High throughput Next-Generation Sequencing Respiratory Viral Panel: A Diagnostic and Epidemiologic Tool for SARS-CoV-2 and Other Viruses.

Sahajpal, N. S.; Mondal, A. K.; Njau, A.; Petty, Z.; Chen, J.; Ananth, S.; Ahluwalia, P.; Williams, C.; Ross, T. M.; Chaubey, A.; DeSantis, G.; Schroth, G. P.; Bahl, J.; Kolhe, R.

Background: In the current phase of the COVID-19 pandemic, we are facing two serious public health challenges that include deficits in SARS-CoV-2 variant monitoring and neglection of other co-circulation respiratory viruses. Additionally, accurate assessment of the evolution, extent, and dynamics of the outbreak are required to understand the transmission of the virus amongst seemingly unrelated cases and provide critical epidemiological information. To address these challenges, we evaluated a new high-throughput next-generation sequencing (NGS) panel that includes 40 viral pathogens to analyze viral subtypes, mutational variants of SARS-CoV-2, model to understand the spread of the virus in the state of Georgia, USA, and to assess other circulating viruses in the same population. Methods This study evaluated a total of 522 samples that included 483 patient samples and 42 synthetic positive control materials. The performance metrics were calculated for both clinical and reference control samples by comparing detection results with the RT-PCR assay. The limit of detection (LoD) studies were conducted as per the FDA guidelines. Inference and visualization of the phylogeny of the SARS-CoV-2 sequences were performed through the Nextstrain Command-Line Interface (CLI) tool, utilizing the associated augur and auspice toolkits. Result The performance metric was calculated using both the clinical samples and the reference control with a PPA, NPA, and accuracy of 95.98%, 85.96%, and 94.4%, respectively. The LoD was determined to be 10 copies/ml with all 25 replicates detected across two different runs. The clade for pangolin lineage B contains certain distant variants, including P4715L in ORF1ab, Q57H in ORF 3a and, S84L in ORF8 covarying with the D614G spike protein mutation were found to be prevalent in the early pandemic in Georgia, USA. Isolates from the same county formed paraphyletic groups in our analysis, which indicated virus transmission between counties. Conclusion The study demonstrates the clinical utility of the NGS panel to identify novel variants that can provide actionable information to prevent or mitigate emerging viral threats, models that provide insights into viral transmission patterns and predict transmission/ resurgence of regional outbreaks and provide critical information on co-circulating respiratory viruses that might be independent factors contributing to the global disease burden.