of Otolaryngology, Wuxi Huishan District Qianqiao Street Community Health Service Center, 22 Qianqiao Street, Huishan District, Wuxi 214153, PR China
| | - Chao Hang
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Yangyang Wang
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Xiangming Meng
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China.
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Meng X, Wang Y, Han C, Gu X, Hang C, Guo J, Jiang Y. Clinical manifestations and outcomes of otitis media with effusion in adult patients following Omicron infection in China. BIOMOLECULES & BIOMEDICINE 2024; 24:1028-1034. [PMID: 38498300 PMCID: PMC11293243 DOI: 10.17305/bb.2024.10239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Within the constantly changing landscape of the coronavirus disease 2019 (COVID-19) pandemic, the emergence of new variants introduces novel clinical challenges, necessitating the acquisition of updated insights into their impacts on various health conditions. This study investigates the clinical features and therapeutic outcomes of otitis media with effusion (OME) in adults following infection with the Omicron variant of COVID-19, in the context of China ending its "Zero-COVID-19" policy. Conducted as a multicenter, retrospective analysis at two medical institutions in Eastern China from December 2022 to February 2023, the study included patients with confirmed Omicron infection who were diagnosed with OME within two months, adhering to guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF). Data on demographics, time from infection to OME manifestation, associated symptoms, and treatment outcomes were collected. Among 68 patients (73 affected ears) with OME post-Omicron infection, common symptoms included cough and nasal obstruction (69.1%). All reported ear fullness, with 86.8% experiencing hearing loss. Tympanic bullae were observed in 72.6% during otoscopy, and most tympanometry results showed a B-type tympanogram (80.0%). An integrated treatment strategy led to an 83.6% cure rate, although 8.2% experienced relapse within 2-3 months. Our findings highlight OME as a prevalent ear complication associated with COVID-19 during the Omicron pandemic, underscoring the necessity for further investigation into its complexities. While the integrated treatment approach proved effective, the 8.2% post-treatment recurrence rate underscores the importance of ongoing monitoring and signals an urgent need for more comprehensive research.
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Affiliation(s)
- Xiangming Meng
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, China
| | - Ying Wang
- Department of Otolaryngology, Wuxi Huishan District Qianqiao Street Community Health Service Center, Wuxi, China
| | - Chengzhou Han
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, China
| | - Xiaobo Gu
- Department of Otolaryngology, Wuxi Huishan District Qianqiao Street Community Health Service Center, Wuxi, China
| | - Chao Hang
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, China
| | - Jianxun Guo
- Department of Otolaryngology, Wuxi Huishan District Qianqiao Street Community Health Service Center, Wuxi, China
| | - Yuting Jiang
- Department of Otolaryngology, Wuxi Huishan District Qianqiao Street Community Health Service Center, Wuxi, China
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Nunes SLP, de França CA, Rocha GD, Oliveira SADS, Freitas MR, da Silva EO, Coutinho KS, Jerônimo AS, de Lima GB, de Lima RE, Bezerra MF, Dezordi FZ, Paiva MHS, Wallau GDL, de Souza CDF, Armstrong ADC, do Carmo RF. Assessment of clinical characteristics and viral load in individuals infected by Delta and Omicron variants of SARS-CoV-2. Heliyon 2023; 9:e18994. [PMID: 37600420 PMCID: PMC10432967 DOI: 10.1016/j.heliyon.2023.e18994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
In late 2021, a new variant of SARS-CoV-2 called Omicron emerged, replacing Delta worldwide. Although it has been associated with a lower risk of hospitalization and severe forms of COVID-19, there is little evidence of its relationship with specific symptoms and viral load. The aim of this study was to verify the relationship between Delta and Omicron variants of concern, viral load, and the occurrence of symptoms in individuals with COVID-19. Nasopharyngeal swab samples were collected and sequenced from patients with COVID-19 from the Northeast Region of Brazil between August 2021 and March 2022. The results showed a gradual replacement of the Delta variant by the Omicron variant during the study period. A total of 316 samples (157 Delta and 159 Omicron) were included. There was a higher prevalence of symptoms in Delta-infected individuals, such as coryza, olfactory and taste disturbances, headache, and myalgia. There was no association between viral load and the variants analyzed. The results reported here contribute to the understanding of the symptoms associated with the Delta and Omicron variants in individuals affected by COVID-19.
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Affiliation(s)
- Sávio Luiz Pereira Nunes
- Postgraduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Recife, Pernambuco, Brazil
| | - Chirles Araújo de França
- Multi-User Research Laboratory (LAMUPE), Dr. Washington Antônio de Barros Hospital – EBSERH/UNIVASF, Petrolina, Pernambuco, Brazil
| | - Gabriela Dias Rocha
- Postgraduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Recife, Pernambuco, Brazil
- Multi-User Research Laboratory (LAMUPE), Dr. Washington Antônio de Barros Hospital – EBSERH/UNIVASF, Petrolina, Pernambuco, Brazil
| | - Samily Aquino de Sá Oliveira
- Multi-User Research Laboratory (LAMUPE), Dr. Washington Antônio de Barros Hospital – EBSERH/UNIVASF, Petrolina, Pernambuco, Brazil
| | - Mariana Ramos Freitas
- Multi-User Research Laboratory (LAMUPE), Dr. Washington Antônio de Barros Hospital – EBSERH/UNIVASF, Petrolina, Pernambuco, Brazil
| | - Eliane Oliveira da Silva
- VIII Regional Health Management, State Health Secretariat of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Katia Sampaio Coutinho
- VIII Regional Health Management, State Health Secretariat of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Aline Silva Jerônimo
- VIII Regional Health Management, State Health Secretariat of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Gustavo Barbosa de Lima
- Technology Platforms Center (NPT), Aggeu Magalhães Institute (IAM), FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
| | - Raul Emídio de Lima
- Technology Platforms Center (NPT), Aggeu Magalhães Institute (IAM), FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
| | - Matheus Filgueira Bezerra
- Departament of Microbiology, Aggeu Magalhães Institute (IAM), FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
| | - Filipe Zimmer Dezordi
- Departament of Entomology, Aggeu Magalhães Institute (IAM)- FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
- Bioinformatics Center (NBI), Aggeu Magalhães Institute (IAM), FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
| | - Marcelo Henrique Santos Paiva
- Departament of Entomology, Aggeu Magalhães Institute (IAM)- FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
- Life Sciences Center, Federal University of Pernambuco (UFPE), Caruaru, Pernambuco, Brazil
| | - Gabriel da Luz Wallau
- Departament of Entomology, Aggeu Magalhães Institute (IAM)- FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
- Bioinformatics Center (NBI), Aggeu Magalhães Institute (IAM), FIOCRUZ-Pernambuco, Recife, Pernambuco, Brazil
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, National Reference Center for Tropical Infectious Diseases, Hamburg, Germany
| | | | - Anderson da Costa Armstrong
- Collegiate of Medicine, Federal University of the São Francisco Valley – UNIVASF, Petrolina, Pernambuco, Brazil
| | - Rodrigo Feliciano do Carmo
- Postgraduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Recife, Pernambuco, Brazil
- Collegiate of Pharmaceutical Sciences, Federal University of the São Francisco Valley – UNIVASF, Petrolina, Pernambuco, Brazil
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Monzani A, Borgogna C, Ferrante D, Ciacchini B, Felici E, Gariglio M, Rabbone I. #Stayathome If You Have a Cold: High SARS-CoV-2 Salivary Viral Loads in Pediatric Patients with Nasopharyngeal Symptoms. Viruses 2022; 15:81. [PMID: 36680121 PMCID: PMC9867493 DOI: 10.3390/v15010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
The choice of the best SARS-CoV-2 detection approach is crucial to predict which children with SARS-CoV-2 are at high risk of spreading the virus in order to manage public health measures and policies. In this prospective observational study of 35 children admitted to the Pediatric Emergency Departments of two tertiary hospitals in Northern Italy who tested positive for SARS-CoV-2 by standard RT-PCR in nasopharyngeal swab (NPS), we evaluated their presenting symptoms according to their salivary viral load (SVL) determined by droplet digital PCR (ddPCR). Despite an overall low concordance between SARS-CoV-2 detected by salivary ddPCR and NPS RT-PCR (54.3%), when only patients with nasopharyngeal symptoms were analyzed, the sensitivity of ddPCR in saliva specimens increased to 71.4%, and over half of these patients had high SVL (>105 copies/mL), which was significantly more frequent than in children without nasopharyngeal symptoms (57.1% vs. 14.3%, OR = 8, CI 95% 1.28−50.03, p = 0.03). All asymptomatic children had low SVL values. Our findings support the hypothesis that children with nasopharyngeal symptoms are at higher risk of spreading SARS-CoV-2 due to their high SVL and, conversely, asymptomatic children are unlikely to spread the virus due to their low SVL, regardless of their NPS positivity.
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Affiliation(s)
- Alice Monzani
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Cinzia Borgogna
- Virology Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
| | - Daniela Ferrante
- Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
| | - Benedetta Ciacchini
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, AO SS. Antonio e Biagio e Cesare Arrigo, 15100 Alessandria, Italy
| | - Marisa Gariglio
- Virology Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
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