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Stern D, Meyer TC, Treindl F, Mages HW, Krüger M, Skiba M, Krüger JP, Zobel CM, Schreiner M, Grossegesse M, Rinner T, Peine C, Stoliaroff-Pépin A, Harder T, Hofmann N, Michel J, Nitsche A, Stahlberg S, Kneuer A, Sandoni A, Kubisch U, Schlaud M, Mankertz A, Schwarz T, Corman VM, Müller MA, Drosten C, de la Rosa K, Schaade L, Dorner MB, Dorner BG. A bead-based multiplex assay covering all coronaviruses pathogenic for humans for sensitive and specific surveillance of SARS-CoV-2 humoral immunity. Sci Rep 2023; 13:21846. [PMID: 38071261 PMCID: PMC10710470 DOI: 10.1038/s41598-023-48581-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
Serological assays measuring antibodies against SARS-CoV-2 are key to describe the epidemiology, pathobiology or induction of immunity after infection or vaccination. Of those, multiplex assays targeting multiple antigens are especially helpful as closely related coronaviruses or other antigens can be analysed simultaneously from small sample volumes, hereby shedding light on patterns in the immune response that would otherwise remain undetected. We established a bead-based 17-plex assay detecting antibodies targeting antigens from all coronaviruses pathogenic for humans: SARS-CoV-2, SARS-CoV, MERS-CoV, HCoV strains 229E, OC43, HKU1, and NL63. The assay was validated against five commercial serological immunoassays, a commercial surrogate virus neutralisation test, and a virus neutralisation assay, all targeting SARS-CoV-2. It was found to be highly versatile as shown by antibody detection from both serum and dried blot spots and as shown in three case studies. First, we followed seroconversion for all four endemic HCoV strains and SARS-CoV-2 in an outbreak study in day-care centres for children. Second, we were able to link a more severe clinical course to a stronger IgG response with this 17-plex-assay, which was IgG1 and IgG3 dominated. Finally, our assay was able to discriminate recent from previous SARS-CoV-2 infections by calculating the IgG/IgM ratio on the N antigen targeting antibodies. In conclusion, due to the comprehensive method comparison, thorough validation, and the proven versatility, our multiplex assay is a valuable tool for studies on coronavirus serology.
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Affiliation(s)
- Daniel Stern
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany.
| | - Tanja C Meyer
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Fridolin Treindl
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Hans Werner Mages
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Maren Krüger
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Martin Skiba
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Jan Philipp Krüger
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Christian M Zobel
- Department of Internal Medicine, Bundeswehr Hospital Berlin, Berlin, Germany
| | | | - Marica Grossegesse
- Highly Pathogenic Viruses (ZBS 1), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Thomas Rinner
- Highly Pathogenic Viruses (ZBS 1), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Caroline Peine
- Immunization Unit (FG 33), Department for Infectious Disease Epidemiology, Robert Koch Institute, 13353, Berlin, Germany
| | - Anna Stoliaroff-Pépin
- Immunization Unit (FG 33), Department for Infectious Disease Epidemiology, Robert Koch Institute, 13353, Berlin, Germany
| | - Thomas Harder
- Immunization Unit (FG 33), Department for Infectious Disease Epidemiology, Robert Koch Institute, 13353, Berlin, Germany
| | - Natalie Hofmann
- Highly Pathogenic Viruses (ZBS 1), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Janine Michel
- Highly Pathogenic Viruses (ZBS 1), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Andreas Nitsche
- Highly Pathogenic Viruses (ZBS 1), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Silke Stahlberg
- Central Epidemiological Laboratory (FG 22), Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101, Berlin, Germany
| | - Antje Kneuer
- Central Epidemiological Laboratory (FG 22), Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101, Berlin, Germany
| | - Anna Sandoni
- Central Epidemiological Laboratory (FG 22), Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101, Berlin, Germany
| | - Ulrike Kubisch
- Central Epidemiological Laboratory (FG 22), Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101, Berlin, Germany
| | - Martin Schlaud
- Central Epidemiological Laboratory (FG 22), Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101, Berlin, Germany
| | - Annette Mankertz
- Measles, Mumps, Rubella, and Viruses Affecting Immunocompromised Patients (FG 12), Robert Koch Institute, 13353, Berlin, Germany
| | - Tatjana Schwarz
- Institute of Virology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Victor M Corman
- Institute of Virology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Corporate Member, Freie Universität Berlin, 10117, Berlin, Germany
- Corporate Member, Humboldt-Universität zu Berlin, 14195, Berlin, Germany
| | - Marcel A Müller
- Institute of Virology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Kathrin de la Rosa
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125, Berlin, Germany
- Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Martin B Dorner
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany
| | - Brigitte G Dorner
- Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353, Berlin, Germany.
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Krause E, Michel J, Puyskens A, Hofmann N, Rinner T, Biere B, Dorner BG, Skiba M, Schaade L, Nitsche A. Flexible upscaling of laboratory PCR testing capacity at the Robert Koch Institute during the SARS-CoV-2 pandemic. Virol J 2023; 20:139. [PMID: 37408040 DOI: 10.1186/s12985-023-02088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/02/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Over the course of the COVID-19 pandemic, laboratories worldwide have been facing an unprecedented increase in demand for PCR testing because of the high importance of diagnostics for prevention and control of virus spread. Moreover, testing demand has been varying considerably over time, depending on the epidemiological situation, rendering efficient resource allocation difficult. Here, we present a scalable workflow which we implemented in our laboratory to increase PCR testing capacity while maintaining high flexibility regarding the number of samples to be processed. METHODS We compared the performance of five automated extraction instruments, using dilutions of SARS-CoV-2 cell culture supernatant as well as clinical samples. To increase PCR throughput, we combined the two duplex PCR reactions of our previously published SARS-CoV-2 PCR assay into one quadruplex reaction and compared their limit of detection as well as their performance on the detection of low viral loads in clinical samples. Furthermore, we developed a sample pooling protocol with either two or four samples per pool, combined with a specifically adapted SARS-CoV-2 quadruplex PCR assay, and compared the diagnostic sensitivity of pooled testing and individual testing. RESULTS All tested automated extraction instruments yielded comparable results regarding the subsequent sensitivity of SARS-CoV-2 detection by PCR. While the limit of detection of the quadruplex SARS-CoV-2 PCR assay (E-Gene assay: 28.7 genome equivalents (ge)/reaction, orf1ab assay: 32.0 ge/reaction) was slightly higher than that of our previously published duplex PCR assays (E-Gene assay: 9.8 ge/reaction, orf1ab assay: 6.6 ge/reaction), the rate of correctly identified positive patient samples was comparable for both assays. Sample pooling with optimized downstream quadruplex PCR showed no loss in diagnostic sensitivity compared to individual testing. CONCLUSION Specific adaptation of PCR assays can help overcome the potential loss of sensitivity due to higher levels of PCR multiplexing or sample dilution in pooled testing. Combining these adapted PCR assays with different sample processing strategies provides a simple and highly adjustable workflow for resource-efficient SARS-CoV-2 diagnostics. The presented principles can easily be adopted in a variety of laboratory settings as well as be adapted to pathogens other than SARS-CoV-2, making it feasible for any laboratory that conducts PCR diagnostics.
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Affiliation(s)
- Eva Krause
- Centre for Biological Threats and Special Pathogens, Unit Highly Pathogenic Viruses (ZBS 1), WHO Collaborating Centre for Emerging Infections and Biological Threats, WHO Reference Laboratory for SARS-CoV-2, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany.
| | - Janine Michel
- Centre for Biological Threats and Special Pathogens, Unit Highly Pathogenic Viruses (ZBS 1), WHO Collaborating Centre for Emerging Infections and Biological Threats, WHO Reference Laboratory for SARS-CoV-2, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Andreas Puyskens
- Centre for Biological Threats and Special Pathogens, Unit Highly Pathogenic Viruses (ZBS 1), WHO Collaborating Centre for Emerging Infections and Biological Threats, WHO Reference Laboratory for SARS-CoV-2, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Natalie Hofmann
- Centre for Biological Threats and Special Pathogens, Unit Highly Pathogenic Viruses (ZBS 1), WHO Collaborating Centre for Emerging Infections and Biological Threats, WHO Reference Laboratory for SARS-CoV-2, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Rinner
- Centre for Biological Threats and Special Pathogens, Unit Highly Pathogenic Viruses (ZBS 1), WHO Collaborating Centre for Emerging Infections and Biological Threats, WHO Reference Laboratory for SARS-CoV-2, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Barbara Biere
- Department for Infectious Diseases, Unit Influenza and Other Respiratory Viruses (FG 17), Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Brigitte G Dorner
- Centre for Biological Threats and Special Pathogens, Unit Biological Toxins (ZBS 3), WHO Collaborating Centre for Emerging Infections and Biological Threats, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Martin Skiba
- Centre for Biological Threats and Special Pathogens, Unit Biological Toxins (ZBS 3), WHO Collaborating Centre for Emerging Infections and Biological Threats, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Unit Highly Pathogenic Viruses (ZBS 1), WHO Collaborating Centre for Emerging Infections and Biological Threats, WHO Reference Laboratory for SARS-CoV-2, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, Unit Highly Pathogenic Viruses (ZBS 1), WHO Collaborating Centre for Emerging Infections and Biological Threats, WHO Reference Laboratory for SARS-CoV-2, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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3
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Stoliaroff-Pepin A, Peine C, Herath T, Lachmann J, Perriat D, Dörre A, Nitsche A, Michel J, Grossegesse M, Hofmann N, Rinner T, Kohl C, Brinkmann A, Meyer T, Dorner BG, Stern D, Treindl F, Hein S, Werel L, Hildt E, Gläser S, Schühlen H, Isner C, Peric A, Ghouzi A, Reichardt A, Janneck M, Lock G, Schaade L, Wichmann O, Harder T. Effectiveness of vaccines in preventing hospitalization due to COVID-19: A multicenter hospital-based case-control study, Germany, June 2021 to January 2022. Vaccine 2023; 41:290-293. [PMID: 36509640 PMCID: PMC9715487 DOI: 10.1016/j.vaccine.2022.11.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/16/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022]
Abstract
We included 852 patients in a prospectively recruiting multicenter matched case-control study in Germany to assess vaccine effectiveness (VE) in preventing COVID-19-associated hospitalization during the Delta-variant dominance. The two-dose VE was 89 % (95 % CI 84-93 %) overall, 79 % in patients with more than two comorbidities and 77 % in adults aged 60-75 years. A third dose increased the VE to more than 93 % in all patient-subgroups.
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Affiliation(s)
- Anna Stoliaroff-Pepin
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany.
| | - Caroline Peine
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany.
| | - Tim Herath
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Johannes Lachmann
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Delphine Perriat
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Achim Dörre
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Janine Michel
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Marica Grossegesse
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Natalie Hofmann
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Thomas Rinner
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Claudia Kohl
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Annika Brinkmann
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Tanja Meyer
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Brigitte G Dorner
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Daniel Stern
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Fridolin Treindl
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Sascha Hein
- Division Virology, Paul-Ehrlich-Institute, Germany
| | - Laura Werel
- Division Virology, Paul-Ehrlich-Institute, Germany
| | | | - Sven Gläser
- Klinik für Innere Medizin - Pneumologie und Infektiologie, Vivantes Klinikum Neukölln und Spandau, Berlin, Germany
| | - Helmut Schühlen
- Vivantes Netzwerk für Gesundheit GmbH, Direktorat Klinische Forschung & Akademische Lehre, Berlin, Germany
| | - Caroline Isner
- Klinik für Innere Medizin - Infektiologie, Vivantes Auguste-Viktoria-Klinikum, Rubensstr. 125, 12157 Berlin, Germany
| | - Alexander Peric
- Klinik für Pneumologie und Infektiologie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany
| | - Ammar Ghouzi
- Schön Klinik Düsseldorf, Interdisziplinäre Notaufnahme, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
| | - Annette Reichardt
- Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Matthias Janneck
- Klinik für Kardiologie, Sektion Nephrologie, Albertinen Krankenhaus, Süntelstraße 11a, 22457 Hamburg, Germany
| | - Guntram Lock
- Klinik für Innere Medizin, Albertinen Krankenhaus, Süntelstraße 11a, 22457 Hamburg, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Germany
| | - Ole Wichmann
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Thomas Harder
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
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4
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Michel J, Targosz A, Rinner T, Bourquain D, Brinkmann A, Sacks JA, Schaade L, Nitsche A. Evaluation of 11 commercially available PCR kits for the detection of monkeypox virus DNA, Berlin, July to September 2022. Euro Surveill 2022; 27:2200816. [PMID: 36367010 PMCID: PMC9650706 DOI: 10.2807/1560-7917.es.2022.27.45.2200816] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 11/13/2022] Open
Abstract
Before the international spread of monkeypox in May 2022, PCR kits for the detection of orthopoxviruses, and specifically monkeypox virus, were rarely available. Here we describe the evaluation of 11 recently developed commercially available PCR kits for the detection of monkeypox virus DNA. All tested kits are currently intended for research use only and clinical performance still needs to be assessed in more detail, but all were suitable for diagnostics of monkeypox virus, with variations in specificity rather than sensitivity.
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Affiliation(s)
- Janine Michel
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Angelina Targosz
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Thomas Rinner
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Daniel Bourquain
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Annika Brinkmann
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Jilian Amber Sacks
- World Health Organization (WHO), Department of Epidemic and Pandemic Preparedness and Prevention, Geneva, Switzerland
| | - Lars Schaade
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Andreas Nitsche
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
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5
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Michel J, Neumann M, Krause E, Rinner T, Muzeniek T, Grossegesse M, Hille G, Schwarz F, Puyskens A, Förster S, Biere B, Bourquain D, Domingo C, Brinkmann A, Schaade L, Schrick L, Nitsche A. Resource-efficient internally controlled in-house real-time PCR detection of SARS-CoV-2. Virol J 2021; 18:110. [PMID: 34078394 PMCID: PMC8170437 DOI: 10.1186/s12985-021-01559-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background The reliable detection of SARS-CoV-2 has become one of the most important contributions to COVID-19 crisis management. With the publication of the first sequences of SARS-CoV-2, several diagnostic PCR assays have been developed and published. In addition to in-house assays the market was flooded with numerous commercially available ready-to-use PCR kits, with both approaches showing alarming shortages in reagent supply. Aim Here we present a resource-efficient in-house protocol for the PCR detection of SARS-CoV-2 RNA in patient specimens (RKI/ZBS1 SARS-CoV-2 protocol). Methods Two duplex one-step real-time RT-PCR assays are run simultaneously and provide information on two different SARS-CoV-2 genomic regions. Each one is duplexed with a control that either indicates potential PCR inhibition or proves the successful extraction of nucleic acid from the clinical specimen. Results Limit of RNA detection for both SARS-CoV-2 assays is below 10 genomes per reaction. The protocol enables testing specimens in duplicate across the two different SARS-CoV-2 PCR assays, saving reagents by increasing testing capacity. The protocol can be run on various PCR cyclers with several PCR master mix kits. Conclusion The presented RKI/ZBS1 SARS-CoV-2 protocol represents a cost-effective alternative in times of shortages when commercially available ready-to-use kits may not be available or affordable. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-021-01559-3.
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Affiliation(s)
- Janine Michel
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Markus Neumann
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Eva Krause
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Thomas Rinner
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Therese Muzeniek
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Marica Grossegesse
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Georg Hille
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Franziska Schwarz
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Andreas Puyskens
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Sophie Förster
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Barbara Biere
- Influenza and Other Respiratory Viruses (FG 17), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Daniel Bourquain
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Cristina Domingo
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Annika Brinkmann
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Livia Schrick
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
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6
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Reimann F, Rinner T, Lindner A, Kofler M, Ianosi BA, Schiefecker AJ, Beer R, Schmutzhard E, Pfausler B, Helbok R, Rass V. Hyperactive delirium in patients after non-traumatic subarachnoid hemorrhage. J Crit Care 2021; 64:45-52. [PMID: 33794466 DOI: 10.1016/j.jcrc.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/12/2020] [Revised: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Hyperactive delirium is common after subarachnoid hemorrhage (SAH). We aimed to identify risk factors for delirium and to evaluate its impact on outcome. METHODS We collected daily Richmond Agitation Sedation Scale (RASS) and Intensive Care Delirium Screening Checklist (ICDSC) scores in 276 SAH patients. Hyperactive delirium was defined as ICDSC ≥4 when RASS was >0. We investigated risk factors for delirium and its association with 3-month functional outcome using generalized linear models. RESULTS Patients were 56 (IQR 47-67) years old and had a Hunt&Hess (H&H) grade of 3 (IQR 1-5). Sixty-five patients (24%) developed hyperactive delirium 6 (IQR 3-16) days after SAH. In multivariable analysis, mechanical ventilation>48 h (adjOR = 4.46; 95%-CI = 1.89-10.56; p = 0.001), the detection of an aneurysm (adjOR = 4.38; 95%-CI = 1.48-12.97; p = 0.008), a lower H&H grade (adjOR = 0.63; 95%-CI = 0.48-0.83; p = 0.001) and a pre-treated psychiatric disorder (adjOR = 3.17; 95%-CI = 1.14-8.83; p = 0.027) were associated with the development of delirium. Overall, delirium was not associated with worse outcome (p = 0.119). Interestingly, patients with delirium more often had a modified Rankin Scale Score (mRS) of 1-3 (77%) compared to an mRS of 0 (14%) or 4-6 (9%). CONCLUSION Our data indicate that hyperactive delirium is common after SAH patients and requires a certain degree of brain connectivity based ono the highest prevalence found in SAH patients with intermediate outcomes.
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Affiliation(s)
- Fabian Reimann
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Thomas Rinner
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Anna Lindner
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Mario Kofler
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bogdan-Andrei Ianosi
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Institute of Medical Informatics, UMIT: University for Health Sciences, Biomedical Informatics and Mechatronics, Medical Informatics and Technology, Eduard Wallnoefer-Zentrum 1, 6060 Hall i.T, Austria
| | - Alois Josef Schiefecker
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ronny Beer
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Erich Schmutzhard
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Verena Rass
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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