BIOPLEX 2200 EBV IGM PANEL ON BIOPLEX 2200 MULTI-ANALYTE DETECTION SYSTEM
Device Facts
| Record ID | K062213 |
|---|---|
| Device Name | BIOPLEX 2200 EBV IGM PANEL ON BIOPLEX 2200 MULTI-ANALYTE DETECTION SYSTEM |
| Applicant | Bio-Rad Laboratories, Inc. |
| Product Code | LSE · Microbiology |
| Decision Date | Dec 8, 2006 |
| Decision | SESE |
| Submission Type | Traditional |
| Regulation | 21 CFR 866.3235 |
| Device Class | Class 1 |
Indications for Use
The BioPlex 2200 EBV IgM kit is a multiplex flow immunoassay intended for the qualitative detection of two (2) separate analytes; Epstein-Barr Virus Viral Capsid Antigen (EBV VCA) IgM antibodies and Heterophile antibodies in human serum. The test system can be used in conjunction with the BioPlex 2200 EBV IgG kit as an aid in the laboratory diagnosis of infectious mononucleosis (IM). The EBV IgM kit is intended for use with the Bio-Rad BioPlex 2200 System. Assay performance characteristics have not been established for immunocompromised or immunosuppressed patients, cord blood, neonatal specimens, or infants. Assay performance characteristics have not been established for the diagnosis of nasopharyngeal carcinoma, Burkitt’s lymphoma, and other EBV-associated lymphomas.
Device Story
Multiplex flow immunoassay system; uses dyed beads coated with EBV VCA p18 recombinant protein and horse erythrocyte stromal extract (heterophile antigen). Patient serum, diluent, and bead reagent incubated in reaction vessel; anti-human IgM-phycoerythrin conjugate added. Instrument detects bead identity via dye fluorescence and antibody capture via phycoerythrin fluorescence. Includes internal standard, serum verification, and reagent blank beads for quality control. Used in clinical laboratories by technicians. Output is antibody index (AI) for each analyte. Results aid clinicians in diagnosing infectious mononucleosis by characterizing EBV serological status (e.g., primary acute, late acute, recovering, previous infection).
Clinical Evidence
Clinical performance evaluated using 621 banked serum samples from patients with ordered EBV tests and 302 unselected hospitalized patient samples. Compared against commercial microplate EIA and agglutination tests. Overall agreement for EBV VCA IgM was 78.3% positive and 94.8% negative; for heterophile, 46.0% positive and 98.8% negative. Reproducibility and precision studies performed across three sites using multiple lots, showing acceptable SD and %CV. Cross-reactivity evaluated against ANA, Rubella, HSV, Toxo, CMV, and other factors.
Technological Characteristics
Multiplex flow immunoassay; dyed bead solid phase; phycoerythrin-conjugated anti-human IgM detection. Reagents include MOPS buffer, ProClin 300, sodium azide. System uses sheath fluid (PBS) and wash solution (PBS/Tween 20). Automated detection via fluorescence. Software-controlled instrument.
Indications for Use
Indicated for qualitative detection of EBV VCA IgM and heterophile antibodies in human serum to aid in laboratory diagnosis of infectious mononucleosis. Not established for immunocompromised/immunosuppressed patients, neonates, infants, or diagnosis of EBV-associated lymphomas/carcinomas.
Regulatory Classification
Identification
Epstein-Barr virus serological reagents are devices that consist of antigens and antisera used in serological tests to identify antibodies to Epstein-Barr virus in serum. The identification aids in the diagnosis of Epstein-Barr virus infections and provides epidemiological information on diseases caused by these viruses. Epstein-Barr viruses are thought to cause infectious mononucleosis and have been associated with Burkitt's lymphoma (a tumor of the jaw in African children and young adults) and postnasal carcinoma (cancer).
Predicate Devices
Related Devices
- K062211 — BIOPLEX 2200 EBV IGG PANEL FOR BIOPLEX 2200 MULTI-ANALYTE DETECTION SYSTEM · Bio-Rad Laboratories, Inc. · Dec 8, 2006
Submission Summary (Full Text)
{0}
1
# 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ASSAY ONLY TEMPLATE
A. 510(k) Number:
k062213
B. Purpose for Submission:
This is an original bundled application for a new multiplexed flow immunoassay for the qualitative detection of two (2) separate analytes; Epstein-Barr Virus Viral Capsid Antigen (EBV VCA) IgM antibodies and Heterophile antibodies in human serum to aid in the diagnosis of infectious mononucleosis.
C. Measurand:
Epstein-Barr Virus Viral Capsid Antigen (EBV VCA) IgM antibodies and Heterophile antibodies
D. Type of Test:
Multiplexed flow immunoassay
E. Applicant:
BIO-RAD LABORATORIES, INC.
F. Proprietary and Established Names:
BioPlex 2200 EBV IgM kit, Controls and Calibrators on the BioPlex 2200 Multi-Analyte Detection System
G. Regulatory Information:
| Product Code | Classification | Regulation Section | Panel |
| --- | --- | --- | --- |
| LJN | I | 866.3235 – Epstein-Barr virus serological reagents | Microbiology (83) |
| KTN | II | 866.5640 Infectious mononucleosis immunological test system | Immunology |
{1}
H. Intended Use:
1. Intended use(s):
The BioPlex 2200 EBV IgM kit is a multiplex flow immunoassay intended for the qualitative detection of two (2) separate analytes; Epstein-Barr Virus Viral Capsid Antigen (EBV VCA) IgM antibodies and Heterophile antibodies in human serum. The test system can be used in conjunction with the BioPlex 2200 EBV IgG kit as an aid in the laboratory diagnosis of infectious mononucleosis (IM).
The EBV IgM kit is intended for use with the Bio-Rad BioPlex 2200 System.
Assay performance characteristics have not been established for immunocompromised or immunosuppressed patients, cord blood, neonatal specimens, or infants. Assay performance characteristics have not been established for the diagnosis of nasopharyngeal carcinoma, Burkitt’s lymphoma, and other EBV-associated lymphomas.
2. Indication(s) for use:
See above
3. Special conditions for use statement(s):
Prescription use only
4. Special instrument requirements:
The BioPlex 2200 EBV IgM kit is intended for use with the BioPlex 2200 System instrument and software.
I. Device Description:
The BioPlex 2200 EBV IgM kit is a multiplex flow immunoassay for the qualitative detection of two (2) separate analytes; Epstein-Barr Virus Viral Capsid Antigen (EBV VCA) IgM antibodies and Heterophile antibodies in human serum. See test principle below for more details.
J. Substantial Equivalence Information:
{2}
Predicate Device 1: Wampole Monolatex Agglutination test.
510k number: K862008
| Component | Similarities | |
| --- | --- | --- |
| | Device | Predicate |
| Intended Use | Aid in diagnosis of infectious mononucleosis | Aid in diagnosis of infectious mononucleosis |
| | Differences | |
| | Device | Predicate |
| Technology | Multiplexed flow immunoassay | Agglutination Assay |
| Intended Use | Qualitative detection | Qualitative or Semi-quantitative detection |
| Matrices | Serum | Serum or plasma |
## J. Substantial Equivalence Information:
Predicate Device 2: Diasorin EBV VCA IgM Capture EIA.
510k number: K946157
| Component | Similarities | |
| --- | --- | --- |
| | Device | Predicate |
| Intended Use | Aid in diagnosis of infectious mononucleosis | Aid in diagnosis of infectious mononucleosis |
| Matrices | Serum | Serum |
| | Differences | |
| | Device | Predicate |
| Technology | Multiplexed flow immunoassay | Traditional EIA |
| Intended Use | Qualitative detection | Qualitative or Semi-quantitative detection |
## K. Standard/Guidance Document Referenced (if applicable):
| STANDARDS |
| --- |
| Title and Reference Number |
| Interference Testing in Clinical Chemistry; Approved Guideline (EP 7-A) |
| Evaluation of Precision Performance of Quantitative Measurement Methods; Approved Guideline-Second Edition (EP5-A2) |
## Other Standards
{3}
| GUIDANCE | | | |
| --- | --- | --- | --- |
| Document Title | Office | Division | Web Page |
| Review Criteria for In Vitro Diagnostic Devices for Detection of IGM Antibodies to Viral Agents | OIVD | DIHD | http://www.fda.gov/cdrh/ode/527.pdf |
| Guidance on Informed Consent for In Vitro Diagnostic Device Studies Using Leftover Human Specimens that are Not Individually Identifiable - Guidance for Sponsors, Institutional Review Boards, Clinical Investigators and FDA Staff | CBER/OIVD | | http://www.fda.gov/cdrh/oivd/guidance/1588.html |
L. Test Principle:
The BioPlex 2200 EBV IgM kit uses multiplex flow immunoassay, a methodology that greatly resembles traditional EIA, but permits simultaneous detection and identification of many antibodies in a single tube. Two (2) different populations of dyed beads are coated with proteins associated with infectious mononucleosis. One (1) is coated with an *E. coli* derived recombinant fusion protein, EBV VCA p18 (40kD), and the other is coated with horse erythrocyte stromal extract (heterophile antigen). The BioPlex 2200 System combines an aliquot of patient sample, sample diluent containing goat anti-human IgG, and bead reagent into a reaction vessel. The mixture is incubated at 37°C. After a wash cycle, anti-human IgM antibody, conjugated to phycoerythrin (PE), is added to the dyed beads and this mixture is incubated at 37°C. The excess conjugate is removed in another wash cycle, and the beads are re-suspended in wash buffer. The bead mixture then passes through the detector. The identity of the dyed beads is determined by the fluorescence of the dyes, and the amount of antibody captured by the antigen is determined by the fluorescence of the attached PE.
Three additional dyed beads, an Internal Standard Bead (ISB), a Serum Verification Bead (SVB), and a Reagent Blank Bead (RBB), are present in each reaction mixture to verify detector response, the addition of serum or plasma to the reaction vessel, and the absence of significant non-specific binding in serum or plasma respectively. The instrument is calibrated using a set of two (2) distinct calibrator vials, supplied separately by Bio-Rad Laboratories. A combination of two (2) vials representing two (2) different antibody concentrations is used for calibration. The result for each of these antibodies is expressed as an antibody index (AI).
M. Performance Characteristics (if/when applicable):
{4}
5
1. Analytical performance:
a. Precision/Reproducibility:
Precision Studies:
A precision panel, consisting of six (6) panel members was prepared by Bio-Rad Laboratories. Two (2) of the six (6) panel members had high levels of the antibodies contained in the BioPlex 2200 EBV IgG kit EBV IgM kit (EBV VCA IgM and Heterophile) and two (2) of the six (6) panel members had antibody levels near the cutoff, both prepared from positive patient samples. Two (2) of the six (6) panel members were negative (one high negative and one low negative) for both of the analytes. Precision testing was performed at Bio-Rad Laboratories on one lot of the EBV IgM kit, one lot of the EBV IgM Calibrator Set and one lot of the EBV IgM Control Set. Each of the six (6) panel members was tested in duplicate (x2) on two (2) runs per day for ten (10) days using one (1) lot of EBV IgM kit, one (1) lot of EBV IgM Calibrator Set and one (1) lot of EBV IgM Control Set (2 times x 2 runs x 10 days = 40 replicates per panel member). The data were analyzed for intra-assay and inter-assay precision according to the principles described in the Clinical Laboratory Standards Institute guidance EP5-A2, revised November 2004 and ISO/TR 22971:2205. The standard deviation (SD) and percent coefficient of variation (%CV) were calculated. Results can be found in Tables U and V.
{5}
Table U. Precision Results; BioPlex 2200 EBV VCA IgM
| EBV VCA IgM Panel Members | Sample N* | AI Mean | Within-Run | | Between-Day | | Between-Run | | Total | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | | SD | %CV | SD | %CV | SD | %CV | SD | %CV |
| High Positive 1 | 42 | 2.5 | 0.2 | 8.8% | 0.1 | 2.4% | 0.2 | 6.6% | 0.3 | 11.2% |
| High Positive 2 | 43 | 2.7 | 0.2 | 5.6% | 0.2 | 6.9% | 0.1 | 1.8% | 0.2 | 9.1% |
| Low Positive 1 | 42 | 1.6 | 0.1 | 6.5% | 0.0 | 0.0% | 0.1 | 4.3% | 0.1 | 7.8% |
| Low Positive 2 | 42 | 1.9 | 0.1 | 4.4% | 0.1 | 2.9% | 0.1 | 4.8% | 0.1 | 7.1% |
| High Negative | 43 | 0.7 | 0.0 | 6.4% | 0.0 | 0.0% | 0.0 | 2.7% | 0.0 | 7.0% |
| Low Negative | 43 | 0.1 | 0.0 | 0.0% | 0.0 | 0.0% | 0.0 | 0.0% | 0.0 | 0.0% |
*Additional samples were run.
Table V. Precision Results; BioPlex 2200 Heterophile
| Heterophile Panel Members | Sample N* | AI Mean | Within-Run | | Between-Day | | Between-Run | | Total | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | | SD | %CV | SD | %CV | SD | %CV | SD | %CV |
| High Positive 1 | 42 | 2.8 | 0.1 | 3.7% | 0.2 | 8.6% | 0.1 | 1.8% | 0.3 | 9.5% |
| High Positive 2 | 43 | 2.8 | 0.1 | 4.7% | 0.3 | 9.9% | 0.1 | 5.3% | 0.3 | 12.2% |
| Low Positive 1 | 42 | 2.1 | 0.1 | 3.9% | 0.1 | 3.7% | 0.2 | 9.0% | 0.2 | 10.5% |
| Low Positive 2 | 42 | 1.9 | 0.1 | 3.9% | 0.1 | 4.6% | 0.1 | 7.5% | 0.2 | 9.6% |
| High Negative | 43 | 0.7 | 0.0 | 7.0% | 0.0 | 4.6% | 0.0 | 0.0% | 0.1 | 8.4% |
| Low Negative | 43 | 0.0 | 0.0 | 0.0% | 0.0 | 0.0% | 0.0 | 0.0% | 0.0 | 0.0% |
*Additional samples were run.
## Reproducibility Studies
A reproducibility panel, consisting of six (6) panel members was prepared by Bio-Rad Laboratories. Two (2) of the six (6) panel members had high levels of the antibodies contained in the BioPlex 2200 EBV IgM kit (EBV VCA IgM and Heterophile) and two (2) of the six (6) panel members had antibody levels near the cutoff, both prepared from positive patient samples. Two (2) of the six (6) panel members were negative (one high negative and one low negative) for both of the analytes. In addition, a positive control (antibody positive for both analytes) and a negative control (antibody negative for both analytes) were also tested. Reproducibility testing was performed at each of three (3) US testing facilities on a total of three (3) lots of the EBV IgM kit, three (3) lots of the EBV IgM Calibrator Set and three (3) lots of the EBV IgM Control Set. The panels were provided to each of the testing sites. Each of the six (6) panel members and positive and negative controls was tested in quadruple (x4) on each day for three (3) days at each of three (3) US testing facilities using one (1) lot of EBV IgM kit, one (1) lot of EBV IgM Calibrator Set and one (1) lot of EBV IgM Control Set (4 times x 3 days x 3 sites = 36 replicates per panel member and controls). The data were analyzed for intra-assay and inter-assay reproducibility according to the
{6}
principles described in the Clinical Laboratory Standards Institute guidance EP5-A2, revised November 2004 and ISO/TR 22971:2205. The standard deviation (SD) and percent coefficient of variation (%CV) were calculated. Positive results can be found in Tables S and T.
Table S. Reproducibility Results; BioPlex 2200 EBV VCA IgM
| EBV VCA IgM Panel Members | Sample N | Grand Mean AI | Within-Run | | Between-Day | | Between-Run | | Between-Site* | | Total | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | | SD | %CV | SD | %CV | SD | %CV | SD | %CV | SD | %CV |
| High Positive 1 | 36 | 1.9 | 0.1 | 5.9% | 0.1 | 4.5% | 0.1 | 3.8% | 0.0 | 0.0% | 0.2 | 8.4% |
| High Positive 2 | 36 | 2.0 | 0.1 | 3.5% | 0.0 | 0.0% | 0.1 | 5.8% | 0.0 | 2.2% | 0.1 | 7.1% |
| Low Positive 1 | 35** | 1.2 | 0.1 | 4.4% | 0.1 | 5.6% | 0.0 | 1.4% | 0.0 | 3.9% | 0.1 | 8.3% |
| Low Positive 2 | 36 | 1.4 | 0.1 | 5.8% | 0.1 | 4.8% | 0.0 | 0.0% | 0.0 | 2.4% | 0.1 | 7.9% |
| Positive Control | 36 | 2.0 | 0.1 | 5.5% | 0.1 | 2.8% | 0.1 | 3.0% | 0.3 | 15.9% | 0.3 | 17.2% |
*Between site variance includes between lot variance.
**1 replicate missing due to insufficient sample volume.
Table T. Reproducibility Results; BioPlex 2200 Heterophile
| Heterophile Panel Members | Sample N | Grand Mean AI | Within-Run | | Between-Day | | Between-Run | | Between-Site* | | Total | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | | SD | %CV | SD | %CV | SD | %CV | SD | %CV | SD | %CV |
| High Positive 1 | 36 | 2.8 | 0.1 | 2.8% | 0.0 | 0.0% | 0.1 | 5.2% | 0.1 | 5.1% | 0.2 | 7.8% |
| High Positive 2 | 36 | 2.7 | 0.1 | 3.2% | 0.0 | 0.0% | 0.1 | 4.4% | 0.0 | 0.7% | 0.1 | 5.5% |
| Low Positive 1 | 35** | 1.9 | 0.1 | 5.0% | 0.0 | 0.0% | 0.0 | 0.0% | 0.0 | 2.3% | 0.1 | 5.5% |
| Low Positive 2 | 36 | 1.8 | 0.1 | 4.7% | 0.0 | 1.0% | 0.0 | 0.0% | 0.1 | 5.6% | 0.1 | 7.4% |
| Positive Control | 36 | 2.5 | 0.1 | 5.3% | 0.1 | 2.6% | 0.0 | 0.0% | 0.0 | 0.0% | 0.1 | 5.9% |
*Between site variance includes between lot variance.
**1 replicate missing due to insufficient sample volume.
b. Linearity/assay reportable range:
Not Applicable.
c. Traceability, Stability, Expected values (controls, calibrators, or methods):
Not Applicable.
d. Detection limit:
Not applicable.
e. Analytical specificity:
A cross-reactivity study was performed to determine if samples from various disease states and other potentially interfering factors interfere with test results when tested with the BioPlex 2200 EBV IgM kit. A panel of at least ten (10)
{7}
specimens* positive for each cross reactant were evaluated for possible cross reactivity with the BioPlex 2200 EBV IgM kit for both EBV IgM antibody assays. The test specimens were also evaluated on corresponding commercially available microplate EIA and latex agglutination tests. Due to the number of VCA IgM positive results obtained with the initial 10 Toxoplasmosis and CMV samples, an additional 33 Toxoplasmosis and 42 CMV positive samples were tested with the BioPlex 2200 EBV IgM kit. This study was performed to demonstrate that the BioPlex 2200 VCA IgM assay does not exhibit cross reactivity with Toxoplasmosis or CMV IgM samples. For these additional samples, only those that exhibited positive reactivity were tested on corresponding commercially available microplate EIA and latex agglutination tests. Most of the samples evaluated were high positive for each disease state. The majority of all samples that elicited a positive result were also confirmed positive by the corresponding commercially available test, indicating reactivity to EBV IgM antibodies rather than cross reactivity with a potentially interfering factor. Results can be found in Table W.
*Due to limited availability of samples, only four E. coli specimens were evaluated.
Table W. Cross-Reactivity
| Cross Reactives | N | Method | BioPlex 2200 EBV IgM | |
| --- | --- | --- | --- | --- |
| | | | EBV VCA | Heterophile |
| ANA | 10 | BioPlex 2200 | 1 | 0 |
| | | Commercial Assay | 1 | 0 |
| | | Discrepants | 0 | 0 |
| Rubella IgM | 10 | BioPlex 2200 | 0 | 0 |
| | | Commercial Assay | 0 | 0 |
| | | Discrepants | 0 | 0 |
| HSV IgM | 10 | BioPlex 2200 | 0 | 0 |
| | | Commercial Assay | 0 | 0 |
| | | Discrepants | 0 | 0 |
| E. Coli | 4* | BioPlex 2200 | 0 | 0 |
| | | Commercial Assay | N/A | N/A |
| | | Discrepants | N/A | N/A |
| Toxo IgM | BioPlex 2200 (N) | 43 | 43 | |
| | | BioPlex 2200 (+) | 14 | 0 |
| | | Commercial Assay (N) | 14† | 10†† |
| | | Commercial Assay (+) | 9 | 0 |
| | | Discrepants | 5 | 0 |
*Commercially available assay data was not obtained, due to low sample volume.
†Commercially available assay testing was performed on BioPlex 2200 positive samples only.
††Commercially available assay testing was performed on the initial ten samples evaluated.
| Cross Reactives | N | Method | BioPlex 2200 EBV IgM | |
| --- | --- | --- | --- | --- |
| | | | EBV VCA | Heterophile |
| Rheumatoid Factor | 10 | BioPlex 2200 | 0 | 0 |
| | | Commercial Assay | 0 | 0 |
| | | Discrepants | 0 | 0 |
| VZV IgM | 10 | BioPlex 2200 | 0 | 0 |
| | | Commercial Assay | 0 | 0 |
| | | Discrepants | 0 | 0 |
| HIV | 10* | BioPlex 2200 | 0 | 0 |
| | | Commercial Assay | N/A | N/A |
| | | Discrepants | N/A | N/A |
| Pregnant women | 10 | BioPlex 2200 | 0 | 0 |
| | | Commercial Assay | 0 | 0 |
| | | Discrepants | 0 | 0 |
| CMV IgM | BioPlex 2200 (N) | 52 | 52 | |
| | | BioPlex 2200 (+) | 25 | 1 |
| | | Commercial Assay (N) | 25† | 10†† |
| | | Commercial Assay (+) | 22 | 0 |
| | | Discrepants | 3 | 1 |
{8}
Interfering Substances:
Testing for interfering substances was conducted according to NCCLS Protocol EP7-A (Vol. 22, No. 27). No significant interference was observed in any of the substances tested. The following substances, listed in Table X, were tested $(N = 10)$ at maximum levels on one reagent lot.
Table X. Interfering Substances
| Substance | Concentration |
| --- | --- |
| Hemoglobin | ≤ 500 mg/dL |
| Bilirubin (unconjugated) | ≤ 20 mg/dL |
| Bilirubin (conjugated) | ≤ 20 mg/dL |
| Triglycerides | ≤ 3000 mg/dL |
| Protein (total) | ≤ 12 g/dL |
| Cholesterol | ≤ 500 mg/dL |
| Red Blood Cells | ≤ 0.4% Concentrate |
| Gamma-globulin | ≤ 2.5 g/dL |
| Ascorbic Acid | ≤ 3 mg/dL |
# f. Assay cut-off:
A final cut-off of 1 AI was established for all BioPlex 2200 EBV IgM kit assays based on an evaluation of 548 serum samples with the BioPlex 2200 EBV IgM kit assays and corresponding commercially available microplate EIA and latex agglutination tests. ROC analysis was performed for each BioPlex 2200 EBV IgM assay using this population of samples. Samples that were equivocal on the commercially available tests were excluded from the analysis. This analysis was used to optimize sensitivity and specificity for the BioPlex 2200 EBV IgM kit assays. A final cut-off of 1 AI was established for all BioPlex 2200 EBV IgM kit assays based on the data collected.
# 2. Comparison studies:
# a. Method comparison with predicate device:
Performance of the EBV IgM kit was tested against corresponding commercially available microplate EIA/agglutination tests. A total of 621 banked serum samples from patients for which an EBV test was ordered were tested at 3 U.S. clinical testing sites. The EBV IgG kit was run in conjunction with the EBV IgM kit to allow for a complete antibody response profile. The characterization by antibody response was not compared with clinical data regarding presence, absence or status of disease. Two (2) samples were excluded due to RBB analysis error messages during BioPlex 2200 EBV IgM testing. One (1) sample was excluded due to RBB analysis error messages
{9}
during BioPlex 2200 EBV IgG testing. Using Table A as a guideline, results were analyzed by BioPlex 2200 EBV IgM analytes and corresponding EBV IgM reference assays according to serological characterization based on reference assay results. For the purpose of percent agreement calculations, BioPlex 2200 EBV IgM equivocal results were assigned to the opposite clinical interpretation than that of the corresponding reference assay result. Results from all sites are shown and summarized in Tables F - I.
Table F. BioPlex 2200 EBV VCA IgM vs. EIA: Comparison by Serological Pattern Characterization
| EBV Serological Status | Reference EBV VCA IgM Interpretation | | | | | | Total |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | Positive | | | Negative | | | |
| | BioPlex 2200 EBV VCA IgM | | | BioPlex 2200 EBV VCA IgM | | | |
| | Pos | Eqv | Neg | Pos | Eqv | Neg | |
| | N | N | N | N | N | N | N |
| Primary Acute | 30 | 1 | 0 | 0 | 0 | 0 | 31 |
| Late Acute | 31 | 1 | 16 | 1 | 4 | 57 | 110 |
| Recovering | 0 | 0 | 0 | 1 | 0 | 3 | 4 |
| Previous Infection | 0 | 0 | 0 | 6 | 6 | 293 | 305 |
| Susceptible | 0 | 0 | 0 | 4 | 0 | 123 | 127 |
| Inconclusive | 4 | 0 | 0 | 6 | 0 | 31 | 41 |
| Overall | 65 | 2 | 16 | 18 | 10 | 507 | 618 |
Table G. BioPlex 2200 EBV VCA IgM vs. EIA: Percent Agreement & Confidence Intervals by Serological Pattern Characterization
| EBV Serological Status | Positive Agreement | | 95% CI | Negative Agreement | | 95% CI |
| --- | --- | --- | --- | --- | --- | --- |
| Primary Acute | (30/31) | 96.8% | 83.8 - 99.4% | (0/0) | N/A* | N/A* |
| Late Acute | (31/48) | 64.6% | 50.4 - 76.6% | (57/62) | 91.9% | 82.5 - 96.5% |
| Recovering | (0/0) | N/A* | N/A* | (3/4) | 75.0% | 30.1 - 95.4% |
| Previous Infection | (0/0) | N/A* | N/A* | (293/305) | 96.1% | 93.2 - 97.7% |
| Susceptible | (0/0) | N/A* | N/A* | (123/127) | 96.9% | 92.2 - 98.8% |
| Inconclusive | (4/4) | 100% | 51.0-100% | (31/37) | 83.8% | 68.9 - 92.3% |
| Overall | (65/83) | 78.3% | 68.3 - 85.8% | (507/535) | 94.8% | 92.5 - 96.4% |
*In cases where agreement resulted in (0/0) samples, percent agreement and 95% confidence interval could not be calculated.
{10}
Table H. BioPlex 2200 Heterophile vs. Agglutination Test: Comparison by Serological Pattern Characterization
| EBV Serological Status | Reference Heterophile Interpretation | | | | | | Total |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | Positive | | | Negative | | | |
| | BioPlex 2200 Heterophile | | | BioPlex 2200 Heterophile | | | |
| | Pos | Eqv | Neg | Pos | Eqv | Neg | |
| | N | N | N | N | N | N | N |
| Primary Acute | 16 | 1 | 2 | 2 | 0 | 10 | 31 |
| Late Acute | 3 | 0 | 1 | 1 | 1 | 104 | 110 |
| Recovering | 0 | 0 | 0 | 0 | 0 | 4 | 4 |
| Previous Infection | 0 | 0 | 0 | 0 | 3 | 302 | 305 |
| Susceptible | 0 | 0 | 0 | 0 | 0 | 127 | 127 |
| Inconclusive | 4 | 0 | 23 | 0 | 0 | 14 | 41 |
| Overall | 23 | 1 | 26 | 3 | 4 | 561 | 618 |
Table I. BioPlex 2200 Heterophile vs. Agglutination Test: Percent Agreement & Confidence Intervals by Serological Pattern Characterization
| EBV Serological Status | Positive Agreement | | 95% CI | Negative Agreement | | 95% CI |
| --- | --- | --- | --- | --- | --- | --- |
| Primary Acute | (16/19) | 84.2% | 62.4 - 94.5% | (10/12) | 83.3% | 55.2 - 95.3% |
| Late Acute | (3/4) | 75.0% | 30.1 - 95.4% | (104/106) | 98.1% | 93.4 - 99.5% |
| Recovering | (0/0) | N/A* | N/A* | (4/4) | 100% | 51.0 - 100% |
| Previous Infection | (0/0) | N/A* | N/A* | (302/305) | 99.0% | 97.1 - 99.7% |
| Susceptible | (0/0) | N/A* | N/A* | (127/127) | 100% | 97.1 - 100% |
| Inconclusive | (4/27) | 14.8% | 5.9 - 32.5% | (14/14) | 100% | 78.5 - 100% |
| Overall | (23/50) | 46.0% | 33.0 - 59.6% | (561/568) | 98.8% | 97.5 - 99.4% |
*In cases where agreement resulted in (0/0) samples, percent agreement and 95% confidence interval could not be calculated.
Comparison of EBV Serological Status
Using Table A as a guideline, samples characterized into serological status associated with EBV disease, using the commercially available microplate EIA and agglutination tests, were compared with characterizations using BioPlex 2200 EBV IgG and IgM kits. The BioPlex 2200 EBV IgM kit was run in conjunction with the BioPlex 2200 EBV IgG kit to allow for a complete antibody response profile. The characterization by antibody response was not compared with clinical data regarding presence, absence or status of disease. Results from 618 serum samples tested at 3 U.S. clinical testing sites are shown in Table N.
{11}
Table N. Comparison of EBV Serological Status
| EBV Serological status | BioPlex 2200 EBV IgG & IgM Profile | | | | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | Primary Acute | Late Acute | Recovering | Previous Infection | Susceptible | Inconclusive | Total | % Serological Agreement | 95% Confidence Interval |
| Commercially Available Assays | Primary Acute | 30 | 0 | 0 | 0 | 0 | 1 | 31 | 96.8% | 83.8 - 99.4% |
| | Late Acute | 5 | 90 | 1 | 13 | 0 | 1 | 110 | 81.8% | 73.6 - 87.9% |
| | Recovering | 1 | 0 | 3 | 0 | 0 | 0 | 4 | 75.0% | 30.0 - 95.4% |
| | Previous Infection | 0 | 31 | 2 | 263 | 4 | 5 | 305 | 86.2% | 81.9 - 89.7% |
| | Susceptible | 4 | 0 | 0 | 0 | 122 | 1 | 127 | 96.1% | 91.1 - 98.3% |
| | Inconclusive | 6 | 10 | 0 | 7 | 11 | 7 | 41 | 17.1% | 8.5 - 31.3% |
| | Overall | 46 | 131 | 6 | 283 | 137 | 15 | 618 | 83.3% | 80.2 - 86.1% |
Note: Calculations are performed for unshaded areas only.
b. Matrix comparison:
Not Applicable.
3. Clinical studies:
Not Applicable
4. Clinical cut-off:
Not Applicable
5. Expected values/Reference range:
Expected values for the EBV IgM kit are presented by age and gender in the following tables for serum samples from unselected hospitalized pediatric and adult patients (N=302) and patients for which an EBV test was ordered (N=619). A total of 303 serum samples from unselected hospitalized pediatric and adult patients and a total of 621 serum samples from patients for which an EBV test was ordered were tested. One (1) sample from the unselected hospitalized population, and two (2) samples from the patients for which an EBV test was ordered population were excluded due to RBB analysis error messages during BioPlex 2200 EBV IgM testing. For all analytes, results of ≤0.8 AI are negative, 0.9 and 1.0 AI are equivocal, and ≥1.1 AI are reported as positive.
{12}
Table B. Hospitalized Patient Samples: EBV VCA IgM
| Age | Gender | BioPlex 2200 EBV VCA IgM | | | | | | Total |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | Positive | | Equivocal | | Negative | | |
| | | N | % | N | % | N | % | N |
| < 5 years of age | F | 3 | 11% | 0 | 0% | 24 | 89% | 27 |
| | M | 1 | 5% | 0 | 0% | 19 | 95% | 20 |
| 5-12 years of age | F | 2 | 9% | 0 | 0% | 20 | 91% | 22 |
| | M | 1 | 3% | 1 | 3% | 32 | 94% | 34 |
| 13-20 years of age | F | 5 | 14% | 1 | 3% | 29 | 83% | 35 |
| | M | 0 | 0% | 1 | 7% | 14 | 93% | 15 |
| 21-30 years of age | F | 0 | 0% | 0 | 0% | 6 | 100% | 6 |
| | M | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| 31-40 years of age | F | 0 | 0% | 0 | 0% | 10 | 100% | 10 |
| | M | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| 41-50 years of age | F | 1 | 8% | 0 | 0% | 12 | 92% | 13 |
| | M | 1 | 14% | 0 | 0% | 6 | 86% | 7 |
| 51-60 years of age | F | 0 | 0% | 0 | 0% | 23 | 100% | 23 |
| | M | 0 | 0% | 1 | 5% | 18 | 95% | 19 |
| 61-70 years of age | F | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| | M | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| 71-80 years of age | F | 1 | 9% | 0 | 0% | 10 | 91% | 11 |
| | M | 0 | 0% | 0 | 0% | 6 | 100% | 6 |
| 81-90 years of age | F | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| | M | 0 | 0% | 0 | 0% | 6 | 100% | 6 |
| 91-100 years of age | F | 0 | 0% | 0 | 0% | 0 | 0% | 0 |
| | M | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| Total | | 15 | 5% | 4 | 1% | 283 | 94% | 302 |
{13}
Table C. Hospitalized Patient Samples: Heterophile
| Age | Gender | BioPlex 2200 Heterophile | | | | | | Total |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | Positive | | Equivocal | | Negative | | |
| | | N | % | N | % | N | % | N |
| < 5 years of age | F | 1 | 4% | 0 | 0% | 26 | 96% | 27 |
| | M | 0 | 0% | 0 | 0% | 20 | 100% | 20 |
| 5-12 years of age | F | 0 | 0% | 0 | 0% | 22 | 100% | 22 |
| | M | 1 | 3% | 0 | 0% | 33 | 97% | 34 |
| 13-20 years of age | F | 0 | 0% | 0 | 0% | 35 | 100% | 35 |
| | M | 0 | 0% | 0 | 0% | 15 | 100% | 15 |
| 21-30 years of age | F | 0 | 0% | 0 | 0% | 6 | 100% | 6 |
| | M | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| 31-40 years of age | F | 0 | 0% | 0 | 0% | 10 | 100% | 10 |
| | M | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| 41-50 years of age | F | 0 | 0% | 0 | 0% | 13 | 100% | 13 |
| | M | 0 | 0% | 0 | 0% | 7 | 100% | 7 |
| 51-60 years of age | F | 0 | 0% | 0 | 0% | 23 | 100% | 23 |
| | M | 0 | 0% | 0 | 0% | 19 | 100% | 19 |
| 61-70 years of age | F | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| | M | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| 71-80 years of age | F | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| | M | 0 | 0% | 0 | 0% | 6 | 100% | 6 |
| 81-90 years of age | F | 0 | 0% | 0 | 0% | 11 | 100% | 11 |
| | M | 0 | 0% | 0 | 0% | 6 | 100% | 6 |
| 91-100 years of age | F | 0 | 0% | 0 | 0% | 0 | 0% | 0 |
| | M | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| Total | | 2 | 1% | 0 | 0% | 300 | 99% | 302 |
Table D. Samples from Patients for which an EBV Test was Ordered: EBV VCA IgM
| Age | Gender | BioPlex 2200 EBV VCA IgM | | | | | | Total |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | Positive | | Equivocal | | Negative | | |
| | | N | % | N | % | N | % | N |
| < 5 years of age | F | 3 | 10% | 0 | 0% | 27 | 90% | 30 |
| | M | 6 | 18% | 0 | 0% | 27 | 82% | 33 |
| 5-12 years of age | F | 9 | 15% | 1 | 2% | 52 | 84% | 62 |
| | M | 6 | 10% | 1 | 2% | 55 | 89% | 62 |
| 13-20 years of age | F | 17 | 22% | 2 | 3% | 59 | 76% | 78 |
| | M | 10 | 26% | 1 | 3% | 27 | 71% | 38 |
| 21-30 years of age | F | 5 | 11% | 1 | 2% | 40 | 87% | 46 |
| | M | 7 | 21% | 1 | 3% | 25 | 76% | 33 |
| 31-40 years of age | F | 5 | 10% | 1 | 2% | 46 | 88% | 52 |
| | M | 1 | 4% | 0 | 0% | 23 | 96% | 24 |
| 41-50 years of age | F | 3 | 9% | 1 | 3% | 30 | 88% | 34 |
| | M | 4 | 13% | 1 | 3% | 26 | 84% | 31 |
| 51-60 years of age | F | 4 | 15% | 1 | 4% | 22 | 81% | 27 |
| | M | 2 | 8% | 1 | 4% | 23 | 88% | 26 |
| 61-70 years of age | F | 1 | 8% | 0 | 0% | 12 | 92% | 13 |
| | M | 0 | 0% | 0 | 0% | 21 | 100% | 21 |
| 71-80 years of age | F | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| | M | 0 | 0% | 0 | 0% | 3 | 100% | 3 |
| 81-90 years of age | F | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| | M | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| 91-100 years of age | F | 0 | 0% | 0 | 0% | 0 | 0% | 0 |
| | M | 0 | 0% | 0 | 0% | 0 | 0% | 0 |
| Total | | 83 | 13% | 12 | 2% | 524 | 85% | 619 |
{14}
Table E. Samples from Patients for which an EBV Test was Ordered: Heterophile
| Age | Gender | BioPlex 2200 Heterophile | | | | | | Total |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | Positive | | Equivocal | | Negative | | |
| | | N | % | N | % | N | % | N |
| < 5 years of age | F | 0 | 0% | 0 | 0% | 30 | 100% | 30 |
| | M | 0 | 0% | 0 | 0% | 33 | 100% | 33 |
| 5-12 years of age | F | 3 | 5% | 0 | 0% | 59 | 95% | 62 |
| | M | 3 | 5% | 0 | 0% | 59 | 95% | 62 |
| 13-20 years of age | F | 8 | 10% | 1 | 1% | 69 | 88% | 78 |
| | M | 7 | 18% | 1 | 3% | 30 | 79% | 38 |
| 21-30 years of age | F | 0 | 0% | 2 | 4% | 44 | 96% | 46 |
| | M | 4 | 12% | 0 | 0% | 29 | 88% | 33 |
| 31-40 years of age | F | 0 | 0% | 0 | 0% | 52 | 100% | 52 |
| | M | 1 | 4% | 1 | 4% | 22 | 92% | 24 |
| 41-50 years of age | F | 0 | 0% | 0 | 0% | 34 | 100% | 34 |
| | M | 0 | 0% | 0 | 0% | 31 | 100% | 31 |
| 51-60 years of age | F | 0 | 0% | 0 | 0% | 27 | 100% | 27 |
| | M | 0 | 0% | 0 | 0% | 26 | 100% | 26 |
| 61-70 years of age | F | 0 | 0% | 0 | 0% | 13 | 100% | 13 |
| | M | 0 | 0% | 0 | 0% | 21 | 100% | 21 |
| 71-80 years of age | F | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| | M | 0 | 0% | 0 | 0% | 3 | 100% | 3 |
| 81-90 years of age | F | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| | M | 0 | 0% | 0 | 0% | 2 | 100% | 2 |
| 91-100 years of age | F | 0 | 0% | 0 | 0% | 0 | 0% | 0 |
| | M | 0 | 0% | 0 | 0% | 0 | 0% | 0 |
| Total | | 26 | 4% | 5 | 1% | 588 | 95% | 619 |
The distribution of BioPlex 2200 EBV VCA IgM and Heterophile AI values for serum samples from adult and pediatric unselected hospitalized patients and from patients for which an EBV test was ordered are presented in the following histograms.
{15}
Figure 1. Hospitalized Patient Samples: EBV VCA IgM
Figure 3. Samples from Patients for which an EBV Test was Ordered: EBV VCA IgM
Figure 2. Hospitalized Patient Samples: Heterophile
Figure 4. Samples from Patients for which an EBV Test was Ordered: Heterophile
# N. Proposed Labeling:
The labeling is sufficient and it satisfies the requirements of 21 CFR Part 809.10.
# O. Conclusion:
1. The submitted information in this premarket notification is complete and supports a substantial equivalence decision.
