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van de Sandt CE, Nguyen THO, Gherardin NA, Crawford JC, Samir J, Minervina AA, Pogorelyy MV, Rizzetto S, Szeto C, Kaur J, Ranson N, Sonda S, Harper A, Redmond SJ, McQuilten HA, Menon T, Sant S, Jia X, Pedrina K, Karapanagiotidis T, Cain N, Nicholson S, Chen Z, Lim R, Clemens EB, Eltahla A, La Gruta NL, Crowe J, Lappas M, Rossjohn J, Godfrey DI, Thomas PG, Gras S, Flanagan KL, Luciani F, Kedzierska K. Newborn and child-like molecular signatures in older adults stem from TCR shifts across human lifespan. Nat Immunol 2023; 24:1890-1907. [PMID: 37749325 PMCID: PMC10602853 DOI: 10.1038/s41590-023-01633-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023]
Abstract
CD8+ T cells provide robust antiviral immunity, but how epitope-specific T cells evolve across the human lifespan is unclear. Here we defined CD8+ T cell immunity directed at the prominent influenza epitope HLA-A*02:01-M158-66 (A2/M158) across four age groups at phenotypic, transcriptomic, clonal and functional levels. We identify a linear differentiation trajectory from newborns to children then adults, followed by divergence and a clonal reset in older adults. Gene profiles in older adults closely resemble those of newborns and children, despite being clonally distinct. Only child-derived and adult-derived A2/M158+CD8+ T cells had the potential to differentiate into highly cytotoxic epitope-specific CD8+ T cells, which was linked to highly functional public T cell receptor (TCR)αβ signatures. Suboptimal TCRαβ signatures in older adults led to less proliferation, polyfunctionality, avidity and recognition of peptide mutants, although displayed no signs of exhaustion. These data suggest that priming T cells at different stages of life might greatly affect CD8+ T cell responses toward viral infections.
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Affiliation(s)
- Carolien E van de Sandt
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thi H O Nguyen
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nicholas A Gherardin
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Jerome Samir
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Mikhail V Pogorelyy
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Simone Rizzetto
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Christopher Szeto
- Viral and Structural Immunology Laboratory, Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jasveen Kaur
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Nicole Ranson
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Sabrina Sonda
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Alice Harper
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Samuel J Redmond
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Hayley A McQuilten
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Tejas Menon
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sneha Sant
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Xiaoxiao Jia
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kate Pedrina
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Natalie Cain
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Zhenjun Chen
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ratana Lim
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - E Bridie Clemens
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Auda Eltahla
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Nicole L La Gruta
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jane Crowe
- Deepdene Surgery, Deepdene, Victoria, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jamie Rossjohn
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Dale I Godfrey
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Paul G Thomas
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stephanie Gras
- Viral and Structural Immunology Laboratory, Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
- Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Katie L Flanagan
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Victoria, Australia
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Fabio Luciani
- School of Medical Sciences and The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
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Hall VG, Nguyen THO, Allen LF, Rowntree LC, Kedzierski L, Chua BY, Lim C, Saunders NR, Klimevski E, Tennakoon GS, Seymour JF, Wadhwa V, Cain N, Vo KL, Nicholson S, Karapanagiotidis T, Williamson DA, Thursky KA, Spelman T, Yong MK, Slavin MA, Kedzierska K, Teh BW. Evolution of Humoral and Cellular Immunity Post-Breakthrough Coronavirus Disease 2019 in Vaccinated Patients With Hematologic Malignancy Receiving Tixagevimab-Cilgavimab. Open Forum Infect Dis 2023; 10:ofad550. [PMID: 38023562 PMCID: PMC10644824 DOI: 10.1093/ofid/ofad550] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background In-depth immunogenicity studies of tixagevimab-cilgavimab (T-C) are lacking, including following breakthrough coronavirus disease 2019 (COVID-19) in vaccinated patients with hematologic malignancy (HM) receiving T-C as pre-exposure prophylaxis. Methods We performed a prospective, observational cohort study and detailed immunological analyses of 93 patients with HM who received T-C from May 2022, with and without breakthrough infection, during a follow-up period of 6 months and dominant Omicron BA.5 variant. Results In 93 patients who received T-C, there was an increase in Omicron BA.4/5 receptor-binding domain (RBD) immunoglobulin G (IgG) antibody titers that persisted for 6 months and was equivalent to 3-dose-vaccinated uninfected healthy controls at 1 month postinjection. Omicron BA.4/5 neutralizing antibody was lower in patients receiving B-cell-depleting therapy within 12 months despite receipt of T-C. COVID-19 vaccination during T-C treatment did not incrementally improve RBD or neutralizing antibody levels. In 16 patients with predominantly mild breakthrough infection, no change in serum neutralization of Omicron BA.4/5 postinfection was detected. Activation-induced marker assay revealed an increase in CD4+ (but not CD8+) T cells post infection, comparable to previously infected healthy controls. Conclusions Our study provides proof-of-principle for a pre-exposure prophylaxis strategy and highlights the importance of humoral and cellular immunity post-breakthrough COVID-19 in vaccinated patients with HM.
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Affiliation(s)
- Victoria G Hall
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Thi H O Nguyen
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Lilith F Allen
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Louise C Rowntree
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Lukasz Kedzierski
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
| | - Brendon Y Chua
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Chhay Lim
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Natalie R Saunders
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Emily Klimevski
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gayani S Tennakoon
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - John F Seymour
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Hematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Vikas Wadhwa
- Department of Ambulatory Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Natalie Cain
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Kim L Vo
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Deborah A Williamson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Timothy Spelman
- Department of Biostatistics and Epidemiology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | - Michelle K Yong
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, Australia
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Nguyen THO, Lim C, Lasica M, Whitechurch A, Tennakoon S, Saunders NR, Allen LF, Rowntree LC, Chua BY, Kedzierski L, Tan H, Wheatley AK, Kent SJ, Karapanagiotidis T, Nicholson S, Williamson DA, Slavin MA, Tam CS, Kedzierska K, Teh BW. Prospective comprehensive profiling of immune responses to COVID-19 vaccination in patients on zanubrutinib therapy. EJHaem 2023; 4:216-220. [PMID: 36819189 PMCID: PMC9928803 DOI: 10.1002/jha2.639] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
Zanubrutinib-treated and treatment-naïve patients with chronic lymphocytic leukaemia (CLL) or Waldenstrom's macroglobulinaemia were recruited in this prospective study to comprehensively profile humoral and cellular immune responses to COVID-19 vaccination. Overall, 45 patients (median 72 years old) were recruited; the majority were male (71%), had CLL (76%) and were on zanubrutinib (78%). Seroconversion rates were 65% and 77% following two and three doses, respectively. CD4+ and CD8+ T-cell response rates increased with third dose. In zanubrutinib-treated patients, 86% developed either a humoral or cellular response. Patients on zanubrutinib developed substantial immune responses following two COVID-19 vaccine doses, which further improved following a third dose.
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Affiliation(s)
- Thi H. O. Nguyen
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Chhay Lim
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Masa Lasica
- Department of HaematologySt Vincent's HospitalFitzroyVictoriaAustralia
| | - Ashley Whitechurch
- Department of Clinical HaematologyPeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Surekha Tennakoon
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Natalie R. Saunders
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Lilith F. Allen
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Louise C. Rowntree
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Brendon Y. Chua
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Lukasz Kedzierski
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Hyon‐Xhi Tan
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Adam K. Wheatley
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Stephen J. Kent
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia,ARC Centre of Excellence in Convergent Bio‐Nano Science and TechnologyUniversity of MelbourneMelbourneVictoriaAustralia,Melbourne Sexual Health Centre, Infectious Diseases Department, Alfred Health, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference LaboratoryThe Peter Doherty Institute for Infection and ImmunityMelbourneVictoriaAustralia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference LaboratoryThe Peter Doherty Institute for Infection and ImmunityMelbourneVictoriaAustralia
| | - Deborah A. Williamson
- Victorian Infectious Diseases Reference LaboratoryThe Peter Doherty Institute for Infection and ImmunityMelbourneVictoriaAustralia,Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia,Department of Infectious DiseasesUniversity of Melbourne, The Peter Doherty Institute for Infection and ImmunityMelbourneVictoriaAustralia
| | - Monica A. Slavin
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Constantine S. Tam
- Department of Clinical HaematologyPeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVictoriaAustralia,Department of Haematology, Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
| | - Katherine Kedzierska
- Department of Microbiology and ImmunologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Benjamin W. Teh
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVictoriaAustralia
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4
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Nicholson S, Karapanagiotidis T, Khvorov A, Douros C, Mordant F, Bond K, Druce J, Williamson DA, Purcell D, Lewin SR, Sullivan S, Subbarao K, Catton M. Evaluation of 6 Commercial SARS-CoV-2 Serology Assays Detecting Different Antibodies for Clinical Testing and Serosurveillance. Open Forum Infect Dis 2021; 8:ofab239. [PMID: 34258311 PMCID: PMC8136026 DOI: 10.1093/ofid/ofab239] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/07/2021] [Indexed: 11/12/2022] Open
Abstract
Background Serological testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complements nucleic acid tests for patient diagnosis and enables monitoring of population susceptibility to inform the coronavirus disease 2019 (COVID-19) pandemic response. It is important to understand the reliability of assays with different antigen or antibody targets to detect humoral immunity after SARS-CoV-2 infection and to understand how antibody (Ab) binding assays compare to those detecting neutralizing antibody (nAb), particularly as we move into the era of vaccines. Methods We evaluated the performance of 6 commercially available enzyme-linked immunosorbent assays (ELISAs), including a surrogate virus neutralization test (sVNT), for detection of SARS-CoV-2 immunoglobulins (IgA, IgM, IgG), total or nAb. A result subset was compared with a cell culture-based microneutralization (MN) assay. We tested sera from patients with prior reverse transcription polymerase chain reaction-confirmed SARS-CoV-2 infection, prepandemic sera, and potential cross-reactive sera from patients with other non-COVID-19 acute infections. Results For sera collected >14 days post-symptom onset, the assay achieving the highest sensitivity was the Wantai total Ab at 100% (95% CI, 94.6%-100%), followed by 93.1% for Euroimmun NCP-IgG, 93.1% for GenScript sVNT, 90.3% for Euroimmun S1-IgG, 88.9% for Euroimmun S1-IgA, and 83.3% for Wantai IgM. Specificity for the best-performing assay was 99.5% for the Wantai total Ab, and for the lowest-performing assay it was 97.1% for sVNT (as per the Instructions for Use [IFU]). The Wantai Total Ab had the best agreement with MN at 98% followed by Euroimmun S1-IgA, Euro NCP-IgG, and sVNT (as per IFU) with 97%, 97% and 95%, respectively; Wantai IgM had the poorest agreement at 93%. Conclusions Performance characteristics of the SARS-CoV-2 serology assays detecting different antibody types are consistent with those found in previously published reports. Evaluation of the surrogate virus neutralization test in comparison to the Ab binding assays and a cell culture-based neutralization assay showed good result correlation between all assays. However, correlation between the cell-based neutralization test and some assays detecting Ab's not specifically involved in neutralization was higher than with the sVNT. This study demonstrates the reliability of different assays to detect the humoral immune response following SARS-CoV-2 infection, which can be used to optimize serological test algorithms for assessing antibody responses post-SARS-CoV-2 infection or vaccination.
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Affiliation(s)
- Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Arseniy Khvorov
- WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Celia Douros
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Francesca Mordant
- Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Katherine Bond
- Department of Microbiology, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Deborah A Williamson
- Department of Microbiology, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Damian Purcell
- Department of Microbiology, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Sheena Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mike Catton
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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5
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Towns JM, Leslie DE, Denham I, Azzato F, Karapanagiotidis T, Williamson DA, Graves SR, Fairley CK, Bissessor M, Chow EPF, Zhang L, Chen MY. Timing of primary syphilis treatment and impact on the development of treponemal antibodies: a cross-sectional clinic-based study. Sex Transm Infect 2021; 98:161-165. [PMID: 33782149 DOI: 10.1136/sextrans-2020-054739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/19/2020] [Accepted: 03/06/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Serology is negative in a proportion of primary syphilis cases where Treponema pallidum PCR testing is positive. We aimed to identify discordant, T. pallidum PCR-positive, serology-negative primary syphilis cases and any clinical or laboratory factors associated with failure to subsequently seroconvert. METHODS Serodiscordant primary syphilis cases that were T. pallidum PCR-positive and serology-negative (including rapid plasma reagin, T. pallidum particle agglutination, T. pallidum enzyme immunoassay or T. pallidum chemiluminescence assay) were identified from the Melbourne Sexual Health Centre electronic records between April 2011 and December 2019. Clinical and laboratory associations were examined. RESULTS There were 814 primary syphilis cases in the study period and 38 (4.7%) were serodiscordant, 35 in men who have sex with men. Thirty-two had follow-up serology performed a median of 24 days later, of which 16 (50%) seroconverted, mostly (81%) within 6 weeks. Failure to seroconvert was significantly associated with treatment on day 1. Of the 12 cases treated on day 1, 10 (83%) failed to seroconvert compared with 6 of 20 (30%) among those who were treated after day 1. DISCUSSION Earlier treatment of primary syphilis can prevent the development of serological markers. T. pallidum PCR can identify primary syphilis lesions before the development of serological markers and improve diagnosis of early primary syphilis lesions. Serology alone will miss a proportion of primary syphilis infections and should be repeated if a diagnosis of syphilis is being considered.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia .,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah A Williamson
- Melbourne Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Microbiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen R Graves
- Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, People's Republic of China.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou, People's Republic of China
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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6
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Bond K, Nicholson S, Lim SM, Karapanagiotidis T, Williams E, Johnson D, Hoang T, Sia C, Purcell D, Mordant F, Lewin SR, Catton M, Subbarao K, Howden BP, Williamson DA. Evaluation of Serological Tests for SARS-CoV-2: Implications for Serology Testing in a Low-Prevalence Setting. J Infect Dis 2020; 222:1280-1288. [PMID: 32761124 PMCID: PMC7454699 DOI: 10.1093/infdis/jiaa467] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Robust serological assays are essential for long-term control of the COVID-19 pandemic. Many recently released point-of-care (PoCT) serological assays have been distributed with little premarket validation. METHODS Performance characteristics for 5 PoCT lateral flow devices approved for use in Australia were compared to a commercial enzyme immunoassay (ELISA) and a recently described novel surrogate virus neutralization test (sVNT). RESULTS Sensitivities for PoCT ranged from 51.8% (95% confidence interval [CI], 43.1%-60.4%) to 67.9% (95% CI, 59.4%-75.6%), and specificities from 95.6% (95% CI, 89.2%-98.8%) to 100.0% (95% CI, 96.1%-100.0%). ELISA sensitivity for IgA or IgG detection was 67.9% (95% CI, 59.4%-75.6%), increasing to 93.8% (95% CI, 85.0%-98.3%) for samples >14 days post symptom onset. sVNT sensitivity was 60.9% (95% CI, 53.2%-68.4%), rising to 91.2% (95% CI, 81.8%-96.7%) for samples >14 days post symptom onset, with specificity 94.4% (95% CI, 89.2%-97.5%). CONCLUSIONS Performance characteristics for COVID-19 serological assays were generally lower than those reported by manufacturers. Timing of specimen collection relative to onset of illness or infection is crucial in reporting of performance characteristics for COVID-19 serological assays. The optimal algorithm for implementing serological testing for COVID-19 remains to be determined, particularly in low-prevalence settings.
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Affiliation(s)
- Katherine Bond
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Seok Ming Lim
- Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Eloise Williams
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Douglas Johnson
- Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
- Department of General Medicine, The University of Melbourne, Melbourne, Australia
| | - Tuyet Hoang
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Cheryll Sia
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Damian Purcell
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Francesca Mordant
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Mike Catton
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- World Health Organization Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Benjamin P Howden
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Deborah A Williamson
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Foley DA, Yeoh DK, Karapanagiotidis T, Nhindri T, Catton M. Fever in the returned traveller: the utility of the Platelia Dengue NS1 antigen enzyme immunoassay for the diagnosis of dengue in a non-endemic setting. Pathology 2020; 52:370-372. [PMID: 32107080 DOI: 10.1016/j.pathol.2020.01.438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/19/2020] [Accepted: 01/23/2020] [Indexed: 11/29/2022]
Abstract
Investigating fever in the returned traveller can be difficult and costly. Dengue is one of the most frequently reported aetiologies. NS1 is a non-structural dengue virus protein detectable during acute infection. The aim of this report is to describe the utility of the Platelia Dengue NS1 antigen enzyme immunoassay (EIA) for detection of dengue in a non-endemic region compared to a composite gold standard of contemporaneous molecular testing and seroconversion. We performed a retrospective analysis of all dengue serology tests from 6 February 2012 to 5 December 2018. Dengue serology and in-house flavivirus molecular results were identified using the laboratory information management system. Dengue serology was performed using the Bio-Rad Platelia Dengue NS1 antigen EIA, and Abbott Panbio Dengue IgG and IgM EIA. True positive NS1 result was defined as positive molecular test within one week of the positive NS1 result or seroconversion within 120 days. NS1 negative samples that remained negative to all dengue markers on repeat more than 10 and up to 120 days after were labelled as true negatives. More than 75% of cases had a serology pattern consistent with primary dengue. Sensitivity and specificity of NS1 Ag EIA was 96.4% (95% CI 92.3-98.7%) and 98.4% (95% CI 94.5-99.8%), respectively. Performance was poorer in serotype 4 infections (sensitivity 50%). Platelia Dengue NS1 antigen EIA test performance in the returned traveller cohort fulfils the remit as a single diagnostic test for acute dengue infection.
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Affiliation(s)
- David A Foley
- Victorian Infectious Diseases Reference Laboratory, Parkville, Vic, Australia; Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia.
| | - Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Tinashe Nhindri
- Victorian Infectious Diseases Reference Laboratory, Parkville, Vic, Australia
| | - Mike Catton
- Victorian Infectious Diseases Reference Laboratory, Parkville, Vic, Australia
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Jackson K, MacLachlan J, Cowie B, Locarnini S, Bowden S, Higgins N, Karapanagiotidis T, Nicholson S, Littlejohn M. Epidemiology and phylogenetic analysis of hepatitis D virus infection in Australia. Intern Med J 2019; 48:1308-1317. [PMID: 29761607 DOI: 10.1111/imj.13967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence and trends of the hepatitis D virus (HDV) in Australia have not been recently assessed, and the circulating genotypes have never been determined. AIM To characterise the current virology and epidemiology of HDV. METHODS Notifiable disease surveillance and laboratory testing data were analysed to assess demographics, risk factors and trends. HDV serology and RNA testing were performed on requested samples from 2010 to 2016. Sequencing of a 500-nucleotide amplicon of the delta antigen and phylogenetic analysis of the strains from 2009 to 2016 were also conducted. RESULTS Ninety HDV notifications were reported to the Victorian Department of Health and Human Services between 2010 and 2016. The majority (64.4%) of those diagnosed were born overseas, most commonly in Sudan, Pakistan and Vietnam. Over the same period, 190 patients tested positive for anti-HDV serology and 166 for HDV RNA. Sequencing of isolates from 169 individuals between 2009 and 2016 found that 80.5% strains were genotype 1, 16% genotype 5 and 3.5% genotype 2. Phylogenetic analysis confirmed the relatedness of strains from birth country, demonstrated the presence of the 'Pacific Island' genotype 1 strain in Queensland and supported possible transmission in correctional facilities and within families. CONCLUSIONS This study demonstrates the ongoing need for routine HDV screening and engagement in clinical care for people living with HBV in Australia. Epidemiological findings highlight the diversity in those affected and provide insights into local and global geographic distribution and transmission patterns.
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Affiliation(s)
- Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jennifer MacLachlan
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Benjamin Cowie
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Scott Bowden
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nasra Higgins
- Department of Health and Human Services Victoria, Melbourne, Victoria, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Karapanagiotidis T. The evaluation and implementation of the Liaison® XL Murex Ab/Ag assay in a HIV reference laboratory. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Causer LM, Kaldor JM, Conway DP, Leslie DE, Denham I, Karapanagiotidis T, Ryan C, Wand H, Anderson DA, Robertson PW, McNulty AM, Donovan B, Fairley CK, Guy RJ. An evaluation of a novel dual treponemal/nontreponemal point-of-care test for syphilis as a tool to distinguish active from past treated infection. Clin Infect Dis 2015; 61:184-91. [PMID: 25810288 DOI: 10.1093/cid/civ243] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/14/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most syphilis point-of-care (POC) tests detect treponemal antibodies, which persist after successful treatment. Subsequent POC tests are positive, despite no active infection, and can lead to unnecessary treatment. We evaluated a new POC test, incorporating a nontreponemal component, to distinguish active from past infection. METHODS Sera stored at 2 Australian laboratories were tested with DPP Screen and Confirm Assay. Treponemal and nontreponemal test lines were compared to corresponding conventional treponemal and nontreponemal reference test results: immunoassays and rapid plasma reagin (RPR), respectively, with RPR quantification by endpoint titration. POC test outcome concordance with conventional test results was assessed according to serological and clinical categories. RESULTS Among 1005 serum samples tested, DPP treponemal line sensitivity was 89.8% (95% confidence interval [CI], 87.3%-91.9%) and specificity was 99.3% (95% CI, 97.0%-99.9%). DPP nontreponemal line sensitivity was 94.2% (95% CI, 91.8%-96.0%) and specificity was 62.2% (95% CI, 57.5%-66.6%). DPP test outcome (pair of test lines) was concordant with both reference test results for 94.3% of 404 high-titer infections, 90.1% of 121 low-titer infections, 27.5% of 211 past/treated infections, and 78.1% of 242 infections classified as not syphilis. Among 211 past/treated infections, 49.8% were incorrectly identified as active infection and a further 22.8% as not syphilis. CONCLUSIONS DPP test use would result in identification of >93% of active syphilis infections, whereas just over half of past infections would be diagnosed as past or not syphilis, avoiding unnecessary treatment compared with other POC tests. This may be at the expense of missing some active infections; thus, its potential benefits will depend on the prevalence of past vs active infection in a population.
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Affiliation(s)
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney
| | | | - David E Leslie
- Victorian Infectious Diseases Reference Laboratory, Melbourne
| | | | | | | | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney
| | | | | | | | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney
| | | | - Rebecca J Guy
- Kirby Institute, University of New South Wales, Sydney
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11
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Causer LM, Kaldor JM, Fairley CK, Donovan B, Karapanagiotidis T, Leslie DE, Robertson PW, McNulty AM, Anderson D, Wand H, Conway DP, Denham I, Ryan C, Guy RJ. A laboratory-based evaluation of four rapid point-of-care tests for syphilis. PLoS One 2014; 9:e91504. [PMID: 24618681 PMCID: PMC3950184 DOI: 10.1371/journal.pone.0091504] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/11/2014] [Indexed: 11/24/2022] Open
Abstract
Background Syphilis point-of-care tests may reduce morbidity and ongoing transmission by increasing the proportion of people rapidly treated. Syphilis stage and co-infection with HIV may influence test performance. We evaluated four commercially available syphilis point-of-care devices in a head-to-head comparison using sera from laboratories in Australia. Methods Point-of-care tests were evaluated using sera stored at Sydney and Melbourne laboratories. Sensitivity and specificity were calculated by standard methods, comparing point-of-care results to treponemal immunoassay (IA) reference test results. Additional analyses by clinical syphilis stage, HIV status, and non-treponemal antibody titre were performed. Non-overlapping 95% confidence intervals (CI) were considered statistically significant differences in estimates. Results In total 1203 specimens were tested (736 IA-reactive, 467 IA-nonreactive). Point-of-care test sensitivities were: Determine 97.3%(95%CI:95.8–98.3), Onsite 92.5%(90.3–94.3), DPP 89.8%(87.3–91.9) and Bioline 87.8%(85.1–90.0). Specificities were: Determine 96.4%(94.1–97.8), Onsite 92.5%(90.3–94.3), DPP 98.3%(96.5–99.2), and Bioline 98.5%(96.8–99.3). Sensitivity of the Determine test was 100% for primary and 100% for secondary syphilis. The three other tests had reduced sensitivity among primary (80.4–90.2%) compared to secondary syphilis (94.3–98.6%). No significant differences in sensitivity were observed by HIV status. Test sensitivities were significantly higher among high-RPR titre (RPR≥8) (range: 94.6–99.5%) than RPR non-reactive infections (range: 76.3–92.9%). Conclusions The Determine test had the highest sensitivity overall. All tests were most sensitive among high-RPR titre infections. Point-of-care tests have a role in syphilis control programs however in developed countries with established laboratory infrastructures, the lower sensitivities of some tests observed in primary syphilis suggest these would need to be supplemented with additional tests among populations where syphilis incidence is high to avoid missing early syphilis cases.
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Affiliation(s)
- Louise M. Causer
- Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
| | - John M. Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - David E. Leslie
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| | - Peter W. Robertson
- SEALS Area Serology Laboratory, Prince of Wales Hospital, Randwick, Australia
| | | | | | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Damian P. Conway
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Carlton, Australia
| | | | - Rebecca J. Guy
- Kirby Institute, University of New South Wales, Sydney, Australia
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Ratnam I, Black J, Leder K, Biggs BA, Gordon I, Matchett E, Padiglione A, Woolley I, Karapanagiotidis T, Gherardin T, Demont C, Luxemburger C, Torresi J. Incidence and risk factors for acute respiratory illnesses and influenza virus infections in Australian travellers to Asia. J Clin Virol 2013; 57:54-8. [DOI: 10.1016/j.jcv.2013.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 11/28/2012] [Accepted: 01/02/2013] [Indexed: 11/29/2022]
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13
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Cowie B, Karapanagiotidis T, Enriquez A, Kelly H. Markers of hepatitis B virus infection and immunity in Victoria, Australia, 1995 to 2005. Aust N Z J Public Health 2010; 34:72-8. [DOI: 10.1111/j.1753-6405.2010.00477.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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14
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Witlox KJ, Karapanagiotidis T, Bruggink LD, Marshall JA. The effect of fecal turbidity on norovirus detection by reverse transcriptase polymerase chain reaction. Diagn Microbiol Infect Dis 2008; 66:230-2. [PMID: 18945570 DOI: 10.1016/j.diagmicrobio.2008.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/30/2008] [Accepted: 08/05/2008] [Indexed: 11/28/2022]
Abstract
A 10-min fecal preparation results in greater specimen turbidity than a 45-min protocol, but reverse transcriptase polymerase chain reaction (RT-PCR) norovirus test sensitivity is essentially the same. Feces processed so that particle size does not exceed approximately 560 nm do not display greater norovirus RT-PCR inhibitory effects than those that have undergone greater purification.
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Affiliation(s)
- Kristie J Witlox
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
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15
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Kelly HA, Gidding HF, Karapanagiotidis T, Leydon JA, Riddell MA. Residual susceptibility to measles among young adults in Victoria, Australia following a national targeted measles-mumps-rubella vaccination campaign. BMC Public Health 2007; 7:99. [PMID: 17555601 PMCID: PMC1913916 DOI: 10.1186/1471-2458-7-99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 06/08/2007] [Indexed: 11/29/2022] Open
Abstract
Background Past measles immunisation policies in Australia have resulted in a cohort of young adults who have been inadequately vaccinated, but who also have low levels of naturally acquired immunity because immunisation programs have decreased the circulation of wild virus. A measles-mumps-rubella (MMR) immunisation campaign aimed at addressing this susceptibility to measles among young adults was conducted in Australia in 2001–2. By estimating age-specific immunity, we aimed to evaluate the success of this campaign in the state of Victoria. Methods We conducted serosurveys after the young adult MMR program at state and national levels to estimate immunity among young adults born between 1968–82. We compared results of the Victorian (state) surveys with the Victorian component of the national surveys and compared both surveys with surveys conducted before the campaign. We also reviewed all laboratory confirmed measles cases in Victoria between 2000–4. Results The Victorian state serosurveys indicated no significant change in immunity of the cohort following the young adult MMR campaign (83.9% immune pre and 85.5% immune post campaign) while the Victorian component of the national serosurvey indicated a significant decline in immunity (91.0% to 84.2%; p = 0.006). Both surveys indicated about 15% susceptibility to measles among young Victorian adults after the campaign. Measles outbreaks in Victoria between 2000–4 confirmed the susceptibility of young adults. Outbreaks involved a median of 2.5 cases with a median age of 24.5 years. Conclusion In Victoria, the young adult MMR program appears to have had no effect on residual susceptibility to measles among the 1968–82 birth cohort. Young adults in Victoria, as in other countries where past immunisation policies have left a residual susceptible cohort, represent a potential problem for the maintenance of measles elimination.
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Affiliation(s)
- Heath A Kelly
- Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory (VIDRL) and World Health Organization (WHO) Western Pacific Region Measles Reference Laboratory, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
| | - Heather F Gidding
- Centre for Infectious Diseases and Microbiology (CIDM)-Public Health, Westmead Hospital, Australia
| | - Theo Karapanagiotidis
- Serology Laboratory, VIDRL and WHO Western Pacific Region Measles Reference Laboratory, Melbourne, Australia
| | - Jennie A Leydon
- Serology Laboratory, VIDRL and WHO Western Pacific Region Measles Reference Laboratory, Melbourne, Australia
| | - Michaela A Riddell
- Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory (VIDRL) and World Health Organization (WHO) Western Pacific Region Measles Reference Laboratory, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
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Leslie DE, Azzato F, Karapanagiotidis T, Leydon J, Fyfe J. Development of a real-time PCR assay to detect Treponema pallidum in clinical specimens and assessment of the assay's performance by comparison with serological testing. J Clin Microbiol 2006; 45:93-6. [PMID: 17065262 PMCID: PMC1828986 DOI: 10.1128/jcm.01578-06] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The incidence of infectious syphilis in men who have sex with men and human immunodeficiency virus-infected patients has increased steadily in Victoria, Australia, since 2002. A TaqMan real-time PCR assay targeting the polA gene of Treponema pallidum (TpPCR) was developed. The analytical sensitivity of the assay was estimated to be 1.75 target copies per reaction. Initially, the assay was used to test a variety of specimens (excluding blood) from 598 patients. Of the 660 tests performed, positive PCR results were obtained for 55 patients. TpPCR results were compared with serology results for 301 patients being investigated for early syphilis. Of these patients, 41 were positive by both TpPCR and serology, 246 were negative by both TpPCR and serology, 4 were TpPCR positive but negative by serology, and 10 were TpPCR negative but showed evidence of recent or active infection by serology. Directly compared with serology, TpPCR showed 95% agreement, with a sensitivity of 80.39% and a specificity of 98.40%. Potential factors leading to the discrepant results are discussed. Concurrent serology on 21 patients with TpPCR-positive primary syphilitic lesions demonstrated that a panel of current syphilis serological tests has high sensitivity for the detection of early syphilis. We found that TpPCR is a useful addition to serology for the diagnosis of infectious syphilis. Direct comparison with other T. pallidum PCR assays will be required to fully assess the limitations of the assay.
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Affiliation(s)
- David E Leslie
- Victorian Infectious Diseases Reference Laboratory, 10 Wreckyn St., North Melbourne, Victoria 3051, Australia.
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17
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Karapanagiotidis T, Riddell M, Kelly H. Detection of rubella immunoglobulin M from dried venous blood spots using a commercial enzyme immunoassay. Diagn Microbiol Infect Dis 2005; 53:107-11. [PMID: 16168610 DOI: 10.1016/j.diagmicrobio.2005.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 06/17/2005] [Indexed: 11/20/2022]
Abstract
Confirmation of the diagnosis is critical to disease control in measles elimination and rubella control programs. In countries with limited infrastructure and laboratory capacity, collection, transport, and testing of venous blood samples may be difficult. We report the adaptation of a commercial enzyme immunoassay for the detection of rubella immunoglobulin M (IgM) in dried venous blood (DVB). We used 60 DVB, prepared at the time of venous blood collection, from the enhanced measles/rubella surveillance program and 28 DVB prepared using donor red blood cells spiked with serum, which had been tested as part of a rubella outbreak. Adaptations of the manufacturer's protocol included variations in incubation times and washing procedures. Optical densities were corrected for kit variation as recommended by the manufacturer, but no further adjustment was needed to compare serum and DVB results. Counting equivocal results as positive, the sensitivity of the DVB compared with serum for the categorization of rubella IgM as positive or negative was 96.7% (95% confidence interval [CI], 83.3-100%) and the specificity was 100% (95% CI, 93.7-100%).
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Affiliation(s)
- Theo Karapanagiotidis
- Serology Laboratory and World Health Organization Western Pacific Regional Reference Laboratory for Measles, Victorian Infectious Diseases Reference Laboratory, Carlton South 3053, Melbourne, Australia
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Leydon J, Curley S, Karapanagiotidis T, Stambos V, Kelly H. Report on a workshop on the laboratory diagnosis of measles. Pac Health Dialog 2005; 12:159-163. [PMID: 18181508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Western Pacific Region of the World Health Organization (WHO) has declared a goal of regional measles elimination with a target date of 2012. To facilitate this goal, and in order to increase the familiarity of staff from some Western Pacific national laboratories with the technique of enzyme immunoassay (EIA) for the detection of anti-measles IgM, a WHO sponsored workshop was held at the Victorian Infectious Diseases Reference Laboratory (VIDRL) in May 2005. The workshop included participants from national laboratories in Cambodia and Lao People's Democratic Republic, and from five Pacific Island countries, Fiji, French Polynesia, Guam, New Caledonia and Papua New Guinea. An observer from Guam also participated. In addition to increasing the workshop participants' familiarity with the Dade Behring Enzygnost Anti-Measles Virus/IgM assay by hands-on involvement, the participants learnt to use dried venous blood spots for measles diagnosis. All participants successfully completed the practical component of the workshop. The workshop also included informal seminars on troubleshooting problems in EIA, good laboratory practice, data management in the laboratory and transporting infectious and diagnostic material. The EIA measles IgM calculation worksheets and the seminar on good laboratory practice were considered to be particularly useful by the majority of participants. The workshop was considered a success in terms of equipping participants with the knowledge and capacity to perform accurate measles IgM testing for both serum and dried venous blood spots. It also provided an introduction to proficiency testing.
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Affiliation(s)
- Jennie Leydon
- Serology Laboratory, Victorian Infectious Diseases Reference Laboratory, North Melbourne.
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Kelly H, Worth L, Karapanagiotidis T, Riddell M. Interruption of rubella virus transmission in Australia may require vaccination of adult males: evidence from a Victorian sero-survey. Commun Dis Intell Q Rep 2004; 28:69-73. [PMID: 15072157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Prior to the introduction of rubella vaccine to Australia in 1970 rubella was primarily a disease of primary school aged children. Vaccination programs have subsequently altered rubella age and sex susceptibility. Between July 2001 and June 2002, 85 per cent of the 32 laboratory-confirmed cases of rubella ascertained from enhanced surveillance in Victoria were males aged 20-42 years. This study aimed to determine rubella susceptibility by age group and sex in Victoria and to examine the implications of susceptibility for the interruption of circulating rubella virus. Rubella immunoglobulin G concentrations were determined for 934 residual diagnostic sera stored at the Victorian Infectious Diseases Reference Laboratory using a standard commercial enzyme immunoassay. Susceptibility was analysed by age groups defined by previous and current Australian rubella immunisation schedules. Among all subjects aged 1-55 years, males were more susceptible to rubella infection than females (10.2% vs 2.6%, p < 0.0001). Although this sex difference occurred in all age groups, it was unlikely to be explained by sampling variation in sera from subjects aged 23-44 years, for whom rubella vaccine had been recommended only for girls aged 10-14 years and rubella susceptible women post-partum. Australia's past rubella immunisation policies have resulted in a susceptible cohort of adult males. If rubella virus transmission is to be interrupted in Australia, consideration needs to be given to a rubella vaccination program targeting men aged 17-44 years. A campaign, targeting both men and women in a similar age group has recently been successful in Costa Rica.
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Affiliation(s)
- Heath Kelly
- Epidemiology and Surveillance, Victorian Infectious Diseases Reference Laboratory, Locked Bag, Carlton South.
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