Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection
Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes tradit...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Fisman, David N [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2009 |
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| Schlagwörter: |
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| Anmerkung: |
© Fisman et al; licensee BioMed Central Ltd. 2009 |
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| Übergeordnetes Werk: |
Enthalten in: Journal of translational medicine - London : BioMed Central, 2003, 7(2009), 1 vom: 26. März |
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| Übergeordnetes Werk: |
volume:7 ; year:2009 ; number:1 ; day:26 ; month:03 |
| Links: |
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| DOI / URN: |
10.1186/1479-5876-7-23 |
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| Katalog-ID: |
SPR02893458X |
|---|
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| 100 | 1 | |a Fisman, David N |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection |
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| 520 | |a Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. | ||
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| 700 | 1 | |a Greer, Amy L |4 aut | |
| 700 | 1 | |a Brouhanski, George |4 aut | |
| 700 | 1 | |a Drews, Steven J |4 aut | |
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10.1186/1479-5876-7-23 doi (DE-627)SPR02893458X (SPR)1479-5876-7-23-e DE-627 ger DE-627 rakwb eng Fisman, David N verfasserin aut Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Fisman et al; licensee BioMed Central Ltd. 2009 Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. Latent Class Analysis (dpeaa)DE-He213 Test Characteristic (dpeaa)DE-He213 Latent Class Model (dpeaa)DE-He213 Outbreak Investigation (dpeaa)DE-He213 Positive Specimen (dpeaa)DE-He213 Greer, Amy L aut Brouhanski, George aut Drews, Steven J aut Enthalten in Journal of translational medicine London : BioMed Central, 2003 7(2009), 1 vom: 26. März (DE-627)369084136 (DE-600)2118570-0 1479-5876 nnns volume:7 year:2009 number:1 day:26 month:03 https://dx.doi.org/10.1186/1479-5876-7-23 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2009 1 26 03 |
| spelling |
10.1186/1479-5876-7-23 doi (DE-627)SPR02893458X (SPR)1479-5876-7-23-e DE-627 ger DE-627 rakwb eng Fisman, David N verfasserin aut Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Fisman et al; licensee BioMed Central Ltd. 2009 Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. Latent Class Analysis (dpeaa)DE-He213 Test Characteristic (dpeaa)DE-He213 Latent Class Model (dpeaa)DE-He213 Outbreak Investigation (dpeaa)DE-He213 Positive Specimen (dpeaa)DE-He213 Greer, Amy L aut Brouhanski, George aut Drews, Steven J aut Enthalten in Journal of translational medicine London : BioMed Central, 2003 7(2009), 1 vom: 26. März (DE-627)369084136 (DE-600)2118570-0 1479-5876 nnns volume:7 year:2009 number:1 day:26 month:03 https://dx.doi.org/10.1186/1479-5876-7-23 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2009 1 26 03 |
| allfields_unstemmed |
10.1186/1479-5876-7-23 doi (DE-627)SPR02893458X (SPR)1479-5876-7-23-e DE-627 ger DE-627 rakwb eng Fisman, David N verfasserin aut Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Fisman et al; licensee BioMed Central Ltd. 2009 Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. Latent Class Analysis (dpeaa)DE-He213 Test Characteristic (dpeaa)DE-He213 Latent Class Model (dpeaa)DE-He213 Outbreak Investigation (dpeaa)DE-He213 Positive Specimen (dpeaa)DE-He213 Greer, Amy L aut Brouhanski, George aut Drews, Steven J aut Enthalten in Journal of translational medicine London : BioMed Central, 2003 7(2009), 1 vom: 26. März (DE-627)369084136 (DE-600)2118570-0 1479-5876 nnns volume:7 year:2009 number:1 day:26 month:03 https://dx.doi.org/10.1186/1479-5876-7-23 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2009 1 26 03 |
| allfieldsGer |
10.1186/1479-5876-7-23 doi (DE-627)SPR02893458X (SPR)1479-5876-7-23-e DE-627 ger DE-627 rakwb eng Fisman, David N verfasserin aut Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Fisman et al; licensee BioMed Central Ltd. 2009 Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. Latent Class Analysis (dpeaa)DE-He213 Test Characteristic (dpeaa)DE-He213 Latent Class Model (dpeaa)DE-He213 Outbreak Investigation (dpeaa)DE-He213 Positive Specimen (dpeaa)DE-He213 Greer, Amy L aut Brouhanski, George aut Drews, Steven J aut Enthalten in Journal of translational medicine London : BioMed Central, 2003 7(2009), 1 vom: 26. März (DE-627)369084136 (DE-600)2118570-0 1479-5876 nnns volume:7 year:2009 number:1 day:26 month:03 https://dx.doi.org/10.1186/1479-5876-7-23 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2009 1 26 03 |
| allfieldsSound |
10.1186/1479-5876-7-23 doi (DE-627)SPR02893458X (SPR)1479-5876-7-23-e DE-627 ger DE-627 rakwb eng Fisman, David N verfasserin aut Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Fisman et al; licensee BioMed Central Ltd. 2009 Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. Latent Class Analysis (dpeaa)DE-He213 Test Characteristic (dpeaa)DE-He213 Latent Class Model (dpeaa)DE-He213 Outbreak Investigation (dpeaa)DE-He213 Positive Specimen (dpeaa)DE-He213 Greer, Amy L aut Brouhanski, George aut Drews, Steven J aut Enthalten in Journal of translational medicine London : BioMed Central, 2003 7(2009), 1 vom: 26. März (DE-627)369084136 (DE-600)2118570-0 1479-5876 nnns volume:7 year:2009 number:1 day:26 month:03 https://dx.doi.org/10.1186/1479-5876-7-23 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2009 1 26 03 |
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Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. 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of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection |
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Of gastro and the gold standard: evaluation and policy implications of norovirus test performance for outbreak detection |
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Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. © Fisman et al; licensee BioMed Central Ltd. 2009 |
| abstractGer |
Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. © Fisman et al; licensee BioMed Central Ltd. 2009 |
| abstract_unstemmed |
Background The norovirus group (NVG) of caliciviruses are the etiological agents of most institutional outbreaks of gastroenteritis in North America and Europe. Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available. © Fisman et al; licensee BioMed Central Ltd. 2009 |
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Identification of NVG is complicated by the non-culturable nature of this virus, and the absence of a diagnostic gold standard makes traditional evaluation of test characteristics problematic. Methods We evaluated 189 specimens derived from 440 acute gastroenteritis outbreaks investigated in Ontario in 2006–07. Parallel testing for NVG was performed with real-time reverse-transcriptase polymerase chain reaction ($ RT^{2} $-PCR), enzyme immunoassay (EIA) and electron microscopy (EM). Test characteristics (sensitivity and specificity) were estimated using latent class models and composite reference standard methods. The practical implications of test characteristics were evaluated using binomial probability models. Results Latent class modelling estimated sensitivities of $ RT^{2} $-PCR, EIA, and EM as 100%, 86%, and 17% respectively; specificities were 84%, 92%, and 100%; estimates obtained using a composite reference standard were similar. If all specimens contained norovirus, $ RT^{2} $-PCR or EIA would be associated with > 99.9% likelihood of at least one test being positive after three specimens tested. Testing of more than 5 true negative specimens with $ RT^{2} $-PCR would be associated with a greater than 50% likelihood of a false positive test. Conclusion Our findings support the characterization of EM as lacking sensitivity for NVG outbreaks. The high sensitivity of $ RT^{2} $-PCR and EIA permit identification of NVG outbreaks with testing of limited numbers of clinical specimens. Given risks of false positive test results, it is reasonable to limit the number of specimens tested when $ RT^{2} $-PCR or EIA are available.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Latent Class Analysis</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Test Characteristic</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Latent Class Model</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Outbreak Investigation</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Positive Specimen</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Greer, Amy L</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Brouhanski, George</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Drews, Steven J</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">Enthalten in</subfield><subfield code="t">Journal of translational medicine</subfield><subfield code="d">London : BioMed Central, 2003</subfield><subfield code="g">7(2009), 1 vom: 26. 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