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Journal of Clinical Microbiology, January 2003, p. 379-385, Vol. 41, No. 1
0095-1137/03/$08.00+0 DOI: 10.1128/JCM.41.1.379-385.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.
Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Fort Collins, Colorado
Received 25 June 2002/ Returned for modification 25 July 2002/ Accepted 24 September 2002
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Surveillance for the presence of North American EEE and WEE viruses in vector mosquitoes is used to assess the risk of epizootic and epidemic activity. Public health efforts include mosquito control programs and education campaigns that can be implemented to decrease the likelihood of virus transmission to vulnerable vertebrate hosts. The timing of these interventions is critical, requiring the use of rapid diagnostic assays for surveillance. Traditionally, the identification of alphaviruses from mosquitoes and vertebrate tissues has been achieved by inoculation of cell culture or suckling mouse brain followed by identification of an isolate by immunofluorescence assays. However, while these methods are reliable, they are also time-consuming and cannot be used in laboratories that do not have cell culture or animal use capabilities.
Nucleic acid amplification assays are ideally suited for surveillance as highly sensitive, time-efficient alternatives to standard methods of detecting virus (5, 8, 9, 10). In particular, the introduction of novel nucleic acid amplification assays, NASBA and TaqMan, as rapid, powerful diagnostic tools has provided a platform for the development of additional assays for the detection of North American EEE and WEE viral RNAs (4, 7, 9, 10, 11, 12, 17, 20).
We present the development and application of NASBA, standard reverse transcription (RT)-PCR, and TaqMan nucleic acid amplification assays designed to detect North American EEE and WEE viral RNAs from a variety of vertebrate and mosquito samples. The sensitivities and specificities of these assays are compared. While all three types of nucleic acid amplification assays have been found to be specific for target RNAs, the TaqMan assays for the detection of North American EEE and WEE viral RNAs are the most sensitive. Additionally, the NASBA and TaqMan assays are the most rapid of the assays compared, providing results in less than 4 h.
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Field-collected and clinical samples. Mosquito pools and avian tissues were collected and tested as a part of arboviral surveillance programs at both state and federal levels. Equine and human tissues were submitted to the CDC for confirmation of EEE virus infection previously inferred by clinical history and diagnostic testing performed at another laboratory. Mosquito pools were processed as previously described (9). Avian, equine, and human tissues were homogenized in Ten Broeck grinders with 1 ml of BA-1 diluent. Mosquito pool and vertebrate tissue homogenates were clarified by centrifugation at 20,000 x g for 3 min; the resultant supernatants were subjected to RNA extraction.
RNA extraction. Viral RNA was extracted from virus seed, as well as from mosquito pool and vertebrate tissue homogenate supernatants processed as described above by using the QIAamp viral RNA minikit, following the manufacturer's instructions (QIAGEN, Valencia, Calif.). A minimum of two aliquots of BA-1 diluent were processed as negative extraction controls along with each group of samples subjected to RNA extraction. Extractions were performed with samples ranging in volume from 70 to 140 µl. RNA was eluted in a volume equal to the volume of starting sample. Eluted RNA was stored at -70°C until used.
NASBA assay. As previously described, NASBA assays were performed with 5 µl of RNA and 50 pmol of each primer (Table 1) by using the NucliSens basic kit (bioMerieux, Durham, N.C.) with the enhanced chemiluminescence (ECL) detection format; samples were read, and positive results were determined by the Nuclisens reader (bioMerieux) (10). Two negative amplification controls were included with each group of samples processed. In the negative amplification control reactions, 5 µl of RNase- and DNase-free water was substituted for 5 µl of extracted RNA.
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TABLE 1. Oligonucleotide primers and probes for NASBA,a standard RT-PCR, and TaqMan assays
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TaqMan RT-PCR.
TaqMan assays were performed with 5 µl of RNA, 50 pmol of each primer (Table 1), and 10 pmol of probe in a total volume of 50 µl by using the TaqMan RT-PCR ready mix kit (PE Applied Biosystems, Foster City, Calif.), according to the manufacturer's instructions. Amplification and fluorescence detection were performed with the ABI Prism 7700 sequence detection system instrument (PE Applied Biosystems); 45 cycles of amplification were performed according to the manufacturer's recommendations for TaqMan RT-PCR cycling conditions. Positive results were determined according to the amplification cycle at which fluorescence increased above the threshold value (CT; fixed at 0.1) along with the relative change in fluorescence (Rn), determined by performing a plate read function at the end of amplification. As previously described, a sample was determined to be positive if the CT value was
37 and the Rn value was two or more times the average of eight negative wells (9). A sample was determined to be equivocal if it met one of the two above criteria for positivity. Eight negative amplification controls were included with each group of samples processed. In the negative amplification control reactions, 5 µl of RNase- and DNase-free water was substituted for 5 µl of extracted RNA.
Primer design. All EEE and WEE virus primers and/or probes were designed by using the published sequences of the North American EEE virus strain 82V2137 (GenBank accession number U01034) and the WEE virus strain 71V_1658 (GenBank accession number AF214040). The EEE and WEE virus standard RT-PCR primers were designed by using the PrimerSelect software program (DNASTAR Inc., Madison, Wis.). The EEE and WEE virus TaqMan primers and probes were designed with the PrimerExpress software package (PE Applied Biosystems). The PrimerExpress-derived TaqMan primer pairs and probes were compared to an alignment of multiple EEE and WEE virus sequences, and primer pairs and probes that demonstrated maximum homology to all virus strains (Table 1) were selected. The EEE and WEE virus TaqMan probes were 5' labeled with the FAM reporter dye and labeled at the 3' end with the quencher molecule BHQ1. EEE and WEE virus NASBA primers and probes were designed by following the primer design guidelines described in the Nuclisens basic kit application manual (bioMerieux). The NASBA reverse primers incorporate the T7 promoter sequence at the 5' end of the primer, and the forward primers contain a generic capture sequence complementary to the ruthenium-labeled detection probe (generic ECL probe) at the 5' end of the primer (Table 1). The NASBA-ECL virus-specific capture probes were 5' biotin labeled and immobilized onto avidin-coated magnetic particles by following the protocol described in the Nuclisens basic kit application manual.
Vero cell culture. Supernatants taken in 100-µl volumes from field-collected and clinical sample homogenates were inoculated onto Vero cells grown in 25-cm2 flasks. Inoculated flasks were incubated at 37°C, 5% CO2 for 10 days and reviewed for signs of cytopathic effect daily. Positive results were determined by the presence of cytopathic effect and were confirmed by immunofluorescence or TaqMan assays.
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TABLE 2. Sensitivities and specificities of North American EEE virus NASBA, standard RT-PCR, TaqMan, and Vero cell culture assaysa
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TABLE 3. Sensitivities and specificities of WEE virus NASBA, standard RT-PCR, TaqMan, and Vero cell culture assaysa
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To evaluate the specificities of the WEE virus NASBA, standard RT-PCR, and TaqMan assays, we tested 12 geographically and temporally distinct strains of WEE virus (Table 3). As with specificity testing of the North American EEE viral RNA assays, a battery of related alphaviruses, including six members of the WEE virus serocomplex (Aura, Whataroa, Kyzylgach, Fort Morgan, Highlands J, Buggy Creek), VEE and EEE viruses and unrelated arboviruses were tested (Table 3). The NASBA, standard RT-PCR, and TaqMan assays detected all WEE virus strains tested (Table 3). The assays were specific for WEE viral RNA and detected none of the related alphaviral or unrelated arboviral RNAs tested (Table 3).
Detection of North American EEE viral RNA in field-collected mosquitoes and vertebrate tissues. A panel of 20 field-collected, veterinary, and human diagnostic samples were tested by isolation of virus in Vero cell culture as well as by NASBA, standard RT-PCR, and TaqMan assays for the presence of North American EEE viral RNA (Table 4). Virus was isolated from 4 of the 20 samples. The standard RT-PCR assay detected North American EEE viral RNA from the four Vero cell culture-positive samples (Table 4). The TaqMan assay detected viral RNA from 9 of the 20 samples tested, including the 4 Vero cell culture-positive samples (Table 4). The NASBA assay yielded positive results from 7 of the 20 samples, including the 4 samples from which North American EEE virus was isolated (Table 4).
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TABLE 4. Detection of North American EEE virus and viral RNA from field-collected mosquitoes and vertebrate tissues by Vero cell culture, NASBA, standard RT-PCR, and TaqMan assaysa
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TABLE 5. Detection of WEE virus and viral RNA from field-collected mosquitoes and vertebrate tissues by Vero cell culture, NASBA, standard RT-PCR, and TaqMan assaysa
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In the testing of field-collected mosquitoes, the NASBA and TaqMan assays for the detection of North American EEE virus have been shown to be highly sensitive, detecting viral RNA from five mosquito pool samples, four of which were Vero cell culture positive (Table 4). Additionally, the standard RT-PCR assay for the detection of North American EEE virus detected viral RNA from the four mosquito pool samples from which virus was isolated (Table 4). Of the WEE viral RNA assays, the standard RT-PCR and TaqMan systems detected WEE viral RNA from three mosquito pool samples; the NASBA assay was shown to be less sensitive, detecting viral RNA from two of the three standard RT-PCR- and TaqMan-positive pools (Table 5). All of the North American EEE and WEE virus nucleic acid amplification assays compared have been shown to have sensitivities of detection in mosquito pools similar to or greater than that of the isolation of virus in Vero cells. These data indicate the utility of NASBA, standard RT-PCR, and TaqMan assays for the surveillance of North American EEE and WEE viruses.
With respect to the detection of viral RNA from avian, equine, and human tissues, the TaqMan assay has demonstrated exceptional sensitivity for the detection of North American EEE viral RNA, yielding positive results from 4 of the 10 vertebrate tissues tested, none of which were Vero cell culture positive (Table 4). These data support the use of the TaqMan assay for the detection of North American EEE viral RNA from veterinary and human clinical samples, as well as from mosquito pools. As WEE virus-infected vertebrate tissues were not available, the WEE virus assays compared here could not be applied to veterinary or human clinical samples. However, the ability of the WEE virus TaqMan assay to detect <0.1 PFU of WEE Fleming virus, combined with its ability to detect viral RNA from field-collected mosquito pools, has demonstrated a level of sensitivity conducive to diagnostic application (Tables 3 and 5). Additionally, the ability of the North American EEE virus TaqMan assay to detect viral RNA from vertebrate tissue samples suggests that the WEE virus TaqMan assay will also be useful with similar tissues (Table 4).
The North American EEE virus nucleic acid amplification assays are generally more sensitive than the WEE virus assays (Tables 2 and 3). We have considered several potential explanations for this discrepancy. (i) The North American EEE virus assays' primers could be more sensitive than the WEE virus assays' primers. When alternative North American EEE and WEE virus NASBA, standard RT-PCR, and TaqMan primer-probe set sensitivities were tested, results similar to those presented here were obtained (data not included). This reduces the likelihood that primer design contributes to the difference in sensitivities. (ii) A difference in the secondary structures of EEE and WEE viral RNAs could cause a difference in primer binding reflected in the reduced sensitivities of the WEE virus assays. At the beginning of amplification, the NASBA assays for the detection of EEE and WEE viral RNAs incorporate an incubation step at 65°C for 5 min. During this step, the secondary structure of RNA becomes denatured, reducing potential primer binding inhibition. If WEE viral RNA secondary structure was the cause of the reduced sensitivity, it would be expected that the WEE virus NASBA assay be more comparable in sensitivity to the EEE virus NASBA and significantly more sensitive than the WEE virus standard RT-PCR and TaqMan assays, because of secondary structure denaturation. In fact, the WEE virus NASBA assay data does not indicate enhanced sensitivity when compared to the EEE virus NASBA and WEE virus standard RT-PCR and TaqMan assays (Tables 2 and 3). These findings contradict the idea that a difference in the secondary structures of EEE virus and WEE viral RNAs is responsible for the differences in sensitivities between the EEE and WEE virus assays. (iii) There could be a difference in the ratio of noninfectious to infectious viral particles for these two viruses in the Vero cell culture system. If the EEE virus strain NJ/60 has a greater ratio of noninfectious to infectious viral particles than the WEE virus strain Fleming, the North American EEE virus assays would appear to be more sensitive than the WEE virus assays when compared to standard plaque assay, due to the ability of nucleic acid amplification assays to detect both noninfectious and infectious viral particles. We have not performed experiments to determine the difference in noninfectious and infectious viral particles for these two viruses; however, these findings warrant further investigation. As nucleic acid amplification technologies become more routinely used for viral RNA detection, we suspect that differences in the sensitivities of assays contingent upon the type of viral RNAs being detected will become more evident when compared to live virus culture systems.
We have developed the North American EEE and WEE virus nucleic acid amplification assays to expedite mosquito control and public health interventions in response to an outbreak of EEE or WEE viruses, as well as to shorten the processing time for veterinary and human diagnostic sample results. One advantage of nucleic acid amplification is the rapid, high-throughput capability that these assays provide, particularly when coupled with an automated RNA extraction system (19). As mentioned previously, the NASBA and TaqMan assays are the most rapid of the assays compared, providing results in less than 4 h. Additionally, the standard RT-PCR assays offer a turnaround time of less than 8 h. In contrast, traditional methods of detecting alphaviruses by cell culture or mouse inoculation followed by immunofluorescence assays can take up to, and in excess of, 1 week to complete. Also, the kit-based format of the NASBA, standard RT-PCR, and TaqMan assays allows for ease of standardization from lab to lab, which is a key component of effective surveillance and diagnosis. In terms of assay reproducibility, we have found that the NASBA, standard RT-PCR, and TaqMan assays provided consistent sensitivities when multiple preparations of EEE and WEE viral dilutions were tested (data not included). A newly elucidated advantage of nucleic acid amplification assays has been demonstrated in recent studies indicating that viral RNA can be detected in the absence of cold chain handling when Vero cell plaque assay fails to recover live virus (8, 21). These findings contribute to the importance of the use of North American EEE and WEE virus NASBA, standard RT-PCR, and TaqMan assays in situations where sample integrity may have been compromised, rendering diagnostic techniques that require live virus recovery no longer useful. It is a concern that nucleic acid amplification assay-positive and live virus assay-negative results could be the product of laboratory contamination rather than evidence of infection. In this study, significant measures including the use of negative controls at the RNA extraction and amplification levels of sample processing as well as a physical separation between pre- and postamplification steps were used to confirm the reliability of such results.
This study has demonstrated that while the NASBA and standard RT-PCR assays have been shown to be sufficiently rapid, specific, and sensitive in their detection of North American EEE and WEE viral RNAs, the TaqMan assays for the detection of North American EEE and WEE viral RNAs provide unparalleled sensitivities. These findings support the use of these TaqMan assays not only for surveillance of virus in field-collected samples, but also for the detection of North American EEE and WEE viral RNAs in veterinary and human diagnostic samples.
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