Abstract:
Background:
Diarrhea is a serious concern worldwide, especially in developing countries. Rotavirus is implicated in
approximately 400,000 infant deaths annually. It is highly contagious elevating the risk of outbreaks especially in
enclosed settings such as daycare centers, hospitals, and boarding schools. Reliable testing methods are critical for
early detection of infections, better clinical management, pathogen surveillance and evaluation of interventions
such as vaccines. Enzyme immunoassays have proved to be reliable and practical in most settings; however, newer
multiplex reverse transcription polymerase assays have been introduced in the Kenya market but have not been
evaluated locally.
Methods: Stool samples collected from an ongoing Surveillance of Enteric Pathogens Causing diarrheal illness in
Kenya (EPS) study were used to compare an established enzyme immunoassay, Premier™ Rotaclone® (Meridian
Bioscience, Cincinnati, Ohio, U.S.A.), that can only detect group A rotavirus against a novel multiplex reverse
transcription polymerase chain reaction kit, Seeplex® Diarrhea-V ACE Detection (Seegene, Seoul, Republic of Korea),
that can detect rotavirus, astrovirus, adenovirus, and norovirus genogroups I and II. Detection frequency, sensitivity,
specificity, turnaround time, and cost were compared to determine the suitability of each assay for clinical work in
austere settings versus public health work in well-funded institutes in Kenya.
Results: The Premier™ Rotaclone® kit had a detection frequency of 11.2%, sensitivity of 77.8%, specificity of 100%,
turnaround time of 93 min and an average cost per sample of 13.33 United States dollars (USD). The Seeplex® DiarrheaV
ACE Detection kit had a detection frequency of 16.0%, sensitivity of 100%, specificity of 98.1%, turnaround time of
359 min and an average cost per samples 32.74 United States dollars respectively. The detection frequency sensitivity
and specificity of the Seeplex® Diarrhea-V ACE Detection kit mentioned above are for rotavirus only.
Conclusions: The higher sensitivity and multiplex nature of the Seeplex® Diarrhea-V ACE Detection kit make it suitable
for surveillance of enteric viruses circulating in Kenya. However, its higher cost, longer turnaround time and complexity
favor well-resourced clinical labs and research applications. The Premier™ Rotaclone®, on the other hand, had a higher
specificity, shorter turnaround time, and lower cost making it more attractive for clinical work in low complexity labs in
austere regions of the country. It is important to continuously evaluate assay platforms’ performance, operational cost,
turnaround time, and usability in different settings so as to ensure quality results that are useful to the patients and
public health practitioners.