National Reference Center (NRC) for Respiratory pathogens

Adenovirus, coronavirus including SARS, human parainfluenza virus, Mycoplasma pneumoniae, Chlamydia pneumoniae, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), Influenza virus

Important messages

Increase in cases of Mycoplasma pneumoniae

The bacterium Mycoplasma pneumoniae is on the rise in Belgium as well as in Europe and Asia [1]. Mainly, infections are reported in the five- to 20-year-old age group. More invasive infections caused by Mycoplasma pneumoniae are also reported. 
Given the rising number of infections with Mycoplasma pneumoniae, the National Reference Centre (NRC) for respiratory pathogens wants to monitor this closely. The NRC also conducts detection of macrolide resistance in Mycoplasma pneumoniae. Hereby, we would like to urge you to send positive samples to us so that we can carry out further typing of Mycoplasma pneumoniae in epidemiological interest and conduct the detection of macrolide resistance if clinically necessary.

[1] P. M. Meyer Sauteur en M. L. Beeton of European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC), and the ESGMAC Mycoplasma pneumoniae Surveillance (MAPS) study group „Mycoplasma pneumoniae: delayed re-emergence after COVID-19 pandemic restrictions,” The Lancet Microbe, 23 11 2023.

General information

Please contact the following website if you would like more information about the weekly SARS-CoV-2 genomic surveillance reports: https://www.uzleuven.be/nl/laboratoriumgeneeskunde/genomic-surveillance-sars-cov-2-belgium

Please contact the following website if you would like more information about the near real-time weekly detection of respiratory pathogens at UZ Leuven: https://www.uzleuven.be/nl/laboratoriumgeneeskunde/wekelijkse-detectieresultaten-respiratoire-pathogenen 

Hepatitis — Outbreak of hepatitis in children in Europe (August 2022)

This event is being followed up in collaboration with the NRC Hepatitis

On April 6 2022, the United Kingdom (UK) reported an increase in the number of cases of acute hepatitis in children. Following this, other countries have also reported cases since Oct. 1, 2021. 

The cases are characterized by elevated transaminase levels (ALT and/or AST > 500 IU/L) and often by icterus (= jaundice). The cause of the hepatitis is unknown: the viruses that usually cause hepatitis (hepatitis A, B, C, D and E viruses) were not detected in any of the cases. 

Currently the most likely hypothesis is that the flare-up is related to an infectious agent, specifically an adenovirus (type 40/41F), which could give this syndrome, if the infection comes together with a cofactor that is itself still unknown. Other possible causes are also being investigated. 

A risk analysis was also conducted in Belgium and pediatricians and infectiologists were asked to report all probable cases to the regional health authorities. The case definition for a probable case is: “A child (up to 16 years old) with acute hepatitis and elevated transaminases (AST and/or ALT > 500 IU/L), in whom hepatitis A to E has been excluded, with a first day of illness from October 1, 2021.” 

Until May 11, 9 probable cases (8 in Flanders) were reported. A survey of the laboratories shows that this clinical picture in children was also seen in previous years: therefore, it cannot yet be concluded whether this number is higher than the expected number. Since the etiology is unknown, appropriate control measures cannot be recommended at this stage. 

Laboratories can send suspicious samples to the NRC hepatitis:

• Accompanied by the specific request form (see left menu);
• See also the newsletter of the NRC hepatitis: newsletter May 2022. 

Workflow

1. Samples meeting the inclusion criteria are sent to the NRC for Hepatitis Viruses (Sciensano) through the regular route. Samples must be accompanied by the correctly completed request form (as much info as possible).
2. Sciensano sends samples to the NRC for Respiratory Pathogens (UZ Leuven) for Pan-Adenovirus qPCR.
3. In case of positivity, the NRC for Respiratory Pathogens (UZ Leuven) performs the typing. In case of negativity, the NRC for Respiratory Pathogens (UZ Leuven) performs metagenomics on the sample.
4. The rest of the sample is kept at the NRC for Hepatitis Viruses (Sciensano) if additional analyses are required.
5. Once the results are known, the NRC for Hepatitis Viruses (Sciensano) provides reporting.

Performed tests

• qPCR Pan-Adenovirus qPCR (UZ Leuven)
• Adenovirus Typering (UZ Leuven)
• Illumina Metagenomics (UZ Leuven)​

Update August 2022

Although the cause of this childhood hepatitis has not yet been determined with certainty, infection with an Adenovirus appears to be a factor or cofactor (https://doi.org/10.2807/1560-7917.ES.2022.27.31.2200483(external link)). A recent publication (https://doi.org/10.110½022.07.19.22277425(external link)) mentions Adeno-associated virus 2 (AAV2) infection as an etiological hypothesis. 

The virus is detectable in plasma. Therefore, we would be grateful if you could draw whole blood and send us the plasma. However, we feel it is important to continue research in other matrices and invite you to continue sending us stool samples, for example, if possible.

COVID-19

In December 2019, an epidemic of COVID-19 broke out in Wuhan, China, caused by a new coronavirus (SARS-CoV-2). The latest epidemiological update provides current epidemiological information. 

Who should be tested for COVID-19?

• The exact description of the case definition and procedures for physicians can be found on the Sciensano website: Case definition and procedures for COVID-19.

How is the diagnostic test organized?

• Digital completion of HealthData’s eForm (for general practitioners) is mandatory, and a printout of this must be sent with the sample. In hospitals, the same data must be collected and sent, through the system provided by the hospital for this purpose. 
• Diagnostics are performed by local clinical laboratories (list of labs available on Sciensano website) or by the National Reference Center for Respiratory Pathogens (Site: UZ Leuven). Triage centers or collectivities can also cooperate with the federal testing platform.
• If you have any questions about the result of a COVID-19 test performed by the NRC, please contact the NRC at the following telephone numbers: 016/34.62.19 or 016/34.64.40.

For details around packaging and sending samples, see the Sciensano website, “COVID19_procedure_sampling”.

To package the COVID-19 samples, please:

1. Place the UTM tube, in
2. a plastic hermetically resealable bag with absorbent paper, in 
3. a padded envelope to be placed.

Please pack the application form in a separate pouch, and attach it to the outside of the padded envelope.

Useful links

The slides of the information session (26/10/2023) regarding the activities of the NRC Respiratory Pathogens can be consulted via: Information Session October 2023