BackgroundNowadays, dried blood spots (DBS) are primarily used to obtain diagnostic access to risk collectives such as intravenous drug users, who are prone to infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Before DBS analyses can be used in this diagnostic context, however, a comprehensive evaluation of its performance characteristics must be conducted. To the best of our knowledge, the current study presents for the first time such essential data for the Abbott ARCHITECT system, which is currently the worldwide leading platform in this field of infection diagnostics.MethodsThe investigation comprised 1,762 paired serum/DBS samples and a total of 3,524 determinations with the Abbott ARCHITECT HBsAg, anti-HBc, anti-HBs, anti-HCV and HIV-1-p24-antigen/anti-HIV 1/2 assays as well as with the artus HBV LC PCR and VERSANT HCV RNA qualitative (TMA) tests.ResultsIn the context of DBS testing, a specificity of 100% was recorded for the seven serological and molecular biological assays. The analytical sensitivity of HBsAg, anti-HBc, anti-HBs, anti-HCV, HIV-1-p24-antigen/anti-HIV 1/2, HBV DNA, and HCV RNA detections in DBS eluates was 98.6%, 97.1%, 97.5%, 97.8%, 100%, 93%, and 100%, respectively.Discussion/conclusionsThe results obtained indicate that it is today possible to reliably detect HBsAg, anti-HBc, anti-HBs, anti-HCV and HIV-1-p24 antigen/anti-HIV 1/2 with state-of-the-art analytical systems such as the Abbott ARCHITECT in DBS eluates even when a comparatively high elution volume of 1,000 μl is used. They also provide evidence for the inherent analytical limits of DBS testing, which primarily concern the anti-HBc/anti-HBs system for individuals with HIV infections and nucleic acid tests with relatively low analytical sensitivity.

The idea of collecting blood on a paper card and subsequently using the dried blood spots (DBS) for diagnostic purposes originated a century ago. Since then, DBS testing for decades has remained predominantly focused on the diagnosis of infectious diseases especially in resourcelimited settings or the systematic screening of newborns for inherited metabolic disorders and only recently have a variety of new and innovative DBS applications begun to emerge. For many years, pre-analytical variables were only inappropriately considered in the field of DBS testing and even today, with the exception of newborn screening, the entire pre-analytical phase, which comprises the preparation and processing of DBS for their final analysis has not been standardized. Given this background, a comprehensive step-by-step protocol, which covers al the essential phases, is proposed, i.e., collection of blood; preparation of blood spots; drying of blood spots; storage and transportation of DBS; elution of DBS, and finally analyses of DBS eluates. The effectiveness of this protocol was first evaluated with 1,762 coupled serum/DBS pairs for detecting markers of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infections on an automated analytical platform. In a second step, the protocol was utilized during a pilot study, which was conducted on active drug users in the German cities of Berlin and Essen.

The detection and quantification of hepatitis C virus (HCV) core antigen in serum or plasma by the use of different assay formats have previously been shown to represent useful markers of viral replication. In the present study, the intrinsic performance characteristics and the potential clinical utility of a novel assay for the quantification of total HCV core antigen were comprehensively assessed by using clinical serum samples and specimens contained in various evaluation panels. The Architect HCV Ag assay showed a specificity of 100%. The intra-and interassay coefficients of variation ranged from 3.6 to 8.0% and from 4.7 to 9.5%, respectively. Except for HCV genotype 2 isolates, the analytical sensitivity was always less than 10 fmol core antigen/liter, corresponding to approximately 500 to 3,000 IU of HCV RNA/ml. Linearity was guaranteed throughout the dynamic range (10 to 20,000 fmol/liter). When seroconversion panels were tested, the assay was not inferior to HCV RNA detection and reduced the preseroconversion period by 4 to 16 days. The results obtained by core antigen and HCV RNA quantification for 385 clinical specimens were correlated by regression analysis (r ‫؍‬ 0.857), but the calculated conversion equation differed significantly from the line of identity. Monitoring of viral kinetics by use of either core antigen or RNA concentrations in 38 HCV-infected patients undergoing antiviral combination therapy resulted in very similarly shaped curves in all cases. Finally, the Architect HCV Ag assay was also shown to enable high-throughput screening of in vitro HCV RNA replication. With these results taken together, the Architect HCV Ag assay proved to be a specific, reproducible, highly sensitive, and clinically applicable test format which will find its future place in the context of virological HCV diagnostics.The virological diagnosis of infection with the hepatitis C virus (HCV) is based on the detection of specific anti-HCV antibodies. Since anti-HCV immunoassays, however, cannot distinguish between acute, past, and persistent infections, screening for HCV RNA is currently regarded as the method of choice for the confirmation of an active infection in both immunocompetent patients who are anti-HCV positive and immunocompromised individuals who may not mount an adequate antibody response (9,27,35,41).Assays for the amplification of HCV RNA are expensive and time-consuming and require sophisticated technical equipment and highly trained personnel. These constraints, however, do not apply to the detection of HCV core antigen, which is easy to perform in an immunoassay format, provides results in a comparably short time frame, and, theoretically, is less prone to sample carryover and, hence, contamination than assays based on nucleic acid amplification (17). During the past decade, therefore, several HCV core antigen tests were developed as potential alternatives to HCV RNA testing (1,4,43). The use of these assays in clinical laboratory settings documented that HCV core antigen can be detected in the s...

Our report includes, to our knowledge, the longest documented treatment course of symptomatic rabies and the first time that the virus concentration was measured over time and in different body compartments. The postmortem virus concentration in the periphery was low, but there was no evidence of a reduction of virus in the brain.

REVENTION and treatment of infections with hepatitis C virus (HCV) remain a major challenge. 1 The main source of HCV infection in developed countries was formerly transfusion of contaminated blood and blood products but is now injection-drug use. [2][3][4] In general, a potential risk factor can be established for about 90 percent of all cases of HCV infection. 3 One way of contracting HCV may be transmission from infected medical personnel to susceptible patients during medical care. Provider-topatient transmission of HCV is rare, and in most cases HCV-positive surgeons are the probable source. 5-7 We studied an outbreak of HCV in a municipal hospital. Our findings suggest that an anesthesiology assistant contracted HCV from a chronically infected patient and subsequently transmitted the virus to five other patients. METHODS PatientsThe municipal hospital in which the HCV outbreak occurred provides general as well as specialty medical and surgical services. Between July 1 and October 13, 1998, HCV infection was diagnosed in four patients (Patients 2, 3, 4, and 6 in this report) on the basis of clinical symptoms, a rise in the serum alanine aminotransferase concentration, or detection of serum HCV antibodies and HCV RNA. All of these patients had undergone orthopedic or general surgery in the same hospital 6 to 18 weeks earlier. A comprehensive investigation was initiated by the public health authorities, and we were asked to determine the circumstances of the suspected nosocomial HCV infections. An institutional review board of Essen University Hospital approved the study protocol, and the patients provided written informed consent. Epidemiologic StudiesThe charts of all patients with HCV infection were reviewed in detail. Interviews were conducted to obtain further information about prior medical interventions, prior hepatitis infections, and P risk factors for the acquisition of HCV. To search for other potential cases of HCV transmission, we performed a retrospective seroepidemiologic study of all patients who had undergone surgery in the hospital between January and July 1998. Fifty-eight of these patients had died, and 904 were still alive; serum was obtained for antibody testing from 833 of these 904 patients. Hospital personnel were interviewed with special attention to compliance with infection-control practices and were tested for HCV antibodies. The hospital -in particular, the surgical facilities -was inspected by experts in hygiene and occupational health. Virologic and Molecular Studies

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Hepatitis C virus (HCV) subtype distribution was studied in 395 chronically infected patients from Germany. HCV genotype 1 was most frequent (80.5%). One hundred forty-three individuals (36.2%) were infected with subtype 1a and 175 (44.3%) were suffering from subtype 1b infection, respectively. HCV subtype 3a was found in 53 (13.42%) persons. Subtypes 2a, 2b, and 2c have been detected in 5 (1.27%), 10 (2.53%), and 4 (1.01%) individuals. Genotypes 4 and 5a accounted for HCV infections in 4 (1.01%) and 1 (0.25%) subjects. There was a notable variation in the distribution of the prevalent subtypes 1a and 1b in different age groups. Subtype 1a was detected in 53.3% and 68.0% of patients aged 1-10 and 11-20 years, whereas subtype 1b in the same groups was present only in 33.3% and 28.0% of patients, respectively. In contrast, in individuals older than 50 years subtype 1b was most frequent. Thus, subtype 1b has been gradually substituted for subtype 1a during the last 20 years. Logistic regression analysis with adjustment for sex and different modes of HCV acquisition demonstrated that age of the infected subjects was a direct explanatory variable for subtype 1a and 1b distribution. Therefore, the observed shift in HCV subtype prevalence could not be attributed to changes in the epidemiological relevance of different known risk factors of HCV transmission, as had been assumed in previous studies. The altered subtype pattern reported here may have a profound influence on the future epidemiology of HCV infection.

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