26th Clinical Virology Symposium
April 25 - 28, 2010 Daytona Beach, Florida, USA
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Session I
Session II
Session III
 

EVALUATION OF THREE COMMERCIAL TESTS AVAILABLE FOR NOROVIRUS ANTIGEN DETECTION IN STOOL SAMPLES COLLECTED DURING GASTROENTERITIS OUTBREAKS

Session ID: T56
Author Name(s): Rena Retallick, Monica Murphy, Mark Cardona, Eddie Chong-King, Pam O'Brien, Dawn Andrews, Carol Kalapos, Kwai Keung Wong, Erik Kristjanson, Jay Gheewala, Sangeeth Rajkumar, Mark Coulter, and Jonathan B Gubbay
Organization: Ontario Agency for Health Protection and Promotion, Toronto, ON
Conference Session: Session III
 
EVALUATION OF THREE COMMERCIAL TESTS AVAILABLE FOR NOROVIRUS ANTIGEN DETECTION IN STOOL SAMPLES COLLECTED DURING GASTROENTERITIS OUTBREAKS
Monica Murphy, Rena Retallick, Mark Cardona, Eddie Chong-King, Pam O’ Brien, Dawn Andrews, Carol Kalapos, Kwai Keung Wong, Erik Kristjanson, Jay Gheewala, Sangeeth Rajkumar, Mark Coulter, and Jonathan B Gubbay
Ontario Agency for Health Protection and Promotion, Toronto, ON
 
Background:  Noroviruses are the most frequent cause of nonbacterial gastroenteritis outbreaks. Although realtime reverse transcriptase PCR (rRT-PCR) is the most sensitive detection method, most testing laboratories do not have rapid access to this modality of testing or the less sensitive traditional detection method of electron microscopy.  The purpose of this study was to compare performance characteristics of three antigen based norovirus detection kits to rRT-PCR for rapid detection of genogroup I and II noroviruses in gastroenteritis outbreak stool samples.  
Methods:Ontario Agency for Health Protection and Promotion (OAHPP) performs gastroenteritis outbreak testing for the province of Ontario. 52 positive and 108 negative stool samples tested previously for norovirus GI/GII by rRT-PCR were blinded and tested at 3 of OAHPP’s testing laboratories using two commercial norovirus EIA detection kits and one ICT kit. The 3 antigen detection assays were compared for sensitivity, specificity, and agreement with rRT-PCR; reproducibility, turnaround time and ease of use were also evaluated.
Results: 
 
Performance characteristics of 3 norovirus antigen detection kits compared to 52 positive and 108 negative samples tested by norovirus rRT-PCR
 
 
Rida®quick Norovirus ICT
(R-Biopharm AG, Germany)
IDEIA NorovirusTM  EIA
(Oxoid, UK)
Ridascreen® Norovirus EIA
(R-Biopharm AG, Germany)
Detection Method
ICT
EIA, visual or plate reader
EIA plate reader
Sensitivity
68.6%
66.7%
67.3%
Specificity
100%
99.1%
99.4%
Agreement with PCR
429/478 (89.7%)
423/478 (88.5%)
425/478 (88.9%)
Time to Complete Test
15 minutes
90 minutes
100 minutes
 
Conclusions:The EIA and ICT norovirus kits evaluated are of excellent specificity but poor sensitivity when compared to rRT-PCR, and cannot exclude norovirus in sporadic cases of gastroenteritis. However, rapid tests should detect a norovirus outbreak if multiple samples are submitted for testing.  They would be of particular use in healthcare settings where molecular diagnostic capacity is not available, in particular remote settings. Due to its ease of use and rapid results, the ICT test kit could be easily implemented for norovirus detection in gastroenteritis outbreaks in remote healthcare settings.