Analytical Performance Characteristics of the Cepheid GeneXpert Ebola Assay for the Detection of Ebola Virus.

BACKGROUND: The recently developed Xpert® Ebola Assay is a novel nucleic acid amplification test for simplified detection of Ebola virus (EBOV) in whole blood and buccal swab samples. The assay targets sequences in two EBOV genes, lowering the risk for new variants to escape detection in the test. The objective of this report is to present analytical characteristics of the Xpert® Ebola Assay on whole blood samples. METHODS AND FINDINGS: This study evaluated the assay's analytical sensitivity, analytical specificity, inclusivity and exclusivity performance in whole blood specimens. EBOV RNA, inactivated EBOV, and infectious EBOV were used as targets. The dynamic range of the assay, the inactivation of virus, and specimen stability were also evaluated. The lower limit of detection (LoD) for the assay using inactivated virus was estimated to be 73 copies/mL (95% CI: 51-97 copies/mL). The LoD for infectious virus was estimated to be 1 plaque-forming unit/mL, and for RNA to be 232 copies/mL (95% CI 163-302 copies/mL). The assay correctly identified five different Ebola viruses, Yambuku-Mayinga, Makona-C07, Yambuku-Ecran, Gabon-Ilembe, and Kikwit-956210, and correctly excluded all non-EBOV isolates tested. The conditions used by Xpert® Ebola for inactivation of infectious virus reduced EBOV titer by ≥6 logs. CONCLUSION: In summary, we found the Xpert® Ebola Assay to have high analytical sensitivity and specificity for the detection of EBOV in whole blood. It offers ease of use, fast turnaround time, and remote monitoring. The test has an efficient viral inactivation protocol, fulfills inclusivity and exclusivity criteria, and has specimen stability characteristics consistent with the need for decentralized testing. The simplicity of the assay should enable testing in a wide variety of laboratory settings, including remote laboratories that are not capable of performing highly complex nucleic acid amplification tests, and during outbreaks where time to detection is critical.

Observed velocity fluctuations in monodisperse droplet generators.

On-chip monodisperse droplet generation and analysis is ideal for low concentration and single molecule applications because it enables reagents to be partitioned into identical nanoliter or smaller reactor volumes while allowing real-time optical interrogation. Typically, these systems operate in a continuous droplet generation mode to maximize sample throughput. We have observed that on-chip droplet production for water-in-oil emulsions causes downstream droplet velocity fluctuations similar to those reported for gas-in-liquid emulsion systems with a periodicity equivalent to the droplet generation rate. This phenomenon can affect the accuracy of data collection due to variation in photon integration times as the moving droplets are observed. Here we perform high speed imaging and frequency domain analysis to describe the periodic velocity fluctuations due to monodisperse droplet generation.

Monodisperse droplet generation and rapid trapping for single molecule detection and reaction kinetics measurement.

On-chip monodisperse droplet analysis systems are ideal for low concentration and single molecule applications because they partition reagents into identical picoliter or smaller reactor volumes that can be observed in real-time. We present a novel trapping method with droplet stopping times of approximately 38 ms that is applicable to most on-chip droplet generators. The technique greatly extends optical interrogation times without droplet motion or coalescence; and will allow on-chip single molecule detection of nanoparticle emitters with simple optics. The method maintains droplet monodispersity without chemistry-altering surfactants, and has been shown to preserve a stationary droplet stream through repetitive high-temperature thermal cycling with no additional energy input required to maintain droplet position.