Sample Adequacy Control (SAC) Lowers False Negatives and Increases the Quality of Screening: Introduction of “Non-Competitive” SAC for qPCR Assays (original) (raw)

Importance of Adequate qPCR Controls in Infection Control

Diagnostics

Respiratory screening assays lacking Sample Adequacy Controls (SAC) may result in inadequate sample quality and thus false negative results. The non-adequate samples might represent a significant proportion of the total performed tests, thus resulting in sub-optimal infection control measures with implications that may be critical during pandemic times. The quantitative sample adequacy threshold can be established empirically, measuring the change in the frequency of positive results, as a function of the numerical value of “sample adequacy”. Establishing a quantitative threshold for SAC requires a big number/volume of tests to be analyzed in order to have a statistically valid result. Herein, we are offering for the first time clear clinical evidence that a subset of results, which did not pass minimal sample adequacy criteria, have a significantly lower frequency of positivity compared with the “adequate” samples. Flagging these results and/or re-sampling them is a mitigation stra...

Sample-to-result molecular infectious disease assays: clinical implications, limitations and potential

Expert Review of Molecular Diagnostics, 2016

Molecular infectious disease diagnostic tests have undergone major advances in the past decade and will continue to rapidly evolve. Assays have become extraordinarily simple to perform, eliminating the need for pre-analytic sample preparation and post-amplification analysis. This allows these tests to be performed in settings without sophisticated expertise in molecular biology, including locations with limited resources. Additionally, the sensitivity and specificity of these assays is superb and many offer extremely fast turn-around times. These tests have major impacts on patient care, but also have some limitations.

Factors affecting sensitivity and specificity of pooled-sample testing for diagnosis of low prevalence infections

Preventive veterinary medicine, 2006

Testing of pooled samples has been proposed as a low-cost alternative for diagnostic screening and surveillance for infectious agents in situations where the prevalence of infection is low and most samples can be expected to test negative. The present study extends our previous work in pooled-sample testing (PST) to evaluate effects of the following factors on the overall PST sensitivity (SE(k)) and specificity (SP(k)): dilution (pool size), cross-contamination, and cross-reaction. A probabilistic model, in conjunction with Monte Carlo simulations, was used to calculate SE(k) and SP(k), as applied to detection of bovine viral diarrhea virus (BVDV) persistently infected (PI) animals using RT-PCR. For an average prevalence of BVDV PI of 0.01 and viremia in each animal between 10(2) and 10(7)virusparticles/mL, the pool size associated with the lowest number of tests, and lowest cost, corresponded to eight samples/pool. However, the least-cost pool size (lowest number of tests) was asso...

Reflections and Proposals to Assure Quality in Molecular Diagnostics

Acta Clinica Belgica, 2011

Real-time polymerase chain reaction (PCR) is a frequently used technique in molecular diagnostics. To date, practical guidelines for the complete process of optimization and validation of commercial and in-house developed molecular diagnostic methods are scare. Therefore, we propose a practical guiding principle for the optimization and validation of real-time PCR assays. Based on literature, existing guidelines, and personal experience, we created a checklist that can be used in different steps of the development and validation process of commercial and in-house developed real-time PCR assays. Furthermore, determination of target values and reproducibility of internal quality controls are included, which allows a statistical follow-up of the performance of the assay. Recently, we used this checklist for the development of various qualitative and quantitative assays for microbiological and hematological applications, for which accreditation according to ISO 15189:2007 was obtained. In our experience, the use of the proposed guidelines leads to a more efficient and standardized optimization and validation. Ultimately, this results in reliable and robust molecular diagnostics. The proposed checklist is independent of environment, equipment, and specific applications and can be used in other laboratories. A worldwide consensus on this kind of checklist should be aimed at.

Quality Control in Screening for Infectious Diseases at Blood Banks. Rationale and Methodology

EJIFCC, 2015

Quality control procedures are indispensable to ensure the reliability of the results provided by laboratories responsible for serological screening in blood banks. International recommendations on systems of quality management classify as a top component the inclusion of two types of control: (a) internal quality control (IQC) and (b) external quality control (EQC). In EQC it is essential to have, at least, a monthly frequency of laboratory assessment. On the other hand, IQC involves the daily use of low-reactivity control sera, which should be systematically added in all run, carried out in the laboratory for each parameter. Through the IQC analysis some variations in the criteria of run acceptance and rejection may be revealed, but it is of paramount importance to ensure the previous definition of these criteria and even more importantly, the adherence to them; and that corresponds to the validation of analytical runs of each test. Since 2010 this has been, for instance, the expe...

Accelerated infection testing at scale: a proposal for inference with single test on multiple patients

arXiv: Other Quantitative Biology, 2020

In pandemics or epidemics, public health authorities need to rapidly test a large number of individuals, both to determine the line of treatment as well as to know the spread of infection to plan containment, mitigation and future responses. However, the lack of adequate testing kits could be a bottleneck, especially in the case of unanticipated new diseases, such as COVID-19, where the testing technology, manufacturing capability, distribution, human skills and laboratories might be unavailable or in short supply. In addition, the cost of the standard PCR test is approximately USD 48, which is prohibitive for poorer patients and most governments. We address this bottleneck by proposing a test methodology that pools the sample from two (or more) patients in a single test. The key insight is that a single negative result from a pooled sample likely implies negative infection of all the individual patients. and It thereby rules out further tests for the patients. This protocol, theref...

Improvement of SARS-COV-2 screening using pooled sampling testing in limited RT-qPCR resources

Journal of Virological Methods, 2022

Background: COVID-19 is a worldwide pandemic representing the most challenging global health crisis currently. Screening tests availability are a problematic task due to resource-limited abilities of some countries using RT-qPCR technique for SARS− COV-2 detection. Objective: To cope with these health emergencies, in particular with this COVID-19 pandemic, states with low molecular diagnostic resources must optimize their capacity in molecular tests. We aimed to design a simple and effective strategy to improve inputs in the RT-qPCR tests as we attempted to check the financial advisability of using such an approach by calculating reduction rate of the test unit cost. Methods: The used RNA was taken from suspected Covid-19 positive people. Nasopharyngeal swabs were collected at

Time to address quality control processes applied to antibody testing for infectious diseases

Clinical Chemistry and Laboratory Medicine (CCLM)

As testing for infectious diseases moves from manual, biological testing such as complement fixation to high throughput automated autoanalyzer, the methods for controlling these assays have also changed to reflect those used in clinical chemistry. However, there are many differences between infectious disease serology and clinical chemistry testing, and these differences have not been considered when applying traditional quality control methods to serology. Infectious disease serology, which is highly regulated, detects antibodies of varying classes and to multiple and different antigens that change according to the organisms’ genotype/serotype and stage of disease. Although the tests report a numerical value (usually signal to cut-off), they are not measuring an amount of antibodies, but the intensity of binding within the test system. All serology assays experience lot-to-lot variation, making the use of quality control methods used in clinical chemistry inappropriate. In many jur...

Evaluation of COVID-19 RT-qPCR test in multi-sample pools

Clinical Infectious Diseases

Background The recent emergence of SARS-CoV-2 lead to a current pandemic of unprecedented scale. Though diagnostic tests are fundamental to the ability to detect and respond, overwhelmed healthcare systems are already experiencing shortages of reagents associated with this test, calling for a lean immediately-applicable protocol. Methods RNA extracts of positive samples were tested for the presence of SARS-CoV-2 using RT-qPCR, alone or in pools of different sizes (2-, 4-, 8- ,16-, 32- and 64-sample pools) with negative samples. Transport media of additional 3 positive samples were also tested when mixed with transport media of negative samples in pools of 8. Results A single positive sample can be detected in pools of up to 32 samples, using the standard kits and protocols, with an estimated false negative rate of 10%. Detection of positive samples diluted in even up to 64 samples may also be attainable, though may require additional amplification cycles. Single positive samples can...