Modelling multiplex testing for outbreak Control

TL;DR

This paper evaluates multiplex testing strategies for outbreak detection, demonstrating that combining LFD and PCR tests can improve detection speed and reduce testing burden across multiple pathogens, with considerations for pathogen-specific viral dynamics.

Contribution

It introduces a model for multiplex testing effectiveness considering viral concentration dynamics, guiding outbreak detection strategies for multiple pathogens.

Findings

Multiplex testing with LFD and PCR achieves high detection rates.

Strategies detect outbreaks rapidly with minimal testing burden.

Influenza B detection is lower due to its viral dynamics.

Abstract

During the SARS-CoV-2 pandemic, polymerase chain reaction (PCR) and lateral flow device (LFD) tests were frequently deployed to detect the presence of SARS-CoV-2. Many of these tests were singleplex, and only tested for the presence of a single pathogen. Multiplex tests can test for the presence of several pathogens using only a single swab, which can allow for: surveillance of more pathogens, targeting of antiviral interventions, a reduced burden of testing, and lower costs. Test sensitivity however, particularly in LFD tests, is highly conditional on the viral concentration dynamics of individuals. To inform the use of multiplex testing in outbreak detection it is therefore necessary to investigate the interactions between outbreak detection strategies and the differing viral concentration trajectories of key pathogens. Viral concentration trajectories are estimated for SARS-CoV-2, and Influenza A/B. Testing strategies for the first five symptomatic cases in an outbreak are then simulated and used to evaluate key performance indicators. Strategies that use a combination of multiplex LFD and PCR tests achieve; high levels of detection, detect outbreaks rapidly, and have the lowest burden of testing across multiple pathogens. Influenza B was estimated to have lower rates of detection due to its modelled viral concentration dynamics.