Meningitis Dipstick Rapid Test: Evaluating Diagnostic Performance During an Urban Neisseria Meningitidis Serogroup A Outbreak, Burkina Faso, 2007

Hdl Handle:
http://hdl.handle.net/10144/127585
Title:
Meningitis Dipstick Rapid Test: Evaluating Diagnostic Performance During an Urban Neisseria Meningitidis Serogroup A Outbreak, Burkina Faso, 2007
Authors:
Rose, Angela M C; Mueller, Judith E; Gerstl, Sibylle; Njanpop-Lafourcade, Berthe-Marie; Page, Anne-Laure; Nicolas, Pierre; Traoré, Ramata Ouédraogo; Caugant, Dominique A; Guerin, Philippe J
Journal:
PloS One
Abstract:
Meningococcal meningitis outbreaks occur every year during the dry season in the "meningitis belt" of sub-Saharan Africa. Identification of the causative strain is crucial before launching mass vaccination campaigns, to assure use of the correct vaccine. Rapid agglutination (latex) tests are most commonly available in district-level laboratories at the beginning of the epidemic season; limitations include a short shelf-life and the need for refrigeration and good technical skills. Recently, a new dipstick rapid diagnostic test (RDT) was developed to identify and differentiate disease caused by meningococcal serogroups A, W135, C and Y. We evaluated the diagnostic performance of this dipstick RDT during an urban outbreak of meningitis caused by N. meningitidis serogroup A in Ouagadougou, Burkina Faso; first against an in-country reference standard of culture and/or multiplex PCR; and second against culture and/or a highly sensitive nested PCR technique performed in Oslo, Norway. We included 267 patients with suspected acute bacterial meningitis. Using the in-country reference standard, 50 samples (19%) were positive. Dipstick RDT sensitivity (N = 265) was 70% (95%CI 55-82) and specificity 97% (95%CI 93-99). Using culture and/or nested PCR, 126/259 (49%) samples were positive; dipstick RDT sensitivity (N = 257) was 32% (95%CI 24-41), and specificity was 99% (95%CI 95-100). We found dipstick RDT sensitivity lower than values reported from (i) assessments under ideal laboratory conditions (>90%), and (ii) a prior field evaluation in Niger [89% (95%CI 80-95)]. Specificity, however, was similar to (i), and higher than (ii) [62% (95%CI 48-75)]. At this stage in development, therefore, other tests (e.g., latex) might be preferred for use in peripheral health centres. We highlight the value of field evaluations for new diagnostic tests, and note relatively low sensitivity of a reference standard using multiplex vs. nested PCR. Although the former is the current standard for bacterial meningitis surveillance in the meningitis belt, nested PCR performed in a certified laboratory should be used as an absolute reference when evaluating new diagnostic tests.
Affiliation:
Epicentre, France; Chronic Disease Research Centre, University of the West Indies, West Indies; Agence de Medecine Preventive, France; Institut de Medecine Tropicale du Service de Sante des Armees (IMTSSA); World Health Organization Collaborating Centre for Reference and Research on Meningococci, France; Laboratoire de Biologie, Centre Hospitalier Universitaire Pediatrique Charles de Gaulle, Burkina Faso; World Health Organization, Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Norway; Institute of General Practice and Community Medicine, University of Oslo, Norway
Issue Date:
11-Jun-2010
URI:
http://hdl.handle.net/10144/127585
DOI:
10.1371/journal.pone.0011086
PubMed ID:
20552035
Additional Links:
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0011086
Submitted date:
2011-03-10
Type:
Article
Language:
en
ISSN:
1932-6203
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorRose, Angela M Cen
dc.contributor.authorMueller, Judith Een
dc.contributor.authorGerstl, Sibylleen
dc.contributor.authorNjanpop-Lafourcade, Berthe-Marieen
dc.contributor.authorPage, Anne-Laureen
dc.contributor.authorNicolas, Pierreen
dc.contributor.authorTraoré, Ramata Ouédraogoen
dc.contributor.authorCaugant, Dominique Aen
dc.contributor.authorGuerin, Philippe Jen
dc.date.accessioned2011-04-06T21:20:51Z-
dc.date.available2011-04-06T21:20:51Z-
dc.date.issued2010-06-11-
dc.date.submitted2011-03-10-
dc.identifier.citationPLoS ONE 2010;5(6):e11086en
dc.identifier.issn1932-6203-
dc.identifier.pmid20552035-
dc.identifier.doi10.1371/journal.pone.0011086-
dc.identifier.urihttp://hdl.handle.net/10144/127585-
dc.description.abstractMeningococcal meningitis outbreaks occur every year during the dry season in the "meningitis belt" of sub-Saharan Africa. Identification of the causative strain is crucial before launching mass vaccination campaigns, to assure use of the correct vaccine. Rapid agglutination (latex) tests are most commonly available in district-level laboratories at the beginning of the epidemic season; limitations include a short shelf-life and the need for refrigeration and good technical skills. Recently, a new dipstick rapid diagnostic test (RDT) was developed to identify and differentiate disease caused by meningococcal serogroups A, W135, C and Y. We evaluated the diagnostic performance of this dipstick RDT during an urban outbreak of meningitis caused by N. meningitidis serogroup A in Ouagadougou, Burkina Faso; first against an in-country reference standard of culture and/or multiplex PCR; and second against culture and/or a highly sensitive nested PCR technique performed in Oslo, Norway. We included 267 patients with suspected acute bacterial meningitis. Using the in-country reference standard, 50 samples (19%) were positive. Dipstick RDT sensitivity (N = 265) was 70% (95%CI 55-82) and specificity 97% (95%CI 93-99). Using culture and/or nested PCR, 126/259 (49%) samples were positive; dipstick RDT sensitivity (N = 257) was 32% (95%CI 24-41), and specificity was 99% (95%CI 95-100). We found dipstick RDT sensitivity lower than values reported from (i) assessments under ideal laboratory conditions (>90%), and (ii) a prior field evaluation in Niger [89% (95%CI 80-95)]. Specificity, however, was similar to (i), and higher than (ii) [62% (95%CI 48-75)]. At this stage in development, therefore, other tests (e.g., latex) might be preferred for use in peripheral health centres. We highlight the value of field evaluations for new diagnostic tests, and note relatively low sensitivity of a reference standard using multiplex vs. nested PCR. Although the former is the current standard for bacterial meningitis surveillance in the meningitis belt, nested PCR performed in a certified laboratory should be used as an absolute reference when evaluating new diagnostic tests.en
dc.language.isoenen
dc.relation.urlhttp://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0011086en
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen
dc.subject.meshBurkina Fasoen
dc.subject.meshDisease Outbreaksen
dc.subject.meshHumansen
dc.subject.meshMeningitis, Meningococcalen
dc.subject.meshPolymerase Chain Reactionen
dc.subject.meshReagent Kits, Diagnosticen
dc.subject.meshSensitivity and Specificityen
dc.titleMeningitis Dipstick Rapid Test: Evaluating Diagnostic Performance During an Urban Neisseria Meningitidis Serogroup A Outbreak, Burkina Faso, 2007en
dc.typeArticleen
dc.contributor.departmentEpicentre, France; Chronic Disease Research Centre, University of the West Indies, West Indies; Agence de Medecine Preventive, France; Institut de Medecine Tropicale du Service de Sante des Armees (IMTSSA); World Health Organization Collaborating Centre for Reference and Research on Meningococci, France; Laboratoire de Biologie, Centre Hospitalier Universitaire Pediatrique Charles de Gaulle, Burkina Faso; World Health Organization, Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Norway; Institute of General Practice and Community Medicine, University of Oslo, Norwayen
dc.identifier.journalPloS Oneen

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