DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India www.dental-tribune.in 06/21 Severe threat Breakthrough COVID-19 infections among the vaccinated may not be a severe threat Award 2021 Sumita Mitra nominated for European Inventor Award 2021 Clinical Test Now a T-cell-based clinical test for COVID-19 PCR detection Are new SARS-CoV-2 variants escaping PCR detection? ” Page 03 ” Page 04 ” Page 05 ” Page 06 Understanding ventilation to curb COVID-19 risk by Amisha Parekh, Dental Tribune South Asia on airborne Information from droplet the transmission of SARS-CoV-2 has constantly been evolving right spread to the virus being declared airborne. The acknowledgment of transmission prioritizes ventilation along with masks, hand hygiene, and social distancing. This article focuses on ventilation, the most critical measure to curb the spread by intentionally introducing outdoor air into closed spaces. SARS-CoV-2 infected individuals generate many small respiratory particles laden with the virus. When they exhale, some of these particles will be inhaled almost immediately by those within a short distance (<1 m). In contrast, many particles disperse over longer distances and can be inhaled by others that are further away (>2 m). Traditionally we refer to the larger-size short- range particles as droplets and the long-range particles as droplet nuclei. However, we need to understand that they are all aerosols because they can be inhaled directly from the air. smaller-sized Ventilation flow rate and viral transmission1,2 Increased viral transmission in crowded and indoor places is not a novel concept and has been previously documented during influenza and the H1N1 pandemic. A study shows that a low ventilation flow rate is associated with relatively high aerosol transmission. In contrast, a sufficiently high ventilation flow rate reduces the chances of airborne transmission to very low levels. Superspreaders of COVID-191,3 Superspreading loosely defined as a situation wherein a single person infects many others in a short time. Poorly ventilated is Ventilation is the key measure to curb COVID-19 spread because it is an airborne infection. CO2 concentrations have been suggested to be a valuable proxy for clean air. (Image: Girts Ragelis/ like spaces slaughterhouses, megachurches, fitness centers, and nightclubs have given rise to many such superspreading events during this pandemic. There have been many instan- ces of COVID-19 superspreading events reported in indoor spa- ces and have surprisingly affec- ted not only people in close con- tact with the infected person but also those at a distance, thereby ruling out any chances of droplet or surface transmission. Examples of some supersprea- ding events: Shutterstock) air conditioner“ could have propagated droplets from one table to another and predicted that there was recirculation of a contaminated bubble in the area where these families were sitting. The most crucial finding from this study was the evidence of low ventilation rates due to a lack of outdoor air supply. The exhaust fans in the walls were turned off, exacerbating the ventilation deficit where these families were sitting. Carbon-dioxide (CO2) and 1. The Guangzhou (China) COVID-19 transmission3,4 restaurant outbreak, 2. Bus in Ningbo carrying 68 passengers, out of which 23 got infected during the one-and- a-half-hour journey, 3. Choir practice in Skagit Valley infected 53 out of the 61 people who attended a two- and-a-half-hour meeting. restaurant outbreak A detailed epidemiological and environmental study of the in Guangzhou showed how families that did not have close contact during lunch got infected. Many members were sitting back to back, which ruled out droplet and surface transmission. This study suggested that the airflow from “strong CO2 concentrations have been suggested to be a valuable proxy for clean air. According to air quality experts, 1. CO2 concentration below 500 ppm in a room means the ventilation is good; 2. at 800 ppm, 1% of the air someone is breathing has already been exhaled recently by someone else; and 3. at 4,400 ppm, it rises to 10% and would be considered dangerous. Such dangerous levels are seen only in crowded spaces with poor airflow. An experiment showed that outdoor air contains around 400 ppm of the CO2, and people‘s exhaled breath contains about 40,000 ppm. So, exhaling in a room can gradually raise its CO2 concentration unless the ventilation is good enough to remove all the excess. Thus, to keep the risk of SARS-CoV-2 low, CO2 transmission levels should be below 700 ppm. Measures to improve venti- lation3,4,5 A work published by Martin Bazant and John Bush from the Massachusetts Institute of Technology calculated how long it could be considered safe to stay within a room that contains an infected person. Dr. Hong, using computer models, studied how aerosols would spread in a classroom. He demonstrated how placing an air cleaner or extractor fan at the front of the room sets up an airflow that prevents aerosol movement. One can achieve an even better aerosol-cleansing effect by elevating the position of fans and filters above the people in the room, for which one can use small, cheap box fans. Air filters, disinfection of air by placing germicidal ultraviolet lamps within air-conditioners or near the ceiling in a room, issuing ventilation certificates for buildings, CO2 level monitors and sensors, etc., are ways to minimize COVID-19 spread in less ventilated places. transmission Conclusion We need to focus on reducing SARS-CoV-2 in indoor settings as the risk for seems outdoor to be minimum6. Improving ventilation will help us achieve virus-free air indoors, and further help us prevent major superspreaders. transmission References 1. Li, Yuguo & Qian, Hua & Hang, Jian & Chen, Xuguang & Cheng, Pan & Ling, Hong & Wang, Shengqi & Liang, Peng & Li, Jiansen & Xiao, Shenglan & Wei, Jianjian & Liu, Li & Cowling, Benjamin & Kang, Min. (2021). Probable airborne transmission of SARS-CoV-2 in a poorly ventilated restaurant. Building and Environment. 196. 107788. 10.1016/j.buildenv.2021.107788 2. X. Gao, J. Wei, P. Xu, et al., Building ventilation as an effective disease intervention strategy on a large and dense social contact network, PLos One 11 (9) (2016) e0162481, https://doi.org/10.1371/ journal.pone.0162481. 3. Improving ventilation will help curb SARS-CoV-2. https:// www.economist.com/science- a nd-te ch nolog y/2021/05/26/ improving-ventilation-will-help- curb-sars-cov-2 4. Environ. Sci. Technol. Lett. 2021, 8, 5, 392–397. Publication Date:April 5, 2021 https://doi. org/10.1021/acs.estlett.1c00183 to limit 5. Bazant MZ, Bush JWM. indoor A guideline airborne of COVID-19. Proc Natl Acad Sci U S A. 2021;118(17):e2018995118. doi:10.1073/pnas.2018995118 transmission 6. A Misleading C.D.C. Number. https://www.nytimes. c o m/2 0 2 1/0 5/11/b r i e f i n g / outdoor-covid-t ransm ission- cdc-number.html
2 News 06/21 Mucormycosis dedicated center at ACPM, Dhule ACPM Dhule has set up a new center dedicated to post-COVID mucormycosis cases. by Rajeev Chitguppi, Dental Tribune South Asia Jawahar Medical Foundation ACPM Medical College and the OMFS department of ACPM Dental College, Dhule, have set up a center dedicated to treat and manage post-COVID mucormycosis cases. (Image: Dr. B.M. Rudagi) We are witnessing a sudden rise in mucormycosis cases in people who from COVID-19 in India, especially in a few states, like Maharashtra and Gujarat. recovered The current crisis has made it essential to create mucormycosis- dedicated centers and post- operative manage the cases effectively. ICUs to treat and Jawahar Medical Foundation ACPM Medical College and the OMFS department of ACPM dental college, Dhule, have set up a dedicated center to manage the rising number of post-COVID mucormycosis cases. The OMFS dept headed by Prof. Bhimappa Mallappa Rudagi has already treated more than 70 post-COVID mucormycosis patients so far. This is going to be a first-of-its- kind center in Maharashtra with two ventilators, a six-bed ICU, and a hundred-bed general ward. The center will be managed by a team of experts, including the oral and maxillofacial surgeons and specialists from general medicine, ENT, ophthalmology, and the nursing staff. This initiative has come to fruition under the leadership and guidance of Kunal Patil . Ad Dental newspapers Specialty magazines Hybrid exhibitions online dental news WE CONNECT THE DENTAL WORLD Media | CME | Marketplace www.dental-tribune.com
3 News 06/21 Breakthrough COVID-19 infections among the vaccinated may not be a severe threat by Amisha Parekh, Dental Tribune South Asia As the COVID-19 vaccina- tion drive continues to expand throughout the world, SARS- CoV-2 variant mutations and breakthrough infections have posed a new public health con- cern. Breakthrough COVID-19 in- fections: A breakthrough infec- tion is a case of illness in which a vaccinated individual becomes sick from the same illness that the vaccine is meant to prevent. Pre- viously, breakthrough infections have been identified in individu- als immunized against a variety of different diseases including mumps, varicella (chickenpox), and influenza and mostly these infections in the vaccinated indi- viduals only result in mild symp- toms and are normally of shorter duration 1. as infection CDC defines breakthrough COVID-19 ‘A person who has SARS-CoV-2 RNA or antigen detected on a respiratory specimen collected ≥14 days after completing the primary series of a U.S. Food and Drug Administration (FDA)- authorized COVID-19 vaccine’ 2. Are these breakthrough infections a major concern? studies have been Several conducted on breakthrough COVID-19 infections in various parts of the world and the following can be summarized from them 3-15: • infections Breakthrough COVID- 19 largely remain asymptomatic or mild and very rarely lead to hospitalization or death. Many vaccines have been found to be effective against the new variants inclusive of the lethal ones. Indian Council of Medical Research (ICMR) recently stated that in India, 2-4 per 10,000 got infected with COVID-19 after vaccinations. • It has been suggested that natural COVID-19 infections or vaccinations help in generating cell-mediated immunity which is minimally affected by the variant mutations and this plays a major role in the prevention of severe disease. Variant mutations have been found to have a negligible effect on the global CD4+ and CD8+ T cell responses and these T cell responses may contribute to limiting COVID- 19 severity that could be caused by variants that have partially or largely escaped the neutralizing antibodies. Thus, the circulating memory T cells in vaccinated individuals and in those that have been previously infected would at least reduce COVID-19 severity if not prevent infection. • High concentrations of SARS-CoV-2 IgG antibodies were detected in the oral and nasal mucosa specimens of vaccinated individuals as well as in the non- vaccinated individuals with previous SARS-CoV-2 infection and it was found that these antibodies persisted for a long period of time. The presence and persistence of such high antibody concentrations at sites of primary infection have been suggested to play a very significant role in the protection as well as prevention of viral transmission. • rapid It was found that an increase in vaccine coverage preceded the decline in mortality amongst the elderly population. This in immunization coverage amongst the elderly was associated with a reduction in the proportionate mortality rate ratios for the elderly. increase • Previously, viral load has been shown to be associated with COVID-19 symptomatic disease, and in vaccinated individuals, this viral load has been found to be decreased up to 2.8–4.5-fold. Thus, it has been suggested that COVID-19 vaccines might reduce the viral load in breakthrough infections and thereby further suppress onward transmission. • Various vaccine manufacturers are working on booster vaccine doses that would target the new variants of concern in order to overcome the partial resistance to neutralizing antibodies generated by natural infections or vaccinations. Conclusion: Owing to the can above safely observations we conclude COVID-19 that breakthrough infections, though inevitable, may not pose a severe threat in the future. As is stated by Dr. Anthony Fauci “It is inevitable that some people who have been fully vaccinated against the coronavirus will still infection get a breakthrough because no vaccine is 100% effective. However, even if a vaccine fails to protect against it often protects infection, against 16. serious disease.” Breakthrough infections are to be expected but are not happening at an alarming rate. References: 1. Wikipedia contributors. (2021, April 21). Breakthrough infection. In Wikipedia, The Free Encyclopedia. Retrieved 15:04, May 6, 2021, from https:// e n .w i k ip e d i a .o r g/w/i n de x . p h p ? t i t l e = B r e a k t h r o u g h _ infection&oldid=1019166390. 3. 2. COVID-19 Breakth- rough Case Investigations and Reporting. https://www.cdc.gov/ vaccines/covid-19/health-depart- ments/breakthrough-cases.html. TYAGI K, GHOSH A, NAIR D, DUTTA K, Singh BHANDARI P, Ahmed ANSARI I, MISRA A, Breakthrough COVID19 after Vaccinations in Healthcare and Other Workers in a Chronic Care Medical Facility in New Delhi, India, Diabetes & Metabolic Syndrome: Clinical Research & Reviews, https://doi. org/10.1016/j.dsx.2021.05.001. Infections 4. ICMR: Covaxin found to be effective against Brazilian variant of virus too. Read more at:http:// timesofindia.indiatimes.com/ articleshow/82361064.cms? 5. Abu-Raddad LJ, Chemaitelly H, Butt AA; National Study Group for COVID-19 Vaccination. Effectiveness of the BNT162b2 Covid-19 Vaccine against the B.1.1.7 and B.1.351 Variants online ahead of print, 2021 May 5]. N Engl J Med. 2021;10.1056/ NEJMc2104974. doi:10.1056/ NEJMc2104974. [published 6. Shinde V, Bhikha S, Hoosain Z, et al. Efficacy of NVX-CoV2373 Covid-19 Vaccine against the B.1.351 Variant [published online ahead of print, 2021 May 5]. N Engl J Med. (Image: Canva.com) 2021;10.1056/NEJMoa2103055. doi:10.1056/NEJMoa2103055. 7. Nursing Teran RA, Walblay KA, Shane EL, et al. Postvaccination SARS-CoV-2 Infections Among Skilled Facility Residents and Staff Members — Chicago, Illinois, December 2020–March 2021. MMWR Morb Mortal Wkly Rep 2021;70:632-638. DOI: http://dx.doi.org/10.15585/ mmwr.mm7017e1. 8. Keehner J, Horton LE, Pfeffer MA, et al. SARS- CoV-2 after in Health Care Vaccination Workers in California. N Engl J Med. 2021;384(18):1774-1775. doi:10.1056/NEJMc2101927. Infection 9. Tarke A, Sidney J, Methot N, et al. Negligible impact of SARS-CoV-2 variants on CD4 + and CD8 + T cell reactivity in COVID-19 exposed donors and vaccinees. Preprint. bioRxiv. 2021;2021.02.27.433180. Published 1. doi:10.1101/2021.02.27.433180. 2021 Mar responses conserved convalescent 10. Redd AD, Nardin A, Kared H, et al. CD8+ T in COVID- cell individuals 19 target epitopes prominent from multiple SARS-CoV-2 circulating variants. Preprint. medRxiv. 2 0 2 1 ; 2 0 2 1 . 0 2 . 1 1 . 2 1 2 5 1 5 8 5 . Published 2021 Feb 12. doi:10.110 1/2021.02.11.21251585. tract 11. Detection of persistent SARS-CoV-2 IgG antibodies in oral mucosal fluid and upper respiratory specimens following COVID-19 mRNA vaccination. Aubree Mades, Prithivi Chellamuthu, Lauren Lopez, Noah Kojima, Melanie A MacMullan, Nicholas Denny, Aaron N Angel, Joseph Casian, Matthew Brobeck, Nina Nirema, Jeffrey D Klausner, Frederick E Turner, Vladimir I Slepnev, Albina Ibrayeva medRxiv 2021.05.06.21256403; doi: https:// doi.org/10.1101/2021.05.06.21256 403. 12. Estimating the early impact of immunization against COVID-19 on deaths among elderly people in Brazil: analyses of secondary data on vaccine coverage and mortality. Cesar Victora, Marcia C Castro, Susie Gurzenda, Aluisio J D Barros medRxiv 2021.04.27.21256187; doi: https://doi.org/10.1101/2021 .04.27.21256187. 13. Levine-Tiefenbrun, M., Yelin, I., Katz, R. et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med (2021). https://doi.org/10.1038/ s41591-021-01316-7. 14. Hacisuleyman E, Hale C, Saito Y, et al. Vaccine Breakthrough Infections with SARS-CoV-2 Variants [published online ahead of print, 2021 Apr 21]. N Engl J Med. 2021;10.1056/ NEJMoa2105000. doi:10.1056/ NEJMoa2105000. protective 15. A DC, F C, N P, et al. escape mutants SARS-CoV-2 immunity and infections or from natural [published immunizations online ahead of print, 2021 Mar 29]. Clin Microbiol Infect. 2021; S1198 -74 3X(21)0 0146 - 4. doi:10.1016/j.cmi.2021.03.011. 16. Fauci: Breakthrough infections after vaccinations ‘inevitable‘. https://news.yahoo. c o m /f a u c i - b r e a k t h r o u g h - i n f e c t i o n s - v a c c i n a t i o n s - inevitable-173725342.html.
4 News 06/21 Sumita Mitra nominated for European Inventor Award 2021 the thanks to Sumita Mitra, who in the late 1990s brought in innovation in traditional composites with the help of nanotechnology ultimately making it more esthetic and strong. in the Sumita Mitra has been nominated category of non-EPO countries for her innovation in ‘Restoring smiles with nanomaterials’, the winners of which shall be announced at a ceremony on 17 June 2021. Sumita Mitra is known for her innovative work in nanocomposite dental materials. (Photo: invent.org) by Amisha Parekh, Dental Tribune South Asia Sumita Mitra, an Indian- American chemist, has been nominated as a finalist for the European Inventor Award 2021 for applying nanotechnology to produce a new composite restorative material, which has many advantages over conventional materials. Ever since its advent in the 1960s, restorations have revolutionized dentistry. All composite Composites prior to the inno- vation 1: Until the 1990s compo- sites used were either composite microfills that were too weak to bear biting forces or hybrid com- posites which were esthetically inferior. Sumita Mitra’s Innovation 1,2: Sumita Mitra was the first person to develop a dental filler using nanotechnology that improved the properties of restorations in terms of strength, wear resistance, and esthetics. This new composite filling material launched in 2002 was called Filtek Supreme Universal Restorative and was recognized as a versatile material that could be used for restoring teeth in any area of the mouth after which 3M Oral Care launched newer generations of Filtek in 2005, 2012, and 2019. Products made using Sumita Mitra’s innovation 1,2: Mitra holds about 100 US patents and their in- ternational equivalents which have helped her and her team to protect as well as commercialize her innovation. Ranging from nanocomposites, resin-modified glass ionomers to dental adhesi- ves, her innovation has formed the base for multiple dental pro- ducts which have been used in over one billion restorations wor- ldwide. Apart from Filtek some other products that have made use of her innovation include Vi- teremer and Vitrebond Resin-mo- dified Glass Ionomers, RelyX Lu- ting Cements, Scotchbond Multi- purpose Adhesive, and APC Or- thodontic Bracket Adhesive. What inspired Mitra’s inno- vation 1: Sumita Mitra explains that the key to her innovation was a bunch of grapes and men- tions that “If we look at a bunch of grapes, they are all of the dif- ferent sizes. Some are small and some are big so that the small ones can fit in between the large ones to create a cluster. Also, the size of the clusters can vary gre- atly. Some of the bunches could have five grapes and some could have 20 grapes or 100 grapes.” Back in the 1990s Sumita Mitra had realized the shortcomings of the traditional composites while working in the Oral Care divi- sion of 3M, an American multina- tional company, and was deter- mined on finding an alternative. On realizing that the root cause of all the problems was the particle size in the case of hybrid composi- tes and loose packing of particles in the case of micro-filled compo- sites, Mitra and her team experi- mented by incorporating uniform nanoparticles of approximately 20 nanometres in size into the re- sins and found that although the mechanical and optical proper- ties improved, this technique was unsuitable in dentistry. nanoclusters Then, inspired by the ‘bunch of grapes model’ they developed a technique for creating loosely bound clusters of nanoparticles of varied sizes and combined these with precisely engineered individual nanoparticles varying diameters which resulted in a robust, durable, and lustrous material with excellent handling properties. Further, by adding tiny amounts of pigment and altering the chemical composition of nanoparticles, they could even create a range of shades to match individual patient’s teeth. of Sumita Mitra currently runs her own consulting company and also volunteers in her community to inspire young minds to develop an interest in science to ensure that the legacy of innovation continues in the future. ‘Just as a magic wand enhances the magic of a magician, innovations like that of Sumita Mitra complement the smiles delivered by dentists’. References 1. Finalist for the European Inventor Award 2021. https:// w w w.e p o.org/n ews - eve nt s/ e ve n t s/e u r o p e a n - i nve n t o r/ finalists/2021/mitra.html 2. Sumita Mitra. https://www. invent.org/inductees/sumita- mitra 1. Sumita Mitra‘s innovation made use of nanotechnology to overcome the drawbacks of traditional composites. 2. The new composite ‚Filtek Supreme Universal Restorative‘ was a versatile material which could be used for restoring teeth in any area of the mouth. 3. Sumita Mitra holds about 100 US patents and their international equivalents. Ad LifeCare Devices Private LimitedNew Jubilee Building, Oﬃce no. 1Laxmiben Chheda Road, Nalasopara West, Palghar 401 203Mumbai Metropolitan RegionMaharashtra, INDIACustomer Service : +91 99304 50170Customer Service WhatsApp : +91 99304 50169Management WhatsApp : +91 99304 50163 +91 99997 86275
6 News 06/21 Are new SARS-CoV-2 variants escaping PCR detection? other RNA viruses, which means fewer mutations and less genetic variability over time. Targets used by RT PCR to detect SARS-CoV-2: The ORF1ab/ RdRp, E, N, and S genes are the most frequently used targets for SARS-CoV-2 detection by RT-PCR. Different protein targets of for the N gene will easily detect SARS-CoV-2. 2. Point mutations in the RdRp gene have given the virus the ability to interfere with diagnostic assays and anti-viral treatments (e.g., Remdesivir). 3. S gene (for the Spike glycoprotein): has multiple mutations that confer a genetic advantage to the virus (greater transmissibility) Conclusion: False-negative PCR tests in the second wave could be mainly due to any of the three reasons mentioned above, but not due to the new variants and their mutations. Labs may have been overwhelmed by the work overload impacting the quality of test results, but no one should worry about the variants missing the PCR tests purely because of the mutations. People in India are worried that PCR tests are not able to detect the SARS-CoV-2: new SARS-CoV-2 variants. (Image: Canva.com) by Rajeev Chitguppi, Dental Tribune South Asia Several media reports have come up with scary headlines that the new SARS-CoV-2 variants are fooling the RT-PCR test, which is considered the gold standard test for detecting the SARS-CoV-2 infection. Anecdotal reports say PCR tests are not able to detect the virus due to the new mutations. Is it true? Let us explore science and find out the truth. Are mutations frequent in coronaviruses? NO. Coronaviruses make far fewer replication errors than 1. The nucleocapsid (N) protein has 90% amino acid similarity with SARS-CoV (the 2003 pandemic of Asia), which means that this gene/ sequence has been conserved over time. This stability makes the N gene one of the most promising targets for detection. Therefore PCR tests designed SARS-CoV-2 Ad Can a PCR be designed to detect a single viral target? A PCR test can have a single target, provided it is a „stable“ target, such as the N protein. What does Health Organization recommend? the World (WHO) WHO recommends at least for SARS-CoV-2 targets two detection by RT PCR: 1. one sarbecovirus speci- fic E-gene Our recommendations for people who have a suspected exposure to an infected person: that Isolate yourself immediately and prevent the spread to other family members. It is an airborne spreads infection rapidly indoors. Hence, take maximum precautions at home. Keep windows open. Improve ventilation and air circulation. Get tested after five to seven days from the day of suspected exposure. During isolation too, keep monitoring SpO2 levels (with a pulse oximeter) and body temperature. 2. one SARS-CoV-2- speci- fic gene (N, RdRp or ORF1b, etc.) The best time to get tested is the first day of symptoms. Why use multiple targets? The advantage of using multiple targets in a PCR is that the test remains accurate even if a target sequence mutates. For the same reason, manufacturers often include secondary and tertiary sites in their assays. If one of the targets produces a false negative due to mutations, the other sites can generate PCR signals to detect SARS-CoV-2 correctly. RT PCR tests in India: The new variants and their mutations can not escape detection and can not give negative results as the RT-PCR tests used in India target more than two genes. Both sensitivity and specificity of the RT- PCR tests remain the same as earlier. Then why are people testing negative? 1. Testing too early after exposure: The best time to test is one week after exposure. It can be a range of five to seven days. Earlier than that, PCR may test negative. 2. too Testing late after infection: eight to nine days after this point, only infection. At BronchoAlveolar Fluid (BALF) samples may test positive and not the nasal/ throat swabs. Lavage 3. No test is perfect. It is well known that all PCR tests have some false negatives. References: 1. DNA Explainer: How the new COVID-19 variant is fooling RT-PCR tests - all you need to know. https://www.dnaindia.com/ explainer/report-dna-explainer- how-the-new-covid-19-variant-is- fooling-rt-pcr-tests-all-you-need-to- know-2886515 2. Kalita D, Deka S (2020) Effectiveness of Different Gene- Target Strategies for SARS-CoV-2 Screening by RT-PCR and Other Modalities: A Scoping Review. J Med Diagn Meth 9:298. doi: 10.35248/2168- 9784.2020.9.298 3. Kocemba-Pilarczyk KA, Bentke-Imiolek A, Dudzik P. Does the absence of SARS-CoV-2 specific genes always exclude the infection? How to interpret RT-PCR results?- The scenario of interactive online workshop. Biochem Mol Biol Educ. 2021 Mar 27. doi: 10.1002/bmb.21506. Epub ahead of print. PMID: 33773033. 4. SARS-C0V-2 Tests & Their Targets. https://blog.microbiologics. com/sars-c0v-2-tests-their-targets/ 5. Viral targets: What makes a good Covid-19 RT- PCR test? https://www.zymoresearch.com/ blogs/blog/what-makes-a-good- covid-19-rt-pcr-test 6. 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Sydney, Australia 26-29 September 2021 Broadcast from the International Convention Centre 4 day Streamed Scientiﬁc Programme 200+ sessions on-demand for an extended period of 60 days High quality International and Local presenters Europe, America, Africa, Middle East, Asia, Australia & New Zealand Extensive virtual Exhibition with product demonstrations Meet the exhibitor’s in a virtual showroom Interact live with speakers, ask questions Passport competition with great prizes Australian CPD Requirements Dental practitioners in Australia are required to complete a minimum of 60 hours of CPD activities over a three-year CPD cycle (current cycle ends Wednesday 30th November 2022). ADA CERP The FDI World Dental Association is an ADA CERP Recognised Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. This continuing education activity has been planned and implemented in accordance with the standards of the American Dental Association Continuing Education Recognition (ADA CERP) through joint efforts between FDI World Dental Association and the Australian Dental Association. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at ADA.org/CERP. Educating for Dental Excellence www.world-dental-congress.org