Evaluation of two commercially available immunoassays for the detection of hantavirus antibodies in serum samples

Serological evidence of hantavirus infection in farm and abattoir workers in Trinidad--a preliminary study

Hantaviruses are established causative agents of hemorrhagic fevers and renal diseases amongst other clinical manifestations in humans, with most diagnosis based on serological assays. The disease, which is rodent-borne, has been reported in numerous countries worldwide but information about the disease is scanty in the Caribbean. The objective of this investigation is to determine the frequency of exposure to hantaviruses in a selected apparently healthy human population associated with abattoirs and livestock farms in Trinidad using a hantavirus immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). Of a total of 236 individuals tested, 27 (11.4%) were seropositive for hantavirus infection. Amongst abattoir workers the frequency of infection was 9.4% (6 of 64) compared with seropositivity rate of 12.4% (18 of 145) and 11.1% (3 of 27) amongst livestock farm workers and office workers and other individuals with minimal animal contact respectively. The differences were, however, not statistically significant (p > .05; χ(2) test). Age, gender, and race did not significantly affect the infection rate by hantavirus in the workers studied. This is considered the first documented evidence of hantavirus infection in Trinidad and Tobago. It is imperative for local physicians to consider hantavirus as a differential diagnosis in patients with hemorrhagic fever and renal diseases, since there may be a number of undiagnosed cases of hantavirus disease in the human population in the country.

Biological terrorism

A biological terrorism event could have a large impact on the general population and health care system. The impact of an infectious disaster will most likely be great to emergency departments, and the collaboration between emergency and infectious disease specialists will be critical in developing an effective response. A bioterrorism event is a disaster that requires specific preparations beyond the usual medical disaster planning. An effective response would include attention to infection control issues and plans for large-scale vaccination or antimicrobial prophylaxis. This article addresses some general issues related to preparing an effective response to a biological terrorism event. It will also review organisms and toxins that could be used in biological terrorism, including clinical features, management, diagnostic testing, and infection control.

A soluble and heat-resistant form of hantavirus nucleocapsid protein for the serodiagnosis of HFRS

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne viral zoonosis characterized by fever, hemorrhagic manifestations, and renal disorder. The causative agent of HFRS has been identified as a hantavirus. Hantavirus nucleocapsid proteins have recently been shown to be immunodominant antigens in HFRS, inducing an early and long-lasting immune response, and their amino termini are sensitive tools for the detection of specific antibodies in HFRS patient sera. Previous work has demonstrated that the introduction of the acidic tail of alpha-synuclein (ATS) into heat-labile proteins protects them from heat-induced aggregation. In this study, the ATS peptide was introduced into the N-terminal antigenic portion of the nucleocapsid proteins (amino acid residues 1-70) of the Hantaan virus (HTNV-delta N) and Seoul virus (SEOV-delta N). The recombinant ATS-HTNV-delta N and ATS-SEOV-delta N fusion proteins were heat-resistant, and the proteins purified by heat treatment were immunoreactive to sera from patients with HFRS. Compared with sera from patients with leptospirosis and scrub typhus, sera from patients with HFRS showed much higher reactivity in ATS-HTNV-delta N- or ATS-SEOV-delta N-based IgG ELISAs. Immunoblotting analysis revealed that only sera from patients with HFRS specifically recognized the ATS-HTNV-delta N and ATS-SEOV-delta N, indicating that the ATS-HTNV-delta N and ATS-SEOV-delta N were highly purified species without any other immunoreactive proteins as contaminants. These data demonstrate that the ATS-HTNV-delta N and ATS-SEOV-delta N fusion proteins offer a safe and inexpensive source of pure and specific antigen for large-scale diagnosis and seroepidemiological studies of HFRS, and that ATS-fusion technology can also be utilized to solubilize other antigens that could be used for large-scale diagnosis and seroepidemiological studies of other diseases.

Utilization of hantavirus antibody results generated over a five-year period to develop an improved serologic algorithm for detecting acute Sin Nombre hantavirus infection

In the United States most cases of hantavirus pulmonary syndrome (HPS) are caused by the Sin Nombre virus (SNV) and are typically identified by serology. The goal of this study was to assess the performance of our hantavirus serologic testing algorithm by reviewing results generated over five years. Sera were screened for pan-hantavirus immunoglobulin (Ig)G and IgM by enzyme-linked immunosorbent assay (ELISA). Screen IgG+ sera were then tested by immunoblot for SNV glycoprotein-specific IgG, and screen IgM+ sera were tested for SNV-specific IgM using an ELISA that measured differential reactivity to SNV and Seoul nucleocapsid proteins. Although only 13% of sera were positive in one or both screening assays, 85% of screen+sera lacked SNV antibodies. Nearly all (97%) screen IgM-IgG+ samples lacked SNV IgG, and 90% of screen IgM+IgG- samples lacked SNV IgM. However, SNV IgM testing of screen IgM+IgG- samples appears to be necessary, since this test identified nine of 37 patients with acute HPS (based on clinical feedback). A screen IgM+IgG+ result was a good predictor of SNV antibody detection and acute HPS. These findings were used to design a modified algorithm that identified all 37 patients with acute HPS, but reduced the number of specimens that required SNV antibody testing by 42%.

Phage display mediated immuno-PCR

Immuno-PCR (IPCR) is a powerful detection technology in immunological study and clinical diagnosis due to its ultrasensitivity. Here we introduce a new strategy termed phage display mediated immuno-PCR (PD-IPCR). Instead of utilization of monoclonal antibody (mAb) and chemically bond DNA that required in the conventional IPCR, a recombinant phage particle is applied as a ready reagent for IPCR experiment. The surface displayed single chain variable fragment (scFv) and phage DNA themselves can directly serve as detection antibody and PCR template, respectively. The aim of the design is to overcome shortcoming of low detection sensitivity of scFv so as to largely facilitate the real application of scFv in immunoassay. The idea has been demonstrated by applying hantaan virus nucleocapsid protein (NP) and prion protein (PrP) as detection targets in three experimental protocols (indirect, sandwich and real-time PD-IPCR assays). The detection sensitivity was increased 1000- to 10 000-folds compared with conventional enzyme-linked immunosorbent assays (ELISAs). This proof-of-concept study may serve as a new model to develop an easy to operate, low cost and ultrasensitive immunoassay method for broad applications.

Threats in bioterrorism. II: CDC category B and C agents

A variety of agents have potential for use as weapons of biological terrorism. Knowledge of the likely organisms may be useful in preparations to mitigate the effects of a BT event. Recognition of the clinical presentation of these organisms could help physicians identify them quickly, allowing more appropriate management and possible prophylaxis of others who may have been exposed. Although many of these agents do not have specific treatments, it is important to recognize those that do. It is also important to know which infections require isolation because of potential for person-to-person spread. Table 3 summarizes important features of the CDC category B and C agents. The list of agents discussed in this article is by no means exhaustive. It is always possible that some "mad scientist" could modify an existing organism or engineer some new agent for use in biological terrorism. The possibilities are limited only by the ingenuity and depravity of those individuals who would take part in such an attack.

Comparison of a new immunochromatographic rapid test with a commercial EIA for the detection of Puumala virus specific IgM antibodies

BACKGROUND

Hantaviruses are associated with two human diseases: haemorrhagic fever with renal syndrome (HFRS) and Hantavirus pulmonary syndrome (HPS). Puumala virus (PUUV), which is one of the Hantaviruses, is a causative agent of nephropathia epidemica (NE), a mild form of HFRS.

OBJECTIVE

a new 5 min rapid test, POC PUUMALA (Erilab Ltd, Finland), for detecting IgM antibodies to PUUV was evaluated and compared with the commercially available Hantavirus (Puumala) IgM ELISA test (Progen, Germany). Discrepant test results between the two tests were confirmed by a mu-capture reference EIA.

STUDY DESIGN

Two hundred and thirty five serum samples, which had earlier been analyzed with the Progen IgM ELISA, were assayed with the POC PUUMALA rapid test. Five persons, without knowing the Progen IgM ELISA test results, interpreted independently the rapid test results. In addition, a panel of 48 serum samples was analyzed in parallel with the rapid test and the Progen IgM ELISA by one technician in daily routine diagnostics in a clinical microbiology laboratory.

RESULTS

the agreement between the results of the five interpreters was 95%, and the congruence of the results between individual readers and commercial ELISA test varied from 93 to 96%. Diagnostic efficacy of the rapid test varied between 98 and 99% compared with 96% of the Progen IgM ELISA. The POC PUUMALA rapid test showed higher or similar sensitivity compared with the Progen IgM ELISA, whereas both the tests had similar levels of specificity.

CONCLUSIONS

the analytical performance of the POC PUUMALA rapid test was found to be as good or even slightly better than the analytical performance of the Progen IgM ELISA. In addition, the rapid and straightforward procedure makes the POC PUUMALA a feasible tool for the diagnosis of the acute PUUV infection.