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Multiantigen serology and a diagnostic algorithm for the detection of arbovirus infections as novel tools for arbovirus preparedness in southeast Europe: a prospective observational study

ABSTRACT: Arboviruses are increasingly impacting Europe, in part due to the effects of climate change. This emphasizes the need for improving preparedness for emerging arboviral infections that often co-circulate and may have overlapping clinical syndromes. Therefore, we aimed to strengthen surveillance networks for four clinically relevant arboviruses in southeast Europe. This study reports secondary objectives of a prospective observational study in adults hospitalized with an arbovirus-compatible disease syndrome in 21 hospitals in seven countries in southeast Europe over four arbovirus seasons (1 May 2016 - 31 October 2019). In this study, given the challenges in arbovirus diagnostics, we developed a diagnostic interpretation algorithm taking into account the (serological) outcomes and sample timing to study arbovirus prevalence in southeast Europe. We used enzyme-linked immunosorbent assay (ELISA) and custom-printed protein microarrays to simultaneously detect serum antibodies against Crimean-Congo haemorrhagic fever virus (CCHFV), tick-borne encephalitis virus (TBEV), Toscana virus (TOSV) and West Nile virus (WNV), followed by confirmation assays (virus neutralization test (VNT) or Indirect immunofluorescence test (IIFT)). Patients were sampled on day 0, 7, 28 and 60 post-hospital admission. This data encompasses the ELISA, protein microarray, VNT and IIFT data of CCHFV, TBEV, TOSV, WNV and USUV, for each included patient, country and year. Furthermore, it contains information about the sampling dates, estimated days post symptom onset (dpso) as well as its diagnostic interpretation according to the developed diagnostic interpretation algorithm.

ORGANISM(S): Homo sapiens (human)

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PROVIDER: S-BSST1853 | biostudies-other |

REPOSITORIES: biostudies-other

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Project description:BackgroundStrengthening the quality of laboratory diagnostics is a key part of building global health capacity. In 2015, the Centers for Disease Control and Prevention (CDC), the Southeast European Center for Surveillance and Control of Infectious Diseases (SECID), WHO European Regional Office (WHO EURO) and American Public Health Laboratories (APHL) collaborated to address laboratory quality training needs in Southeast Europe. Together, they developed a quality assurance (QA) mentorship program for six national laboratories (Laboratories A-E) in five countries utilizing APHL international consultants. The primary goal of the mentorship program was to help laboratories become recognized by WHO as National Influenza Centers (NICs). The program aimed to do this by strengthening influenza laboratory capacity by implementing quality management systems (QMS) action steps. After 1 year, we evaluated participants' progress by the proportion of QMS action steps they had successfully implemented, as well as the value of mentorship as perceived by laboratory mentees, mentors, and primary program stakeholders from SECID and WHO EURO.MethodsTo understand perceived value we used the qualitative method of semi-structured interviews, applying grounded theory to the thematic analysis.ResultsMentees showed clear progress, having completed 32 to 68% [median: 62%] of planned QMS action steps in their laboratories. In regards to the perceived value of the program, we found strong evidence that laboratory mentorship enhances laboratory quality improvement by promoting accountability to QMS implementation, raising awareness of the importance of QMS, and fostering collaborative problem solving.ConclusionIn conclusion, we found that significant accomplishments can be achieved when QA programs provide dedicated technical mentorship for QMS implementation. Since the start of the mentoring, Laboratory "B" has achieved NIC recognition by WHO, while two other labs made substantial progress and are scheduled for recognition in 2018. In the future, we recommend that mentorship is more inclusive of laboratory directors, and that programs evaluate the amount of staff time needed for mentorship activities, including lab-based assessments and mentoring.

Project description:Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity.DesignProspective cohort study.SettingMulticenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals representing diverse geographic regions across the United States.PatientsPatients with SARI caused by infection with respiratory viruses that can cause outbreaks, epidemics, and pandemics.InterventionsNone.Measurements and main resultsMeasurements include patient demographics, signs, symptoms, and medications; microbiology, imaging, and associated tests; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes and hospital stress, with specimens collected on days 0, 3, and 7-14 after enrollment and at discharge. The primary outcome measure is the number of consecutive days alive and free of mechanical ventilation (VFD) in the first 30 days after hospital admission. Important secondary outcomes include organ failure-free days before acute kidney injury, shock, hepatic failure, disseminated intravascular coagulation, 28-day mortality, adaptive immunity, as well as immunologic and microbiologic outcomes.ConclusionsSARI-Preparedness is a multicenter study under the collaboration of the Society of Critical Care Medicine Discovery, Resilience Intelligence Network, and National Emerging Special Pathogen Training and Education Center, which seeks to improve understanding of prognostic factors associated with worse outcomes and increased resource utilization. This can lead to interventions to mitigate the clinical impact of respiratory virus infections associated with SARI.

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Multiantigen serology and a diagnostic algorithm for the detection of arbovirus infections as novel tools for arbovirus preparedness in southeast Europe: a prospective observational study

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