Nora Pisanic1, Atiqur Rahman2, Samir K Saha2, Alain B Labrique3, Kenrad E Nelson4, Douglas A Granger5, Steve W Granger6, Barbara Detrick7, Christopher D Heaney8. 1. Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 2. Department of Microbiology, Dhaka Shishu (Children's) Hospital, Dhaka 1207, Bangladesh. 3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family, and Reproductive, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 5. Institute for Interdisciplinary Salivary Bioscience, University of California at Irvine, Irvine, CA, USA; Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA; Research and Technology Center, Salimetrics, LLC, Carlsbad, CA, USA. 6. Research and Technology Center, Salimetrics, LLC, Carlsbad, CA, USA. 7. Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA. 8. Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Interdisciplinary Salivary Bioscience, University of California at Irvine, Irvine, CA, USA. Electronic address: cheaney1@jhu.edu.
Abstract
BACKGROUND: Hepatitis E virus (HEV) infection causes significant morbidity and mortality worldwide, particularly among pregnant women. In clinical settings blood-based testing protocols are commonly used to diagnose HEV infection, but in community settings such invasive sampling can hinder study participation and limit discovery of the ecology and natural history of HEV infection. Oral fluid is a non-invasive biospecimen that can harbor pathogen-specific antibodies and has the potential to replace blood-based testing protocols. OBJECTIVES: To develop an immunoassay to assess past and recent HEV infection that uses oral fluid instead of serum or plasma. METHODS: The assay was validated using paired oral fluid and serum samples collected from 141 patients who presented either with (n=76) or without (n=65) symptoms of acute viral hepatitis at a clinical diagnostics center in Dhaka, Bangladesh. The sensitivity and specificity of the oral fluid-based immunoassay for HEV IgG (past HEV infection) and HEV IgA (recent HEV infection) antibodies was calculated in reference to Wantai's (Beijing Wantai) serum-based HEV enzyme-linked immunosorbent assay (ELISA) kits for IgG and IgM antibodies, respectively. RESULTS: The sensitivity and specificity of the oral fluid-based immunoassay for HEV-IgG antibodies were 98.7% and 98.4%, respectively. The sensitivity and specificity of the oral fluid-based immunoassay for HEV IgA were 89.5% and 98.3%, respectively. CONCLUSIONS: The high concordance of our non-invasive oral fluid-based immunoassays (HEV IgG and HEV IgA) with commercial high-performance serum HEV ELISA kits (IgG and IgM) means that population-based surveillance of past and recent HEV infection could be expanded to improve understanding of its ecology and natural history.
BACKGROUND:Hepatitis E virus (HEV) infection causes significant morbidity and mortality worldwide, particularly among pregnant women. In clinical settings blood-based testing protocols are commonly used to diagnose HEV infection, but in community settings such invasive sampling can hinder study participation and limit discovery of the ecology and natural history of HEV infection. Oral fluid is a non-invasive biospecimen that can harbor pathogen-specific antibodies and has the potential to replace blood-based testing protocols. OBJECTIVES: To develop an immunoassay to assess past and recent HEV infection that uses oral fluid instead of serum or plasma. METHODS: The assay was validated using paired oral fluid and serum samples collected from 141 patients who presented either with (n=76) or without (n=65) symptoms of acute viral hepatitis at a clinical diagnostics center in Dhaka, Bangladesh. The sensitivity and specificity of the oral fluid-based immunoassay for HEV IgG (past HEV infection) and HEVIgA (recent HEV infection) antibodies was calculated in reference to Wantai's (Beijing Wantai) serum-based HEV enzyme-linked immunosorbent assay (ELISA) kits for IgG and IgM antibodies, respectively. RESULTS: The sensitivity and specificity of the oral fluid-based immunoassay for HEV-IgG antibodies were 98.7% and 98.4%, respectively. The sensitivity and specificity of the oral fluid-based immunoassay for HEVIgA were 89.5% and 98.3%, respectively. CONCLUSIONS: The high concordance of our non-invasive oral fluid-based immunoassays (HEV IgG and HEVIgA) with commercial high-performance serum HEV ELISA kits (IgG and IgM) means that population-based surveillance of past and recent HEV infection could be expanded to improve understanding of its ecology and natural history.
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