ZOMBIE WAR

Chapter 2: Testing

The underlying issue with Z pathogen is its latent period - despite its image in popular movies it was shown, that it takes between 30-46 days since the biting to the transformation into a zombie. Moreover, it seems that the infection can be transmitted through the saliva or in rare cases even by touch. The transformation itself takes only few seconds and is a source of many secondary infections - immediately after the transformation, new zombie starts to bite everything around. For this and other reasons, it is important to identify tests, which are able to detect the infection in time, so the patient can be isolated. Often, it is necessary to test hundreds or even thousands of patients at once.

Being isolated for suspection of Z-infection is a huge stigma and is a cause of unbeareable amount of stress for the patient and their family. Due to t his, many people are hidding the bite until the very last moment. And that is not the only issue. If you isolate a person wrongly diagnosed with infection together with trully infected people, you are exposing them to the risk of getting the disease. It is therefore crucial to put into isolation only patients, who are really infected.

On the other hand - infected patient not recognised on time is the source of many secondary infections and complicates the management of the epidemic. And as always - the financial resources are, of course, limited...

Below you can find the characteristics of a few of the available tests for Z-pathogen.

Test 1: Eye reflection

Relatively soon after the start of the epidemic it was noted that infected people have unusual refleciton in their eyes, developing shortly after being bitten (in a few days). After short training, almost everybody is able to recognize that. However, it also depends on the lighting conditions. And people are of course paranoid...

Results:

  • Sensitivity: 98%
  • Specificity: 77%
  • Positive predictive value: 59%
  • Negative predictive value: 99%
  • Price: 3$

Test 2: Cultivation of Z-patogen

A lot of lab work, expensive reagens, kit, which only one company can produce, contamination and high risk for the lab workes, but it is possible: Cultivation of Z pathogen from the blood of patient. Or more exactly - most of the time it is possible.

Results:

  • Sensitivity: 99%
  • Specificity: 92%
  • Positive predictive value: 93%
  • Negative predictive value: 99%
  • Price: 300$

Test 3: Histological examination

Smear of buccal mucosa, microscope and effort to find pathologically changed cells, until t he patient starts to bite. Later since the initial biting we examine, more cells can beo discovered.

The results of the test, 2 weeks after the incident:

  • Sensitivity: 20%
  • Specificity: 95%
  • Positive predictive value: 59%
  • Negative predictive value: 78%
  • Price: 10$

Test 4: Biochemical markers

Peripheral blood and measurement of the set of markers associated with the disease. The markers can be detected approximately one week after the incident.

Results:

  • Sensitivity: 84%
  • Specificity: 54%
  • Positive predictive value: 38%
  • Negative predictive value: 91%
  • Price: 20$

Test 5: Biochemistry - again and better?

Measurement of blood markers is comfortable and popular. Another company is following the trend, trying a different method, sensitive since 10 days after being bitten.

Results:

  • Sensitivity: 64%
  • Specificity: 99%
  • Positive predictive value: 96%
  • Negative predictive value: 89%
  • Price: 100$

Obligatory questions:

  1. Which test are you going to use for quick screening of a small town (circa 5000 people) during evacuation?
  2. Which test is suitable for voluntary testing of persons, which came into contact with somebody infected? And why?
  3. To whom would you recommend such testing? (based on all of the information you have)?
  4. Which test do you recommend for definitive confirmation of the infection?
  5. Find information about sensitivity and specifity of the physical examination of your choice. How do you interpret the values?
  6. What influences the values of sensitivity, specifity, PPV and NPV?

Further questions:

  1. Company ZombieStop comes to a market with revolutionary innovation: Kit for self-testing. Below you cna find the table with the results for the referential population:
  2. CasesControls
    Test positive168148
    Test negative3252
  3. Count the sensitivity, specifity, NPV and PPV for the ZombieStop test.
  4. Your patient got a positive result from the test. What is the probability, that he is trully infected?
  5. What will be the value of NPV and PPV, if the prevalence of the disease in the population is 65%?
  6. Would you recommend the use of the kit for self-testing? Why yes, why not?