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  1. AU="van der Moeren, Nathalie"
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  1. Article ; Online: A SARS-CoV-2 and influenza rapid antigen test-based hospital isolation policy awaiting RT-PCR, a prospective observational study.

    Van der Moeren, Nathalie / Zwart, Vivian F / Louise van Leest, Marie / Thijssen, Marcel / Groenewegen, Robbert / Heer, Marieke Kuipers-de / Murk, Jean-Luc / Tjhie, Jeroen T / Diederen, Bram M W / Stohr, Joep J J M

    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

    2023  Volume 29, Issue 12, Page(s) 1595–1599

    Abstract: Objectives: This study aimed to evaluate the clinical performance of a combined SARS-CoV-2/influenza rapid antigen test (SIRAT) and to evaluate a SIRAT-based hospital isolation policy awaiting RT-PCR results for patients presenting at the emergency ... ...

    Abstract Objectives: This study aimed to evaluate the clinical performance of a combined SARS-CoV-2/influenza rapid antigen test (SIRAT) and to evaluate a SIRAT-based hospital isolation policy awaiting RT-PCR results for patients presenting at the emergency department (ED).
    Methods: We performed a prospective observational study including all adult patients presenting with influenza-like symptoms at the ED of two hospitals from 31 October 2022 to 31 March 2023. A SIRAT and SARS-CoV-2 and influenza RT-PCR were performed on upper respiratory samples. SIRAT results were compared with RT-PCR. Droplet and contact isolation measures (DCIM) were imposed based on SIRAT results awaiting RT-PCR. We monitored symptomatic nosocomial SARS-CoV-2 and influenza infections potentially caused by delayed isolation of patients with false negative SIRAT and the hours of unnecessary DCIM saved.
    Results: We included 1740 patients of whom 1296 were hospitalized. SARS-CoV-2 and influenza A/B prevalence were 12.7% (221/1740) and 9.9% (171/1740). Sensitivity and specificity of the SIRAT were 67.7% (95% CI 61.1-73.9%) (149/220) and 99.4% (95% CI 99.0-99.8%) (1510/1518) for SARS-CoV-2 and 52.7% (95% CI 44.9-60.4%) (89/169) and 99.1% (95% CI 98.5-99.5%) (1530/1544) for influenza A/B. We found a 0% nosocomial transmission risk for SARS-CoV-2 (95% CI 0-8.8%) and influenza (95% CI 0-10%). In all, 8712 hours in total or a median up to 6 hours 59 minutes (IQR (interquartile range) 11h03) per patient of unnecessary DCIM were saved.
    Discussion: A SIRAT-guided hospital isolation policy awaiting RT-PCR results for patients who present at the ED can save unnecessary isolation hours without having to lead to significant symptomatic nosocomial transmission of SARS-CoV-2 or influenza viruses.
    MeSH term(s) Adult ; Humans ; SARS-CoV-2/genetics ; COVID-19/diagnosis ; COVID-19/epidemiology ; Influenza, Human/diagnosis ; Influenza, Human/epidemiology ; Reverse Transcriptase Polymerase Chain Reaction ; Cross Infection/diagnosis ; Cross Infection/epidemiology ; Sensitivity and Specificity ; COVID-19 Testing
    Language English
    Publishing date 2023-09-20
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 1328418-6
    ISSN 1469-0691 ; 1470-9465 ; 1198-743X
    ISSN (online) 1469-0691
    ISSN 1470-9465 ; 1198-743X
    DOI 10.1016/j.cmi.2023.09.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab.

    Van der Moeren, Nathalie / Selhorst, Philippe / Ha, My / Heireman, Laura / Van Gaal, Pieter-Jan / Breems, Dimitri / Meysman, Pieter / Laukens, Kris / Verstrepen, Walter / Van Gasse, Natasja / Ogunjimi, Benson / Arien, Kevin K / Naesens, Reinout

    Viruses

    2022  Volume 14, Issue 4

    Abstract: Background: Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed.: Methods: We describe the viral evolution, ... ...

    Abstract Background: Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed.
    Methods: We describe the viral evolution, immunologic response and clinical course of a patient with a lymphoma in complete remission who had received therapy with rituximab and remained SARS-CoV-2 RT-qPCR positive for 161 days.
    Results: The patient remained hospitalised for 10 days, after which he fully recovered and remained asymptomatic. A progressive increase in Ct-value, coinciding with a progressive rise in lymphocyte count, was seen from day 137 onward. Culture of a nasopharyngeal swab on day 67 showed growth of SARS-CoV-2. Whole genome sequencing (WGS) demonstrated that the virus belonged to the wildtype SARS-CoV-2 clade 20B/GR, but rapidly accumulated a high number of mutations as well as deletions in the N-terminal domain of its spike protein.
    Conclusion: SARS-CoV-2 persistence in immunocompromised individuals has important clinical implications, but halting immunosuppressive therapy might result in a favourable clinical course. The long-term shedding of viable virus necessitates customized infection prevention measures in these individuals. The observed accelerated accumulation of mutations of the SARS-CoV-2 genome in these patients might facilitate the origin of new VOCs that might subsequently spread in the general community.
    MeSH term(s) COVID-19/drug therapy ; Humans ; Immunocompromised Host ; Male ; Persistent Infection ; Rituximab/therapeutic use ; SARS-CoV-2/genetics
    Chemical Substances Rituximab (4F4X42SYQ6)
    Language English
    Publishing date 2022-04-03
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2516098-9
    ISSN 1999-4915 ; 1999-4915
    ISSN (online) 1999-4915
    ISSN 1999-4915
    DOI 10.3390/v14040752
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: SARS-CoV-2 Alpha-Variant Outbreak Amongst a Partially Vaccinated Long-Term Care Facility Population in The Netherlands-Phylogenetic Analysis and Infection Control Observations.

    Van der Moeren, Nathalie / Weterings, Veronica A T C / Pas, Suzan D / Verweij, Jaco J / van den Bijllaardt, Wouter / Geurts, Joyce / Zwart, Vivian F / Lodder, Esther B / Kluytmans, Jan A J W / Murk, Jean-Luc / Stohr, Joep J J M

    Pathogens (Basel, Switzerland)

    2022  Volume 11, Issue 10

    Abstract: Despite extensive vaccination and booster programs, SARS-CoV-2 outbreaks in long-term care facilities (LTCF) continue to occur. We retrospectively describe a SARS-CoV-2 outbreak amongst a partially vaccinated LTCF population in The Netherlands which ... ...

    Abstract Despite extensive vaccination and booster programs, SARS-CoV-2 outbreaks in long-term care facilities (LTCF) continue to occur. We retrospectively describe a SARS-CoV-2 outbreak amongst a partially vaccinated LTCF population in The Netherlands which occurred in March 2021. The facility comprised three floors functioning as separate wards. Nasopharyngeal swabs for SARS-CoV-2 qRT-PCR were obtained from residents and staff presenting with COVID-19-like symptoms and from all residents and staff during two point prevalence screenings (PPS). Samples meeting technical criteria were included for phylogenetic analysis. Positive SARS-CoV-2 qRT-PCR were obtained from 11 (18%) of 61 residents and 8 (7%) of 110 staff members between March 8 and March 25. Seven (37%) cases and five (63%) vaccinated cases were diagnosed through PPS. Cases were found on all wards. Phylogenetic analysis (
    Language English
    Publishing date 2022-09-20
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2695572-6
    ISSN 2076-0817
    ISSN 2076-0817
    DOI 10.3390/pathogens11101070
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Evaluation of the test accuracy of a SARS-CoV-2 rapid antigen test in symptomatic community dwelling individuals in the Netherlands.

    Van der Moeren, Nathalie / Zwart, Vivian F / Lodder, Esther B / Van den Bijllaardt, Wouter / Van Esch, Harald R J M / Stohr, Joep J J M / Pot, Joost / Welschen, Ineke / Van Mechelen, Petra M F / Pas, Suzan D / Kluytmans, Jan A J W

    PloS one

    2021  Volume 16, Issue 5, Page(s) e0250886

    Abstract: Background: SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction (qRT-PCR) is well suited for the diagnosis of clinically ill patients requiring treatment. Application for community testing of symptomatic individuals for disease control ... ...

    Abstract Background: SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction (qRT-PCR) is well suited for the diagnosis of clinically ill patients requiring treatment. Application for community testing of symptomatic individuals for disease control purposes however raises challenges. SARS-CoV-2 rapid antigen tests might offer an alternative, but quality evidence on their performance is limited.
    Methods: We conducted an evaluation of the test accuracy of the 'BD Veritor System for Rapid Detection of SARS-CoV-2' (VRD) compared to qRT-PCR on combined nose/throat swabs obtained from symptomatic individuals at Municipal Health Service (MHS) COVID-19 test centers in the Netherlands. In part one of the study, with the primary objective to evaluate test sensitivity and specificity, all adults presenting at one MHS test center were eligible for inclusion. In part two, with the objective to evaluate test sensitivity stratified by Ct (cycle threshold)-value and time since symptom onset, adults who had a positive qRT-PCR obtained at a MHS test center were eligible.
    Findings: In part one (n = 352) SARS-CoV-2 prevalence was 4.8%, overall specificity 100% (95%CI: 98·9%-100%) and sensitivity 94·1% (95%CI: 71·1%-100%). In part two (n = 123) the sensitivity was 78·9% (95%CI: 70·6%-85·7%) overall, 89·4% (95% CI: 79·4%-95·6%) for specimen obtained within seven days after symptom onset and 93% (95% CI: 86%-97.1%) for specimen with a Ct-value below 30.
    Interpretation: The VRD is a promising diagnostic for COVID-19 testing of symptomatic community-dwelling individuals within seven days after symptom onset in context of disease control. Further research on practical applicability and the optimal position within the testing landscape is needed.
    MeSH term(s) COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19 Serological Testing/economics ; COVID-19 Serological Testing/methods ; Humans ; Independent Living ; Netherlands/epidemiology ; Prospective Studies ; SARS-CoV-2/isolation & purification ; Sensitivity and Specificity ; Time Factors
    Language English
    Publishing date 2021-05-13
    Publishing country United States
    Document type Evaluation Study ; Journal Article
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0250886
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Evaluation of the SARS-CoV-2 positivity ratio and upper respiratory tract viral load among asymptomatic individuals screened before hospitalization or surgery in Flanders, Belgium.

    Heireman, Laura / Abrams, Steven / Bruynseels, Peggy / Cartuyvels, Reinoud / Cuypers, Lize / De Schouwer, Pieter / Laffut, Wim / Lagrou, Katrien / Hens, Niel / Ho, Erwin / Padalko, Elizaveta / Reynders, Marijke / Vandamme, Sarah / Van der Moeren, Nathalie / Verstrepen, Walter / Willems, Philippe / Naesens, Reinout

    PloS one

    2021  Volume 16, Issue 11, Page(s) e0259908

    Abstract: Introduction: The incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in the Belgian community is mainly estimated based on test results of patients with coronavirus disease (COVID-19)-like symptoms. The aim of this ... ...

    Abstract Introduction: The incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in the Belgian community is mainly estimated based on test results of patients with coronavirus disease (COVID-19)-like symptoms. The aim of this study was to investigate the evolution of the SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) positivity ratio and distribution of viral loads within a cohort of asymptomatic patients screened prior hospitalization or surgery, stratified by age category.
    Materials/methods: We retrospectively studied data on SARS-CoV-2 real-time RT-PCR detection in respiratory tract samples of asymptomatic patients screened pre-hospitalization or pre-surgery in nine Belgian hospitals located in Flanders over a 12-month period (1 April 2020-31 March 2021).
    Results: In total, 255925 SARS-CoV-2 RT-PCR test results and 2421 positive results for which a viral load was reported, were included in this study. An unweighted overall SARS-CoV-2 real-time RT-PCR positivity ratio of 1.27% was observed with strong spatiotemporal differences. SARS-CoV-2 circulated predominantly in 80+ year old individuals across all time periods except between the first and second COVID-19 wave and in 20-30 year old individuals before the second COVID-19 wave. In contrast to the first wave, a significantly higher positivity ratio was observed for the 20-40 age group in addition to the 80+ age group compared to the other age groups during the second wave. The median viral load follows a similar temporal evolution as the positivity rate with an increase ahead of the second wave and highest viral loads observed for 80+ year old individuals.
    Conclusion: There was a high SARS-CoV-2 circulation among asymptomatic patients with a predominance and highest viral loads observed in the elderly. Moreover, ahead of the second COVID-19 wave an increase in median viral load was noted with the highest overall positivity ratio observed in 20-30 year old individuals, indicating they could have been the hidden drivers of this wave.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asymptomatic Diseases/epidemiology ; Belgium/epidemiology ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/pathology ; COVID-19/virology ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Respiratory Tract Infections/epidemiology ; Respiratory Tract Infections/pathology ; Respiratory Tract Infections/surgery ; Respiratory Tract Infections/virology ; SARS-CoV-2/isolation & purification ; SARS-CoV-2/pathogenicity ; Young Adult
    Language English
    Publishing date 2021-11-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0259908
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: PERFORMANCE EVALUATION OF A SARS-COV-2 RAPID ANTIGENTEST: TEST PERFORMANCE IN THE COMMUNITY IN THE NETHERLANDS

    Van der Moeren, Nathalie / Zwart, Vivian / Lodder, Esther / Van den Bijllaardt, Wouter / Van Esch, Harald / Stohr, Joep / Pot, Joost / Welschen, Ineke / Van Mechelen, Petra / Pas, Suzan / Kluytmans, Jan

    medRxiv

    Abstract: Objectives: This study was primarily conducted to evaluate clinical sensitivity and specificity of the SARS-CoV-2 rapid antigen test BD Veritor System for Rapid Detection of SARS-CoV-2 (VRD) compared to real time reverse transcriptase polymerase chain ... ...

    Abstract Objectives: This study was primarily conducted to evaluate clinical sensitivity and specificity of the SARS-CoV-2 rapid antigen test BD Veritor System for Rapid Detection of SARS-CoV-2 (VRD) compared to real time reverse transcriptase polymerase chain reaction (qRT-PCR). Furthermore, the VRD sensitivity for different Ct-value groups (Ct <20; Ct 20-25, Ct 25-30 and Ct > 30) and different intervals since symptom onset (< 7 days; > 7 days) were examined. Design: Prospective performance evaluation study. Setting: Municipal Health Service (GGD) COVID-19 test centres in West-Brabant, the Netherlands Participants: In order to evaluate clinical specificity, 352 symptomatic adults (> 18 years) who presented at a participating GGD test centre for a COVID- 19 test between September 28 and October 7 2020 were included. In order to evaluate clinical sensitivity, 123 symptomatic adults (> 18 years) who were tested positive with qRT-PCR in a participating GGD test centre between September 26 and October 6 were included. Results: An overall clinical specificity of 100% (95%CI : 98.9%-100%) and sensitivity of 80.7% (95% CI: 73,2%-86,9%) was found for the VRD compared to qRT-PCR. Sensitivity was the highest for low Ct-value categories and for specimen obtained within the first days after disease onset. For specimen obtained within 7 days after onset of symptoms, the overall sensitivity was 91.0% (95%: CI 82,4%-96,3%) and 98,6% (95%: CI 92,3%-100%) for samples with qRT-PCR Ct-value beneath 30. Conclusion: The VRD is a promising diagnostic test for COVID-19 community screening for symptomatic individuals within 7 days after symptom onset in function of disease control. The clinical sensitivity was highest when viral load was high, which correlated with the duration of symptoms. Further research on practical applicability and the optimal position of the test within the current testing landscape is needed.
    Keywords covid19
    Language English
    Publishing date 2020-10-21
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2020.10.19.20215202
    Database COVID19

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  7. Article ; Online: Performance of Various Lateral Flow SARS-CoV-2 Antigen Self Testing Methods in Healthcare Workers: a Multicenter Study.

    Zwart, Vivian F / van der Moeren, Nathalie / Stohr, Joep J.J.M. / Feltkamp, Mariet C.W. / Bentvelsen, Robbert G. / Diederen, Bram M.W. / de Laat, Adrie C. / Mascini, Ellen M. / Schilders, Isabelle G.P. / Vlassak, Henk T.M. / Wertheim, Heiman F.L. / Murk, Jean-Luc A.N. / Kluytmans, Jan A.J.W. / van den Bijllaardt, Wouter

    medRxiv

    Abstract: Introduction: Rapid antigen detection tests (RDT) are suitable for large-scale testing for SARS-CoV-2 among the population and recent studies have shown that self-testing with RDT in the general population is feasible and yields acceptable sensitivities ... ...

    Abstract Introduction: Rapid antigen detection tests (RDT) are suitable for large-scale testing for SARS-CoV-2 among the population and recent studies have shown that self-testing with RDT in the general population is feasible and yields acceptable sensitivities with high specificity. We aimed to determine the accuracy of two different RDT, with two different sample collection methods for one of the RDT among healthcare workers (HCW). Secondary objectives were to determine the accuracy of RDT using a viral load cut-off as proxy of infectiousness and to identify predictors for a false negative RDT. Methods: Centers that participated were secondary care hospitals, academic teaching hospitals, and long-term care facilities. All HCW that met inclusion criteria were asked to perform a RDT self-test next to a regular SARS-CoV-2 nucleic acid amplification test (NAAT). Three study groups were created. Study group 1; Veritor™ System, Becton Dickinson, Franklin Lakes, USA (BD-RDT) with combined oropharyngeal - mid-turbinate nasal sampling, group 2; BD-RDT with mid-turbinate nasal sampling only and group 3; SD Biosensor SARS-CoV-2 Rapid Antigen Test, Roche, Basel, Switzerland (Roche-RDT) with combined oropharyngeal - mid-turbinate nasal sampling. RDT accuracy was calculated using NAAT as reference standard. For samples processed in the cobas® 6800/8800 platform (Roche Diagnostics, Basel, Switzerland), established cycle threshold values (Ct-values) could be converted into viral loads. A viral load cut-off of ≥5.2 log10 SARS-CoV-2 E gene copies/ml was used as proxy of infectiousness. Logistic regression analysis was performed to identify predictors for a false negative RDT. Results: In total, 7,196 HCW were included. Calculated sensitivities were 61.5% (95%CI 56.6%-66.3%), 50.3% (95%CI 42.8%-57.7%) and 74.2% (95%CI 66.4%-80.9%) for study groups 1, 2 and 3, respectively. After application of a viral load cut-off as a proxy for infectiousness for samples processed in the cobas® 6800/8800 platform sensitivities increased to 82.2% (95%CI 76.6-86.9%), 61.9% (95%CI 48.8%-73.9%) and 90.2% (95%CI 76.9%-97.3%) for group 1, group 2 and group 3, respectively. Multivariable regression analysis showed that use of Roche-RDT (p <0.01), combined oropharyngeal - mid-turbinate nasal sampling (p <0.05) and the presence of COVID-19 like symptoms at the time of testing (p <0.01) significantly reduced the likeliness of a false-negative RDT result. Conclusion: SARS-CoV-2 RDT has proven able to identify infectious individuals, especially when upper respiratory specimen is collected through combined oropharyngeal - mid-turbinate sampling. Reliability of self-testing with RDT among HCW seems to depend on the type of RDT, the sampling method and the presence of COVID-19 like symptoms at the time of testing.
    Keywords covid19
    Language English
    Publishing date 2022-01-29
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2022.01.28.22269783
    Database COVID19

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