External Quality Assessment of MERS-CoV Molecular Diagnostics During the 2015 Korean Outbreak

Abstract

Background: The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside Middle East Asia in 2015 has necessitated the rapid expansion of laboratories that conduct MERS-CoV molecular testing in Korea, together with external quality assessment (EQA) to evaluate the assays used.

Methods: The EQA program consisted of two phases; self-validation and blind assessment. For the first EQA phase, in vitro transcribed upstream region of the envelope gene (upE) and the open reading frame (ORF)1a RNAs were used at a concentration of 1,000 copies/μL. The test panel for the second EQA phase consisted of RNA extracts from three samples, which were obtained from two MERS-CoV positive patients and one MERS-CoV negative patient.

Results: The first EQA phase results for 46 participants showed a linear relationship between the threshold cycle (C(T)) values of RNA materials and the logarithmic concentrations for both upE and ORF1a gene targets (R²=0.73 and 0.75, respectively). The mean C(T) value for each concentration was different depending on which commercial kit was used for the assay. Among the three commonly used kits, PowerChek MERS Real-Time PCR kit (KogeneBiotech, Korea) showed the lowest C(T) values at all concentrations of upE and most concentrations of ORF1a. The second EQA phase results for 47 participants were 100% correct for all tested samples.

Conclusions: This EQA survey demonstrates that the MERS-CoV molecular testing performed in Korea during the 2015 outbreak is of robust capability. However, careful establishment and validation of a cut-off value are recommended to ensure good analytical sensitivity.

Keywords: External quality assessment; MERS-CoV; Molecular diagnostics; ORF1a; Real-time PCR; upE.

Fig. 1. Boxplot of threshold cycle (C_T) values of external quality assessment (EQA) materials by target genes. The central line shows the median and the box covers the interquartile range. The four clusters for the upE gene and ORF1a gene represent 1,000, 100, 10, and 1 copies/µL, respectively. Each cluster denotes results from all methods, PowerChek kit (KogeneBiotech), and DiaPlexQ kit (Solgent), respectively, from left to right.