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BOUKLI N, FLAMAND C, CHEA KL, HENG L, KEO S, SOUR K, IN S, CHHIM P, CHHOR B, KRUY L, FEENSTRA JDM, GANDHI M, OKAFOR O, ULEKLIEV C, AUERSWALD H, HORM VS, KARLSSON EA. ONE ASSAY TO TEST THEM ALL: COMPARING MULTIPLEX ASSAYS FOR EXPANSION OF RESPIRATORY VIRUS SURVEILLANCE. medRxiv 2023:2023.01.19.23284806. [PMID: 36711477 PMCID: PMC9882628 DOI: 10.1101/2023.01.19.23284806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Molecular multiplex assays (MPAs) for simultaneous detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza and respiratory syncytial virus (RSV) in a single RT-PCR reaction reduce time and increase efficiency to identify multiple pathogens with overlapping clinical presentation but different treatments or public health implications. Methods Clinical performance of XpertXpress ® SARS-CoV-2/Flu/RSV (Cepheid, GX), TaqPath™ COVID-19, FluA/B, RSV Combo kit (Thermo Fisher Scientific, TP), and PowerChek™ SARS-CoV-2/Influenza A&B/RSV Multiplex RT-PCR kit II (KogeneBiotech, PC) was compared to individual Standards of Care (SoC). Thirteen isolates of SARS-CoV-2, human seasonal influenza, and avian influenza served to assess limit of detection (LoD). Then, positive and negative residual nasopharyngeal specimens, collected under public health surveillance and pandemic response served for evaluation. Subsequently, comparison of effectiveness was assessed. Results The three MPAs confidently detect all lineages of SARS-CoV-2 and influenza viruses. MPA-LoDs vary from 1-2 Log10 differences from SoC depending on assay and strain. Clinical evaluation resulted in overall agreement between 97% and 100%, demonstrating a high accuracy to detect all targets. Existing differences in costs, testing burden and implementation constraints influence the choice in primary or community settings. Conclusion TP, PC and GX, reliably detect SARS-CoV-2, influenza and RSV simultaneously, with reduced time-to-results and simplified workflows. MPAs have the potential to enhancediagnostics, surveillance system, and epidemic response to drive policy on prevention and control of viral respiratory infections. IMPORTANCE Viral respiratory infections represent a major burden globally, weighed down by the COVID-19 pandemic, and threatened by spillover of novel zoonotic influenza viruses. Since respiratory infections share clinical presentations, identification of the causing agent for patient care and public health measures requires laboratory testing for several pathogens, including potential zoonotic spillovers. Simultaneous detection of SARS-CoV-2, influenza, and RSV in a single RT-PCR accelerates time from sampling to diagnosis, preserve consumables, and streamline human resources to respond to other endemic or emerging pathogens. Multiplex assays have the potential to sustain and even expand surveillance systems, can utilize capacity/capability developed during the COVID-19 pandemic worldwide, thereby strengthening epidemic/pandemic preparedness, prevention, and response.
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Affiliation(s)
- Narjis BOUKLI
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Claude FLAMAND
- Epidemiology Unit, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Kim Lay CHEA
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Leangyi HENG
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Seangmai KEO
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Kimhoung SOUR
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sophea IN
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Panha CHHIM
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Bunthea CHHOR
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Lomor KRUY
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Manoj GANDHI
- Thermo Fisher Scientific, South San Francisco CA, United States
| | - Obiageli OKAFOR
- Thermo Fisher Scientific, South San Francisco CA, United States
| | | | - Heidi AUERSWALD
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Viseth Srey HORM
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Erik A KARLSSON
- Virology Unit, National Influenza Center, WHO H5 Regional reference Laboratory, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, Phnom Penh, Cambodia
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