One year of laboratory-based COVID-19 surveillance system in Belgium: main indicators and performance of the laboratories (March 2020-21).

BACKGROUND: With the spread of coronavirus disease 2019 (COVID-19), an existing national laboratory-based surveillance system was adapted to daily monitor the epidemiological situation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Belgium by following the number of confirmed SARS-CoV-2 infections, the number of performed tests and the positivity ratio. We present these main indicators of the surveillance over a one-year period as well as the impact of the performance of the laboratories, regarding speed of processing the samples and reporting results, for surveillance. METHODS: We describe the evolution of test capacity, testing strategy and the data collection methods during the first year of the epidemic in Belgium. RESULTS: Between the 1st of March 2020 and the 28th of February 2021, 9,487,470 tests and 773,078 COVID-19 laboratory confirmed cases were reported. Two epidemic waves occurred, with a peak in April and October 2020. The capacity and performance of the laboratories improved continuously during 2020 resulting in a high level performance. Since the end of November 2020 90 to 95% of the test results are reported at the latest the day after sampling was performed. CONCLUSIONS: Thanks to the effort of all laboratories a performant exhaustive national laboratory-based surveillance system to monitor the epidemiological situation of SARS-CoV-2 was set up in Belgium in 2020. On top of expanding the number of laboratories performing diagnostics and significantly increasing the test capacity in Belgium, turnaround times between sampling and testing as well as reporting were optimized over the first year of this pandemic.

Bigger and Better? Representativeness of the Influenza A Surveillance Using One Consolidated Clinical Microbiology Laboratory Data Set as Compared to the Belgian Sentinel Network of Laboratories.

Infectious diseases remain a serious public health concern globally, while the need for reliable and representative surveillance systems remains as acute as ever. The public health surveillance of infectious diseases uses reported positive results from sentinel clinical laboratories or laboratory networks, to survey the presence of specific microbial agents known to constitute a threat to public health in a given population. This monitoring activity is commonly based on a representative fraction of the microbiology laboratories nationally reporting to a single central reference point. However, in recent years a number of clinical microbiology laboratories (CML) have undergone a process of consolidation involving a shift toward laboratory amalgamation and closer real-time informational linkage. This report aims to investigate whether such merging activities might have a potential impact on infectious diseases surveillance. Influenza data was used from Belgian public health surveillance 2014-2017, to evaluate whether national infection trends could be estimated equally as effectively from only just one centralized CML serving the wider Brussels area (LHUB-ULB). The overall comparison reveals that there is a close correlation and representativeness of the LHUB-ULB data to the national and international data for the same time periods, both on epidemiological and molecular grounds. Notably, the effectiveness of the LHUB-ULB surveillance remains partially subject to local regional variations. A subset of the Influenza samples had their whole genome sequenced so that the observed epidemiological trends could be correlated to molecular observations from the same period, as an added-value proposition. These results illustrate that the real-time integration of high-throughput whole genome sequencing platforms available in consolidated CMLs into the public health surveillance system is not only credible but also advantageous to use for future surveillance and prediction purposes. This can be most effective when implemented for automatic detection systems that might include multiple layers of information and timely implementation of control strategies.

Assessing the sensitivity and representativeness of the Belgian Sentinel Network of Laboratories using test reimbursement data.

BACKGROUND: The Belgian Sentinel Network of Laboratories (SNL) was created in 1983 in order to monitor trends in infectious diseases. Given the evolution of the surveillance system, such as the waivers, fusions and adhesions of laboratories over time, it is important to evaluate whether the SNL is still fit for purpose. This study aims to evaluate aspects of the sensitivity and representativeness of the SNL by means of a test coverage analysis. METHODS: We estimated test coverage of the SNL using the ratio of reimbursed tests performed by participating laboratories to the total number of tests performed between 2007 and 2012, for 12 (groups of) pathogens. We further evaluated the geographical difference coverage of the SNL at regional and provincial levels. RESULTS: We found that test coverage of the SNL was stable over time and close to, or greater than, 50 % for the 12 (groups of) pathogens studied. These results hold for the three regions of Belgium but not for all provinces. We showed that some provinces had a low test coverage for some pathogens and that test coverage was more variable over time at provincial level. CONCLUSIONS: This sensitivity and representativeness study based on test coverage suggests that the SNL is capable to describe trend and to monitor changes in the 12 (groups of) pathogens studied both at national and regional levels. Therefore, the SNL is useful to contribute to estimate the burden of disease and to inform preventive measures. It should however be reinforced to allow to be used as an alert system at provincial level.

Surveillance of Infectious Diseases by the Sentinel Laboratory Network in Belgium: 30 Years of Continuous Improvement.

In 1983 the sentinel laboratory network was established because of the need to describe the epidemiological evolution of infectious diseases. During the study period of 30 years (1983-2013), microbiology laboratories reported on weekly basis the laboratory diagnosed cases for a selection of infectious diseases. This resulted in a large longitudinal laboratory based database allowing to provide trends over time and distribution by person and place. During this period, adaptations to data collection were made due to changes in diagnostic methods and public health priorities, introduction and application of digital revolution, and multiple reorganizations of the laboratories. Since the surveillance network is dynamic, it necessitates a continuous evaluation to ensure that, over time, it continues to be representative of the general epidemiological trends in the country. Secondly the aim is to examine the robustness and stability of this surveillance system. Here we demonstrated that the flexibility of the data collection methodology by the sentinel laboratory network is unique and that adaptations do not affect the capacity of the system to follow trends. Therefore, the surveillance by this network is representative of the current epidemiological situation in Belgium. To our knowledge, no such surveillance network with such a long-term follow-up and demonstrated stability for multiple infectious diseases in the general population was earlier described. Furthermore, expected trends due to the implementation of vaccination or other events were accurately detected. The collected data obtained from this network allows interesting comparisons with other national and international information sources.

Pressure and temperature jump relaxation kinetics of the conformational change in Salmonella typhimurium tryptophan synthase L-serine complex: large activation compressibility and heat capacity changes demonstrate the contribution of solvation.

Tryptophan synthase is an alpha2beta2 multienzyme complex that exhibits coupling of the alpha- and beta-subunit reactions by tightly controlled allosteric interactions. A wide range of parameters can affect the allosteric interactions, including monovalent cations, pH, alpha-site and beta-site ligands, temperature, and pressure. Rapid changes in hydrostatic pressure (P-jump) and temperature (T-jump) were used to examine the effects of pressure and temperature on the rates of the interconversion of external aldimine and aminoacrylate intermediates in the Tryptophan synthase-L-Ser complex. The intense fluorescence emission of the Tryptophan synthase L-Ser external aldimine complex at 495 nm, with 420 nm excitation, provides a probe of the conformational state of Trp synthase. P-jump measurements allowed the determination of rate constants for the reactions in the presence of Na(+), Na(+) with benzimidazole (BZI), and NH4(+). The data require a compressibility term, beta(o)(double dagger), to obtain good fits, especially for the NH4(+) and BZI/Na(+) data. The compressibility changes are consistent with changes in solvation in the transition state. The transition state for the relaxation is more similar in volume to the closed aminoacrylate complex in the presence of Na(+), while it is more similar to the open external aldimine in the presence of NH4(+). Differences between the relaxations for positive and negative P-jumps may arise from changing relative populations of microstates with pressure. T-jump experiments of the Na(+) form of the tryptophan synthase-L-Ser complex show large changes in rate and amplitude over the temperature range from 7 to 45 degrees C. The Arrhenius plots show strong curvature, and hence require a heat capacity term, DeltaC(p)(double dagger), to obtain good fits. The values of DeltaC(p)(double dagger) are very large and negative (-3.6 to -4.4 kJ mol(-1) K(-1)). These changes are also consistent with large changes in solvation in the transition state for interconversion of external aldimine and aminoacrylate intermediates in the Tryptophan synthase-L-Ser complex.

Distinct unfolding and refolding pathways of ribonuclease a revealed by heating and cooling temperature jumps.

Heating and cooling temperature jumps (T-jumps) were performed using a newly developed technique to trigger unfolding and refolding of wild-type ribonuclease A and a tryptophan-containing variant (Y115W). From the linear Arrhenius plots of the microscopic folding and unfolding rate constants, activation enthalpy (DeltaH(#)), and activation entropy (DeltaS(#)) were determined to characterize the kinetic transition states (TS) for the unfolding and refolding reactions. The single TS of the wild-type protein was split into three for the Y115W variant. Two of these transition states, TS1 and TS2, characterize a slow kinetic phase, and one, TS3, a fast phase. Heating T-jumps induced protein unfolding via TS2 and TS3; cooling T-jumps induced refolding via TS1 and TS3. The observed speed of the fast phase increased at lower temperature, due to a strongly negative DeltaH(#) of the folding-rate constant. The results are consistent with a path-dependent protein folding/unfolding mechanism. TS1 and TS2 are likely to reflect X-Pro(114) isomerization in the folded and unfolded protein, respectively, and TS3 the local conformational change of the beta-hairpin comprising Trp(115). A very fast protein folding/unfolding phase appears to precede both processes. The path dependence of the observed kinetics is suggestive of a rugged energy protein folding funnel.

Cooperative sub-millisecond folding kinetics of apomyoglobin pH 4 intermediate.

For small single-domain proteins, formation of the native conformation (N) from a fully unfolded form (U) or from a partially folded intermediate (I) occurs typically in a highly cooperative process that can be described by a two-state model. However, it is not clear whether cooperativity arises early along the folding reaction and whether folding intermediates are also formed in highly cooperative processes. Here, we show that each previously identified step leading apomyoglobin from its unfolded form to its native form, namely, the U <= => Ia, the Ia <= => Ib, and the Ib <= => N reactions, exhibits typical features of a two-state reaction. First, refolding and unfolding kinetics of the earliest U <= => Ia reaction are measurable at pH 4.2 within the urea-induced unfolding transition [Jamin, M., and Baldwin, R. L. (1996) Nat. Struct. Biol. 3, 613-618; Jamin, M., and Baldwin, R. L. (1998) J. Mol. Biol. 276, 491-504], and we report here that sub-millisecond kinetics measured by far-UV circular dichroism (CD), a probe of secondary structure, are similar to those measured by Trp fluorescence, a probe of hydrophobic core formation and chain collapse. These results confirm that folding of the earliest intermediate, Ia, occurs in a highly cooperative process, in which hydrophobic collapse and secondary structure formation occur concomitantly in the A(B)GH core. Second, when the refolding of N is measured at high pH, starting from the acid-unfolded ensemble, the formation of Ia occurs in the mixing time of the sub-millisecond stopped-flow, but the subsequent steps, the Ia <= => Ib and Ib <= => N reactions, exhibit similar kinetics by far-UV CD and Trp fluorescence, indicating that these two late stages of the apoMb folding process also occur in highly cooperative, two-state reactions.

Structural changes associated with switching activities of human iron regulatory protein 1.

Metazoan iron regulatory protein 1 is a dual activity protein, being either an aconitase or a regulatory factor binding to messenger RNA involved in iron homeostasis. Sequence comparisons and site-directed mutagenesis experiments have supported a structural relationship between mitochondrial aconitase and iron regulatory protein 1. The structural properties of human recombinant iron regulatory protein 1 have been probed in the present work. Although iron-free iron regulatory protein 1 displays a significantly larger radius of gyration measured by small-angle neutron scattering than calculated for mitochondrial aconitase, binding of either the [4Fe-4S] cluster needed for aconitase activity or of a RNA substrate turns iron regulatory protein 1 into a more compact molecule. These conformational changes are associated with the gain of secondary structural elements as indicated by circular dichroism studies. They likely involve alpha-helices covering the substrate binding cleft of cytosolic aconitase, and they suggest an induced fit mechanism of iron-responsive element recognition. These studies refine previously proposed models of the "iron-sulfur switch" driving the biological function of human iron regulatory protein 1, and they provide a structural framework to probe the relevance of the numerous cellular molecules proposed to affect its function.