INSTRUCTIONS FOR USE

Transcription

1 VITROS Immunodiagnostic Products Anti HBc Reagent Pack VITROS Immunodiagnostic Products Anti HBc Calibrator Caution: Federal law restricts this device to sale by or on the order of a physician. Intended Use VITROS Immunodiagnostic Products Anti HBc Reagent Pack For the in vitro qualitative detection of total antibody (IgG and IgM) to hepatitis B core antigen (total anti-hbc) in human adult and pediatric serum and plasma (EDTA and citrate) and neonate serum using the VITROS ECi/ECiQ Immunodiagnostic Systems, the VITROS 3600 Immunodiagnostic System and the VITROS 5600 Integrated System. Assay results, in conjunction with other serological and clinical information, may be used for the laboratory diagnosis of individuals with acute or chronic hepatitis B, or recovery from hepatitis B infection. The presence of anti-hbc may be used as an aid in the determination of exposure to HBV infection for individuals prior to HBV vaccination. WARNING: This test has not been FDA cleared or approved for the screening of blood or plasma donors. VITROS Immunodiagnostic Products Anti HBc Calibrator For use in the calibration of the VITROS ECi/ECiQ Immunodiagnostic Systems, the VITROS 3600 Immunodiagnostic System and the VITROS 5600 Integrated System for the in vitro qualitative detection of total antibody (IgG and IgM) to hepatitis B core antigen (total anti-hbc) in human adult and pediatric serum and plasma (EDTA and citrate) and neonate serum using VITROS Anti-HBc Reagent Packs. The VITROS Anti-HBc Calibrator has been validated for use only on the VITROS ECi/ECiQ Immunodiagnostic Systems, the VITROS 3600 Immunodiagnostic System and the VITROS 5600 Integrated System with VITROS Immunodiagnostic Products Anti-HBc Reagent Packs. Summary and Explanation of the Test The VITROS Anti-HBc test can be used to detect antibodies against hepatitis B core antigen (anti-hbc) in serum and plasma following exposure to infectious hepatitis B virus (HBV). 1, 2 Anti-HBc is detectable shortly after the appearance of hepatitis B surface antigen (HBsAg). As the appearance of anti-hbsag may be delayed after HBsAg clearance, anti-hbc is sometimes the only serological marker for HBV infection and potentially infectious blood. 3 Anti-HBc is found in acute and chronic hepatitis B patients and also indicates past resolved infection. Principles of the Procedure The VITROS Anti-HBc test is performed using the VITROS Anti-HBc Reagent Pack and VITROS Immunodiagnostic Products Anti-HBc Calibrator on the VITROS ECi/ECiQ Immunodiagnostic Systems, the VITROS 3600 Immunodiagnostic System and the VITROS 5600 Integrated System. A competitive immunoassay technique is used. This involves the reaction of anti-hbc in the sample with hepatitis B core antigen (HBcAg) coated wells. Unbound sample is removed by washing. Horseradish peroxidase (HRP)-labeled antibody conjugate (mouse monoclonal anti-hbc) is then allowed to react with the remaining exposed HBcAg on the well surface. Unbound conjugate is removed by washing. The bound HRP conjugate is measured by a luminescent reaction. 4 A reagent containing luminogenic substrates (a luminol derivative and a peracid salt) and an electron transfer agent, is added to the wells. The HRP in the bound conjugate catalyzes the oxidation of the luminol derivative, producing light. The electron transfer agent (a substituted acetanilide) increases the level of light produced and prolongs its emission. The light signals are read by the system. The amount of HRP conjugate bound is indicative of the concentration of anti HBc present. Test Type System Incubation Time Time to first result Test Temperature Competitive immunoassay ECi/ECiQ, 3600, 5600 Reaction Sample Volume 46 minutes 55 minutes 37 C 50 μl Version 11.1 Pub. No. GEM1211_US_EN 1 of 21

2 INSTRUCTIONS FOR USE Warnings and Precautions Reaction Scheme Warnings and Precautions For in vitro diagnostic use only. WARNING: Potentially Infectious Material Use caution when handling material of human origin. Consider all samples potentially infectious. No test method can offer complete assurance that hepatitis B virus, HCV, HIV 1+2 or other infectious agents are absent. Handle, use, store and dispose of solid and liquid waste from samples and test components, in accordance with procedures defined by appropriate national biohazard safety guideline or regulation (e.g. CLSI document M29). 5, 6 Human blood products provided as components of the VITROS Anti HBc Reagent Pack and the VITROS Anti HBc Calibrator have been obtained from donors who were tested individually and who were found to be negative for hepatitis B surface antigen, and for antibodies to human immunodeficiency virus (HIV 1+2) and hepatitis C virus (HCV), using approved methods (enzyme immunoassays). Treat as if capable of transmitting infection. WARNING: Contains Kathonor ProClin 200 (CAS ) and Sodium Hydroxide (CAS ) 7 The VITROS Anti HBc Reagent Pack contains 0.5% Kathon or ProClin 200 and 0.87% Sodium Hydroxide. H315: Causes skin irritation. H317: May cause an allergic skin reaction. H319: Causes serious eye irritation. P280: Wear protective gloves/protective clothing/eye protection/face protection. P305 + P351 + P338: IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. P337 + P313: If eye irritation persists: Get medical advice/attention. P302 + P352: IF ON SKIN: Wash with plenty of soap and water. P333 + P313: If skin irritation or rash occurs: Get medical advice/ attention. P321: Specific treatment (see Section 4, First aid measures, in Safety Data Sheet). Refer to for the Safety Data Sheets and for OCD contact information. WARNING 2 of 21 Pub. No. GEM1211_US_EN Version 11.1

3 Reagents Reagents Reagent Pack Contents 1 reagent pack containing: 100 coated wells [recombinant HBcAg derived from bacteria (E.coli) coated at 1.5 ng per well] 14.6 ml assay reagent [buffer with newborn calf serum, bovine gamma globulins and antimicrobial agent (0.5% Kathon w/w)] 20.6 ml conjugate reagent (HRP-mouse monoclonal anti-hbc, 0.1 μg/ml), in buffer with mouse serum, human plasma and antimicrobial agent (0.5% Kathon w/w) Reagent Pack Handling The reagent pack is supplied ready for use. The reagent pack contains homogeneous liquid reagents that do not require shaking or mixing prior to loading onto the system. Handle the reagent pack with care. Avoid the following: allowing condensation to form on the pack causing reagents to foam agitation of the pack Reagent Pack Storage and Preparation Reagent Storage Condition Stability Unopened Refrigerated 2 8 C (36 46 F) expiration date Opened On system System turned on 8 weeks Opened Refrigerated 2 8 C (36 46 F) 8 weeks The VITROS Anti HBc Reagent Pack is suitable for use until the expiration date on the carton when stored and handled as specified. Do not use beyond the expiration date. Do not freeze unopened reagent packs. Load reagent packs directly from refrigerated storage to minimize condensation. Store opened refrigerated reagent packs in a sealed reagent pack storage box that contains dry desiccant. Calibrator Contents 1 VITROS Anti HBc Calibrator (anti-hbc negative human plasma, 2.2 ml) with antimicrobial agent, Bronidox 1.0% Lot calibration card Protocol card 8 calibrator bar code labels Calibrator Handling Use only with reagent packs of the same lot number. Mix thoroughly by inversion and bring to C (59 86 F) before use. Each pack contains sufficient for a minimum of 6 determinations of each calibrator. Handle calibrators in stoppered containers to avoid contamination and evaporation. To avoid evaporation, limit the amount of time calibrators are on the system. Refer to the operating instructions for your system. Return to 2 8 C (36 46 F) as soon as possible after use, or load only sufficient volume for a single determination. Calibrator Storage and Preparation Calibrator Storage Condition Stability Unopened Refrigerated 2 8 C (36 46 F) expiration date Opened Refrigerated 2 8 C (36 46 F) 13 weeks Opened Frozen -20 C ( -4 F) 13 weeks The VITROS Anti HBc Calibrator is supplied ready for use. The VITROS Anti HBc Calibrator is suitable for use until the expiration date on the carton when they are stored and handled as specified. Do not use beyond the expiration date. Opened calibrators may be stored frozen (with no more than 1 freeze-thaw cycle). The VITROS Anti HBc test uses 50 μl of calibrator for each determination. The VITROS Anti HBc Calibrators may be used directly on the VITROS Immunodiagnostic and VITROS Integrated Systems. Alternatively, transfer an aliquot of each calibrator into a sample container (taking account of the minimum fill volume of the container), which may be bar coded with the labels provided. For details on minimum fill volume of sample cups or containers, refer to the operating instructions for your system. Version 11.1 Pub. No. GEM1211_US_EN 3 of 21

4 INSTRUCTIONS FOR USE Specimen Collection, Preparation and Storage The VITROS Anti HBc Calibrator is automatically processed in duplicate. Specimen Collection, Preparation and Storage Patient Preparation No special patient preparation is necessary. Specimens Recommended Serum EDTA plasma Citrate plasma Specimens Not Recommended Do not use turbid specimens. Turbidity in specimens may affect test results. Do not use heat inactivated samples. Special Precautions IMPORTANT: Certain collection devices have been reported to affect other analytes and tests. 8 Owing to the variety of specimen collection devices available, Ortho Clinical Diagnostics is unable to provide a definitive statement on the performance of its products with these devices. Confirm that your collection devices are compatible with this test. Specimen Collection and Preparation Collect specimens using standard procedures. 9, 10 Samples should be thoroughly separated from all cellular material. Failure to do so may lead to an erroneous result. Thoroughly mix samples by inversion and bring to C (59 86 F) before use. The VITROS Anti HBc test uses 50 μl of sample for each determination. This does not take account of the minimum fill volume of the chosen sample container. For details on minimum fill volume of sample cups or containers, refer to the operating instructions for your system. Handling and Storage Conditions Handle specimens in stoppered containers to avoid cross-contamination and evaporation. Use a separate disposable tip if samples are manually pipetted. Avoid splashing, forming an aerosol, or cross-contaminating sample tube stoppers. The amount of time samples are on the system prior to analysis should be limited to avoid evaporation. This time should not exceed 3 hours. Refer to the operating instructions for your system. The National Committee for Clinical Laboratory Standards (NCCLS) provides the following recommendations for storing specimens: 11 Store samples at 22 C (72 F) for no longer than 8 hours. If the test will not be completed within 8 hours, refrigerate samples at 2 8 C (36 46 F). If the test will not be completed within 48 hours, or for shipment, freeze samples at or below -20 C (-4 F). Samples are not to be repeatedly frozen and thawed because this can cause analyte deterioration. Samples are to be thawed only once. Testing Procedure Materials Provided VITROS Immunodiagnostic Products Anti HBc Reagent Pack VITROS Immunodiagnostic Products Anti HBc Calibrator Materials Required but Not Provided VITROS Immunodiagnostic Products Signal Reagent VITROS Immunodiagnostic Products Universal Wash Reagent Quality control materials, such as VITROS Immunodiagnostic Products Anti HBc Controls VITROS Immunodiagnostic Products High Sample Diluent B VITROS Immunodiagnostic Products Reagent Pack Storage Box (optional) with desiccant 4 of 21 Pub. No. GEM1211_US_EN Version 11.1

5 Calibration Operating Instructions Check the inventory regularly to aid the management of reagents and ensure that sufficient VITROS Signal Reagent, VITROS Universal Wash Reagent and calibrated reagent lots are available for the work planned. When performing panels of tests on a single sample, ensure that the sample volume is sufficient for the tests ordered. For detailed instructions on the operation of the VITROS Immunodiagnostic and VITROS Integrated Systems refer to the operating instructions for your system. Note: Do not use visibly damaged product. Sample Dilution Rare patient samples occur that give high result ratios (s/c) greater than the normal negative population and which may be negative or positive for anti-hbc total antibody. These samples are defined by a result of greater than or equal to 4.8 s/c ratio and are most likely attributed to an unidentified interferent. For samples with results flagged Equivocal, dilute a measured aliquot with an appropriate volume of VITROS High Sample Diluent B to give a 1 in 20 dilution. For example, dilute 100 μl sample with 1.90 ml VITROS High Sample Diluent B and vortex mix. The system does not need to be programmed for the dilution factor when testing the diluted sample using the VITROS Anti-HBc Reagent Pack. The results for a diluted sample should be interpreted as described in the VITROS Anti-HBc Reagent Pack Instructions for Use. Default Test Name The default test name which will appear on patient reports is Anti HBc. The default short name that will appear on the test selection menus and laboratory reports is. These defaults may be reconfigured, if required. For detailed information refer to the operating instructions for your system. Calibration Calibration Procedure Calibration is lot specific; reagent packs and calibrators are linked by lot number. Reagent packs from the same lot may use the same calibration. A Master Calibration is established for each new reagent lot by performing multiple tests. This is the process by which a lot-specific parameter [a] which links the signal at the cutoff (cutoff value) to the calibrator signal is determined. Cutoff value = (a x Signal of Cal 1) Ensure that the Master Calibration for each new reagent lot is available on your system. Process the calibrator in the same manner as samples. Load sufficient for the automatic duplicate determination. Calibration need not be programmed if bar code labels are used; Calibration will be initiated automatically. When the calibrator is processed the validity of the calibration is assessed against quality parameters which compares the actual signal of the calibrator with the expected signal. If the calibration is acceptable the cutoff value is calculated and stored for use with any reagent pack of that lot. The quality of calibration cannot be completely described by a single parameter. The calibration report should be used in conjunction with acceptable control values to determine the validity of the calibration. Recalibration is required after a pre-determined calibration interval, or when a different reagent lot is loaded. Calibration results are assessed against a range of quality parameters. Failure to meet any of the defined quality parameter ranges will be coded in the calibration report. For actions to be taken following a failed calibration, refer to the operating instructions for your system Refer to the operating instructions for your system for detailed instructions on the calibration process. When to Calibrate Calibrate when the reagent pack and calibrator lot changes. Calibrate every 28 days. After specified service procedures have been performed. If quality control results are consistently outside of your acceptable range. For additional information on when to calibrate, refer to the operating instructions for your system. Traceability of Calibration The calibration of the VITROS Anti-HBc test is traceable to in-house reference calibrators, which have been value-assigned to optimize the clinical sensitivity and specificity performance. Calibration Model Results are calculated as a normalized signal, relative to a cutoff value. During the calibration process a lot-specific parameter is used to determine a valid stored cutoff value for the VITROS Immunodiagnostic and VITROS Integrated Systems. Version 11.1 Pub. No. GEM1211_US_EN 5 of 21

6 INSTRUCTIONS FOR USE Quality Control Quality Control Quality Control Material Selection VITROS Anti HBc Controls are recommended for use with the VITROS Immunodiagnostic and VITROS Integrated Systems. The performance of other commercial control fluids should be evaluated for compatibility with this test before they are used for quality control. Choose control material that has a composition similar to or identical with the patient sample matrix being analyzed. 12 Control materials may show a difference when compared with other anti HBc methods if they contain high concentrations of preservatives, stabilizers, or other nonphysiological additives, or otherwise depart from a true human sample matrix. Appropriate quality control value ranges must be established for all quality control materials used with the VITROS Anti HBc test. Quality Control Procedure Recommendations Good laboratory practice requires that controls be processed to verify the performance of the test. Choose control levels that check the clinically relevant concentrations. The recommendation is to run a negative control and a positive control close to the anti-hbc decision point [signal/cutoff (s/c) 1.00]. To verify system performance, analyze control materials: After calibration According to local regulations or at least once each day that the test is being performed After specified service procedures or maintenance to critical parts or subsystems that might influence performance of the test If quality control procedures within your laboratory require more frequent use of controls, follow those procedures. Analyze quality control materials in the same manner as patient specimens. If control results fall outside your acceptable range, investigate the cause before deciding whether to report patient results. Investigate and determine the cause for the unacceptable control results. When the condition is corrected, retest the controls and confirm that results are within acceptable limits. It is advisable to repeat some or all patient specimens before reporting results for this run. Refer to published guidelines for general quality control recommendations. 13 Additional controls may be tested according to guidelines or requirements of local, state, and/or federal regulations or accrediting organizations. For more detailed information, refer to the operating instructions for your system. Quality Control Material Preparation and Storage Refer to the manufacturer s product literature for preparation, storage, and stability information. Results Results are automatically calculated by the VITROS Immunodiagnostic and VITROS Integrated Systems. Result Calculation Results are calculated as a normalized signal, relative to the cutoff value (signal/cutoff, s/c). During the calibration process, a lot-specific parameter, is used to determine a valid stored cutoff value for the VITROS Immunodiagnostic and VITROS Integrated Systems. Result = Signal for test sample Cutoff value Patient sample results will be displayed with a Reactive, Retest?, Negative or Equivocal label. An initial result labeled with Retest? indicates a sample that requires duplicate repeat testing for anti-hbc. An initial result labeled Equivocal indicates a sample that requires dilution and re-test. Result (s/c) < and 1.10 >1.10 and < Result Text Reactive Retest? Negative Equivocal Final results should be manually interpreted using the algorithm below. 6 of 21 Pub. No. GEM1211_US_EN Version 11.1

7 Results Testing Algorithm Interpretation of Results The following table summarizes the interpretation of results obtained with the VITROS Anti-HBc test upon completion of all testing steps required in the testing algorithm. Initial VITROS Anti-HBc Test Result (s/c) Conclusion from Testing Algorithm Interpretation <0.90 Reactive Specimen is presumed to be reactive for anti-hbc and 1.10 Retest in duplicate 0.90 and 1.10 Retest in duplicate If 2 of 3 results are 1.00 then specimen is presumed to be reactive for anti-hbc If 2 of 3 results are >1.00 and <4.80 then specimen is negative for anti-hbc. >1.10 and <4.80 Negative Specimen is negative for anti-hbc Dilute 1:20 and retest 4.80 Dilute 1:20 and retest 4.80 Dilute 1:20 and retest * Results of the diluted sample do not require correction for the dilution factor. If 1:20 dilution and retest * result is 1.00, then specimen is presumed to be reactive for anti-hbc. If 1:20 dilution and retest * result is >1.00 and <4.80, then specimen is negative for anti-hbc. If 1:20 dilution and retest * result is still 4.80, then do not dilute the sample further but examine using an alternate method. Results obtained with the VITROS Anti-HBc test may not be used interchangeably with values obtained with different manufacturers test methods. The magnitude of a VITROS Anti-HBc test result cannot be correlated to an endpoint titer. Neonate samples with results 0.90 and 1.10 should not be retested in duplicate. Obtain a new sample and retest. Version 11.1 Pub. No. GEM1211_US_EN 7 of 21

8 INSTRUCTIONS FOR USE Expected Values Expected Values Approximately 65.7% (1111/1691) of the prospective subjects in Population I reported no recent or current signs or symptoms of hepatitis. Of these 1111 asymptomatic individuals, 25.3% were enrolled in Miami, FL, 36.5% were enrolled in Dallas, TX, and 38.2% were enrolled in Chicago, IL. The group was Caucasian (27.7%), African American (44.8%), Hispanic (18.7%), and Asian (4.8%) with the remaining 4% represented by other ethnic groups. The group was 51.6% male and 48.4% female and ranged in age from 5 to 89 years. All were at risk for viral hepatitis due to lifestyle, behavior, occupation or known exposure event. The VITROS Anti-HBc test was reactive in 20.6% of the individuals in this group. The percent VITROS Anti-HBc reactive results observed in the asymptomatic population at each site was 4.5% at Miami, FL, 8.3% at Dallas, TX, and 7.8% at Chicago, IL. The table below summarizes the distribution of VITROS Anti-HBc reactive and negative results among the study subjects without signs or symptoms of hepatitis, by age and gender. Expected Results for the VITROS Anti-HBc Test in Study Subjects without Signs or Symptoms of Hepatitis - Population I (N=1111) Age Range Gender Reactive VITROS Anti-HBc Result Negative N Percent N Percent Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Total * * Age was not reported for 3 subjects. Expected results for the VITROS Anti-HBc test were also determined using unlinked samples from a population of pediatric and adolescent subjects in Utah at low risk for viral hepatitis (N=100). The group was 57% male and 43% female, and the subjects ages ranged from two to 19 years. Three (3.0%) samples were reactive with the VITROS Anti-HBc test and were tested with the reference anti-hbc test. Two of these three were found to be reference anti-hbc test reactive. Total 8 of 21 Pub. No. GEM1211_US_EN Version 11.1

9 Limitations of the Procedure Expected Results for the VITROS Anti-HBc Test in Pediatric and Adolescent Subjects at Low Risk for Viral Hepatitis (N=100) Age Range Gender Reactive VITROS Anti-HBc Result Negative N Percent N Percent Female Male Female Male Female Male Female Male Total Total Limitations of the Procedure Known Interferences The VITROS Anti-HBc test was evaluated for interference consistent with CLSI document EP7. 14 Commonly encountered substances were tested on 2 lots of reagents. Of the compounds tested, none was found to interfere with the clinical interpretation of the test. Refer to Substances that do not Interfere for a list of compounds tested that did not show interference. Other Limitations The results from this or any other diagnostic kit should be used and interpreted only in the context of the overall clinical picture. A negative test result does not exclude the possibility of exposure to hepatitis B virus. Levels of anti-hbc may be undetectable both in early infection and late after infection. Heterophilic antibodies in serum or plasma samples may cause interference with immunoassays. 15 These antibodies may be present in blood samples from individuals regularly exposed to animals or who have been treated with animal serum products. Results, which are inconsistent with clinical observations, indicate the need for additional testing. Performance Characteristics Unless otherwise noted, data in the Performance Characteristics section were generated using the VITROS ECi/ECiQ Immunodiagnostic Systems. Clinical Performance A multi-center prospective study was conducted to evaluate the clinical performance of the VITROS Anti-HBc test among individuals with signs or symptoms or biochemical manifestations (elevated liver function tests) of hepatitis and those at high risk of hepatitis infection due to lifestyle, behavior, occupation, or known exposure events. Specimens were obtained from 1691 subjects prospectively enrolled at three geographically separated collection sites within the United States (Population I) located in Miami, FL (37.0%), Dallas, TX (28.1%) and Chicago, IL (34.9%). Specimens were also obtained from 315 subjects prospectively enrolled in an area in India with a high prevalence of viral hepatitis (Population II). Statistical testing performed to evaluate the homogeneity of the distribution of VITROS Anti-HBc s/c values across the four collection sites indicated that the data from Population I and Population II could not be pooled for statistical analysis. The HBV disease classification for each subject was determined by a single point serological assessment using a hepatitis marker profile consisting of reference tests (previously licensed or approved by the FDA) for the detection of HBsAg, HBeAg, anti-hbc, anti-hbc IgM, anti-hbe, and anti-hbs (quantitative). The reference tests' procedures were adhered to during the clinical laboratory study. The subjects in Population I were Caucasian (24.9%), African American (44.1%), Hispanic (22.4%) and Asian (3.7%), with the remaining 4.9% represented by other ethnic groups. The group was 52.4% male and 47.6% female, and ranged in age from 5 to 89 years. Testing of these specimens with the VITROS Anti-HBc test occurred at diagnostic laboratories located in Miami, FL (37.0%), Port Jefferson, NY (34.9%) and Minneapolis MN, (28.1%). Agreement of the VITROS Anti-HBc test was assessed relative to the reference anti-hbc test and HBV disease classification using serum samples from the 1691 subjects in Population I. The subjects in Population II were Indian (100.0%). The group was 73.0% male and 27.0% female, and ranged in age from 18 to 90 years. Testing of these specimens with the VITROS Anti-HBc test occurred at diagnostic laboratories located in Miami, FL (33.0%), Minneapolis MN, (32.4%) and Los Angeles, CA (34.6%). Agreement of the VITROS Anti-HBc test was Version 11.1 Pub. No. GEM1211_US_EN 9 of 21

10 INSTRUCTIONS FOR USE Performance Characteristics assessed relative to the reference anti-hbc test and HBV disease classification using serum samples from the 315 subjects in Population II. Results by Specimen Classification The data were analyzed following the assignment of HBV disease classifications based upon the positive (+) / negative (-) patterns for the six HBV serological reference markers. The table below summarizes how these classifications were derived. There were 28 unique reference marker profiles observed among the subjects in Populations I and II (24 unique patterns in Population I and 18 unique patterns in Population II) during the VITROS Anti-HBc clinical study. HBV Reference Marker Profiles and HBV Disease Classification Reference HBsAg *, ** Reference HBeAg Reference IgM Reference Total Reference ahbe Reference ahbs 10 miu/ml HBV Disease Classification Acute Acute Acute Acute Acute + Acute Chronic Chronic Chronic Chronic Chronic + + Chronic Early Recovery Early Recovery Early Recovery + + Early Recovery + + Early Recovery Recovery + + Recovered + Recovered + HBV Vaccine Response Not Previously Infected with HBV Uninterpretable + + Uninterpretable + + Uninterpretable + + Uninterpretable + Uninterpretable + Uninterpretable * Positive = Reference HBsAg test reactive and confirmed by neutralization. ** Negative = Reference HBsAg test negative or not confirmed by neutralization. Comparison of Results The table below compares the VITROS Anti-HBc results with the reference anti-hbc results by specimen classification for the subjects in Population I. 10 of 21 Pub. No. GEM1211_US_EN Version 11.1

11 Performance Characteristics Comparison of VITROS Anti-HBc Results with Reference Anti-HBc Results by HBV Disease Classification - Population I (N=1691) HBV Disease Classification Reference Anti-HBc Result Reactive Negative VITROS Anti-HBc Test Result VITROS Anti-HBc Test Result Reactive Negative * Reactive Negative Total Acute Chronic Early Recovery Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV ** Uninterpretable Overall * These samples were tested with a second FDA approved anti-hbc test with the following results: Chronic: 2/3 negative, Early recovery: 1/1 indeterminate, Recovered: 18/28 negative; 1/28 indeterminate, Uninterpretable: 1/1 negative, Overall: 23/33 (69.7%) negative or indeterminate. ** These samples were tested with a second FDA approved anti-hbc test with the following results: 2/5 (40%) positive. The table below compares the VITROS Anti-HBc results with the reference anti-hbc results by specimen classification for the subjects in Population II. Comparison of VITROS Anti-HBc Results with Reference Anti-HBc Results by HBV Disease Classification - Population II (N=315) HBV Disease Classification Reference Anti-HBc Result Reactive Negative VITROS Anti-HBc Test Result VITROS Anti-HBc Test Result Reactive Negative * Reactive Negative Total Acute Chronic Early Recovery Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV Uninterpretable Overall * Zero of three samples were negative with a second FDA approved anti-hbc test. One sample (Chronic) was not tested (insufficient volume). Percent Agreement Positive and negative percent agreement between the VITROS Anti-HBc test and the reference anti-hbc test were calculated for subjects in Population I (N=1691) with various HBV disease classifications, and for the overall study population. The table below summarizes these calculations and provides the upper and lower 95% exact confidence intervals. Version 11.1 Pub. No. GEM1211_US_EN 11 of 21

12 INSTRUCTIONS FOR USE Performance Characteristics Positive and Negative Percent Agreement between the VITROS Anti-HBc and Reference Anti-HBc Tests in Population I Overall Acute Chronic HBV Disease Classification Early Recovery Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV Uninterpretable Positive Percent Agreement (%) 400/433 (92.38%) 8/8 40/43 (93.02%) 46/47 (97.87%) 138/ /196 (85.71%) () () 0/1 (0%) 95% Exact Confidence Interval Negative Percent Agreement (%) 1253/1258 (99.60%) 9/9 () () () () 169/ /1074 (99.53%) 6/6 95% Exact Confidence Interval The positive percent agreement with the reference anti-hbc test was determined by dividing the number of reactive VITROS Anti-HBc results by the total number of subjects reactive with the reference anti-hbc test. As a result of this study, the overall positive percent agreement of the VITROS Anti-HBc test with the reference anti-hbc test in Population I was estimated to be 92.38% (400/433, with a 95% exact confidence interval of 89.46% to 94.70%). The negative percent agreement with the reference anti-hbc test was determined by dividing the number of negative VITROS Anti-HBc results by the total number of subjects negative with the reference anti-hbc test. As a result of this study, the overall negative percent agreement of the VITROS Anti-HBc test with the reference anti-hbc test in Population I was estimated to be 99.60% (1253/1258, with a 95% exact confidence interval of 99.07% to 99.87%). Positive and negative percent agreement between the VITROS Anti-HBc test and the reference anti-hbc test were also calculated for subjects in Population II (N=315) with various HBV disease classifications, and for the overall study population. The table below summarizes these calculations and provides the upper and lower 95% exact confidence intervals. Positive and Negative Percent Agreement between the VITROS Anti-HBc and Reference Anti-HBc Tests in Population II Overall Acute Chronic HBV Disease Classification Early Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV Uninterpretable Positive Percent Agreement (%) 273/277 (98.56%) 86/88 (97.73%) 184/185 (99.46%) 1/1 2/3 (66.67%) () () () 95% Exact Confidence Interval Negative Percent Agreement (%) 38/38 16/16 () () () 3/3 17/17 2/2 95% Exact Confidence Interval The positive percent agreement with the reference anti-hbc test was determined by dividing the number of reactive VITROS Anti-HBc results by the total number of subjects repeatedly reactive with the reference anti-hbc test. As a result of 12 of 21 Pub. No. GEM1211_US_EN Version 11.1

13 Performance Characteristics this study, the overall positive percent agreement of the VITROS Anti-HBc test with the reference anti-hbc test in Population II was estimated to be 98.56% (273/277, with a 95% exact confidence interval of 96.34% to 99.61%). The negative percent agreement with the reference anti-hbc test was determined by dividing the number of negative VITROS Anti-HBc results by the total number of subjects negative with the reference anti-hbc test. As a result of this study, the overall negative percent agreement of the VITROS Anti-HBc test with the reference anti-hbc test in Population II was estimated to be 100.0% (38/38, with a 95% exact confidence interval of 90.75% to 100.0%). The performance of the VITROS Anti-HBc test was further evaluated among archived serum samples from subjects with clinical and laboratory documentation of acute or chronic (HBsAg present for 6 months) HBV infection. The table below summarizes the performance of the VITROS Anti-HBc test in samples from subjects with documented acute or chronic HBV infection. Overall Clinical Performance of the VITROS Anti-HBc Test in Samples from Subjects with Clinically Documented Acute or Chronic HBV Infection HBV Infection Number of Samples Number (%) of VITROS Anti-HBc Reactive Samples 95% Exact Confidence Interval Acute 8 8 (100.0) Chronic (98.7) Total (98.8) Clinical Performance of the VITROS Anti-HBc Test in Pre-Vaccination Samples Serum samples obtained from 41 individuals immediately prior to HBV vaccination were tested with the VITROS and reference anti-hbc tests. The results are shown below for both tests. VITROS and Reference Anti-HBc Results in Pre-Vaccination Samples (N=41) Test Result Reference Anti-HBc Test VITROS Anti-HBc Test Initially Negative Initially Reactive 4 NA Repeatedly Reactive 0 NA Total Negative Results Seroconversion Panels Six commercially available seroconversion panels were tested. The VITROS and reference anti-hbc test results are summarized below. The table lists the first bleed of each panel that tested reactive with the VITROS and the reference tests as well as the difference between the two tests in identifying the first reactive panel member by number of days. Anti-HBc Seroconversion Panel Study - Summary Results Panel ID Days to Reactive Anti-HBc Result Reference Anti-HBc Test VITROS Anti-HBc Test Difference in Days to Anti HBc Reactive Result * + ** * + ** Reference - VITROS PHM935A RP RP RP * Post bleed day of last nonreactive result, usually denotes previous bleed from first reactive. ** Post bleed day of first reactive result. Potentially Cross-Reacting Subgroups Samples with evidence of hepatitis A virus infection (HAV) or hepatitis C virus infection (HCV) were identified in a population of 1691 samples prospectively collected from subjects in the U.S with signs or symptoms of, or at risk for, viral hepatitis (Population I). The tables below compare VITROS Anti-HBc results with reference anti-hbc results according to the HBV disease classifications assigned to the study subjects. Version 11.1 Pub. No. GEM1211_US_EN 13 of 21

14 INSTRUCTIONS FOR USE Performance Characteristics Comparison of VITROS and Reference Anti-HBc Results and HBV Disease Classification Among Anti HAV IgM Reactive Study Subjects - Population I (N=7) HBV Disease Classification Reactive VITROS Anti-HBc Result Reference Anti-HBc Result Negative VITROS Anti-HBc Result Reactive Negative Reactive Negative Acute Chronic Early Recovery Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV Uninterpretable Overall Total Comparison of VITROS and Reference Anti-HBc Results and HBV Disease Classification Among Anti-HCV Reactive Study Subjects - Population I (N=353) HBV Disease Classification Reference Anti-HBc Result Reactive Negative VITROS Anti-HBc Result VITROS Anti-HBc Result Reactive Negative Reactive Negative Total Acute Chronic Early Recovery Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV Uninterpretable Overall Samples with evidence of hepatitis A virus infection (HAV) and/or hepatitis C virus infection (HCV) were identified in a population of 315 samples prospectively collected from subjects in an area in India with a high prevalence of viral hepatitis (Population II). The tables below compare VITROS Anti-HBc results with reference anti-hbc results according to the HBV disease classifications assigned to the study subjects. Comparison of VITROS and Reference Anti-HBc Results and HBV Disease Classification Among Anti-HAV IgM Reactive Study Subjects - Population II (N=29) HBV Disease Classification Reactive VITROS Anti-HBc Result Reference Anti-HBc Result Negative VITROS Anti-HBc Result Reactive Negative Reactive Negative Acute Chronic Early Recovery Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV Uninterpretable Overall Total 14 of 21 Pub. No. GEM1211_US_EN Version 11.1

15 Performance Characteristics Comparison of VITROS and Reference Anti-HBc Results and HBV Disease Classification among Anti HCV Reactive Study Subjects - Population II (N=90) HBV Disease Classification Reactive VITROS Anti-HBc Result Reference Anti-HBc Result Negative VITROS Anti-HBc Result Reactive Negative Reactive Negative Acute Chronic Early Recovery Recovery Recovered HBV Vaccine Response Not Previously Infected with HBV Uninterpretable Overall The specificity of the VITROS Anti-HBc test was evaluated by testing 232 samples from 16 potentially cross-reacting subgroups. Patient samples from the following sub-groups were tested: HAV, HEV, HCV, non-viral liver disease, autoimmune disease (rheumatoid arthritis and systemic lupus erythrematosis), CMV, EBV, HSV, parvovirus B19 infection, rubella, syphilis, toxoplasmosis, HIV 1/2 antibody positive, HTLV 1/2 antibody positive, and HBV vaccine recipients. Of the 232 samples tested, 230 were observed to be negative. One autoimmune disease (rheumatoid arthritis) sample was initially reactive in the VITROS Anti-HBc test, but was negative on repeat determination. One Syphilis sample was reactive initially in the VITROS Anti-HBc test and also on repeat determination. Total Summary of Specificity Data from Cross-Reacting Sub-Groups Sample Category No. Samples Tested VITROS Anti HBc Test Results Negative Initial Reactive Repeat Reactive Hepatitis A Infection Hepatitis C Infection HEV Infection Nonviral Liver Disease Autoimmune Diseases (Rheumatoid arthritis) Autoimmune Diseases (Lupus Erythrematosis) CMV IgM Positive EBV IgM Positive HSV IgM Positive Parvovirus B19 Infection Rubella Infection Syphilis Infection Toxoplasmosis Infection HIV ½ Ab Positive HTLV ½ Ab Positive HBV Vaccine Recipients A total of 20 cord blood patient samples were tested in the VITROS Anti-HBc test. In testing the cord blood samples, 1 out of 20 samples was found to give a repeatedly reactive result in the VITROS Anti- HBc test. This repeatedly reactive sample was also repeatedly reactive in the reference method. Summary of VITROS Anti-HBc Specificity Data from Cross-Reacting Sub-Groups Sample Category No. Samples Tested No. Negative No. Initially Reactive No. Repeatedly Reactive * Cord Blood * The sample was also repeatedly reactive with the reference Anti-HBc test. Version 11.1 Pub. No. GEM1211_US_EN 15 of 21

16 INSTRUCTIONS FOR USE Performance Characteristics Substances that do not Interfere The potentially interfering effects of hemoglobin, bilirubin and triolein were evaluated using samples from 10 blood donors. The results (mean of test results at each level of interferent) demonstrate that hemoglobin (up to 500 mg/dl), bilirubin (up to 20 mg/dl) and triolein (up to 3000 mg/dl), cause no misclassification of results. Anti-HBc spiked samples were tested near the cutoff (cutoff s/c=1.00), and were observed to remain reactive at all levels tested with each potential interferent. Similarly no interference was observed in samples not spiked with anti-hbc (Negative), with anti-hbc values remaining above 2.00 s/c. Hemoglobin Test Substance Maximum Level Tested Mean Result at 0 Interferent Level Mean Result at Maximum Interferent Level s/c Classification s/c Classification anti-hbc Spiked Specimen 500 mg/dl 0.76 Reactive 0.76 Reactive anti-hbc Negative Specimen 500 mg/dl 2.97 Negative 2.92 Negative Bilirubin anti-hbc Spiked Specimen 20 mg/dl 0.69 Reactive 0.50 Reactive anti-hbc Negative Specimen 20 mg/dl 2.99 Negative 2.91 Negative Triolein anti-hbc Spiked Specimen 3000 mg/dl 0.62 Reactive 0.54 Reactive anti-hbc Negative Specimen 3000 mg/dl 2.98 Negative 3.00 Negative Precision VITROS ECi/ECiQ Immunodiagnostic System Precision was evaluated 16 on a different VITROS ECi/ECiQ Immunodiagnostic System at three external sites, using one reagent pack and calibrator kit lot. At least two replicates each of a three member panel were tested on a single occasion per day on 20 different days. The data shown in the table were rounded following all calculations. Clinical Site Site 1 Site 2 Site 3 Mean VITROS S/C (Ratio) Within Day * Between Day ** Total *** No. SD CV (%) SD CV (%) SD CV (%) Obs * Within Day: Variability of the test performance from replicate to replicate. ** Between Day: Variability of the test performance from day to day. *** Total: Variability of the test performance combining the effects of within day and between day. No. Days Precision was further evaluated incorporating between site and between lot variation. The study was performed at three external sites using three reagent lots. At least three replicates each of a four member panel were tested on a single occasion per day on six different days. The between site, between lot, and total precision estimates (CV (%)) were derived from a variance component analysis. The data shown in the table were rounded following all calculations. Mean VITROS Anti-HBc S/C (Ratio) Between Site * Between Lot ** Total *** No. Obs. SD CV (%) SD CV (%) SD CV (%) * Between site: Variability of the test performance from site to site. ** Between lot: Variability of the test performance from lot-to-lot, calculated using data across all sites. *** Total: Variability of the test incorporating factors of site, lot and day. 16 of 21 Pub. No. GEM1211_US_EN Version 11.1

17 Performance Characteristics WARNING: Test reproducibility has not been established when using a plasma matrix. It is recommended when using these matrices the user establish reproducibility by performing the appropriate reproducibility studies. VITROS 3600 Immunodiagnostic System and VITROS 5600 Integrated System Precision was evaluated consistent with CLSI document EP5. 17 Two replicates each of 4 samples were tested on 2 separate occasions per day on at least 20 different days. The experiment was performed using 1 reagent lot on each system. The data presented are a representation of the product performance. System ECi/ECiQ Mean VITROS Anti-HBc S/C (Ratio) Units = S/C (Ratio) Within Day * Between Day ** Total *** SD CV (%) SD CV (%) SD CV (%) No. Observ * Within Day: variability of the assay performance from replicate to replicate ** Between Day: variability of the assay performance from day to day *** Total: variability of the assay performance combining the effects of within day and between day No. Days Precision was further evaluated incorporating between site variation. The study was performed at four sites using one reagent lot. Four replicates each of a four member panel were tested on two occasions per day on five different days. The within lab, between site, and total precision estimates (CV (%)) were derived from a variance component analysis. The data shown in the table were rounded following all calculations. System ECi/ECiQ Mean VITROS Anti-HBc S/C (Ratio) Units = S/C (Ratio) Within Lab Between Site Total Inter-lab SD CV (%) SD CV (%) SD CV (%) No. Observ Percent Agreement Between VITROS ECi/ECiQ Immunodiagnostic Systems, the VITROS 3600 Immunodiagnostic System and the VITROS 5600 Integrated System Percent agreement was evaluated in a method comparison study using 183 serum and plasma patient samples (93 negative and 90 positive) that targeted the testing range of the assay. Results from samples analyzed on the VITROS ECi/ ECiQ Immunodiagnostic System were compared with those analyzed on the VITROS 3600 Immunodiagnostic and the VITROS 5600 Integrated Systems at 4 different sites with a single reagent lot. Positive and negative percent confidence intervals were determined using a bootstrap analysis. Version 11.1 Pub. No. GEM1211_US_EN 17 of 21

18 INSTRUCTIONS FOR USE References Percent Agreement of Samples to VITROS ECi/ECiQ Immunodiagnostic Systems System Positive Agreement ( 1.00 s/c) 95% Confidence Intervals Negative Agreement (>1.00 s/c) 95% Confidence Intervals % % % % References 1. Hoofnagle, JH., Seeff, LB., Bales, ZB., Zimmerman, HJ. Veterans Administration Hepatitis Cooperative Study Group. Type B Hepatitis After Transfusion With Blood Containing Antibody to Hepatitis B Core Antigen. New England Journal of Medicine, 298: (1978). 2. Hoofnagle, JH., Gerety, RJ., Barker, LF., Antibody to Hepatitis B Virus Core in Man. Lancet, ii: (1973). 3. Hoofnagle, JH., Gerety, RJ., Ni, LY., Barker, LF. Antibody to Hepatitis B Core Antigen: A Sensitive Indicator of Hepatitis B Virus Replication. New England Journal of Medicine, 290: (1974). 4. Summers M et al. Luminogenic Reagent Using 3-Chloro 4-Hydroxy Acetanilide to Enhance Peroxidase/Luminol Chemiluminescence. Clin Chem. 41:S73; CDC-NIH. Biosafety in Microbiological and Biomedical Laboratories 3rd Edition, HHS Publication No. CDO U.S. Government Printing Office, Washington, D.C CLSI. Protection of Laboratory Workers from Occupationally Acquired Infections; Approved Guideline - Fourth Edition. CLSI document M29-A4. Wayne, PA: Clinical and Laboratory Standards Institute; Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures, amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/ Calam RR. Specimen Processing Separator Gels: An Update. J Clin Immunoassay. 11:86 90; CLSI. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard Sixth Edition. CLSI document H3-A6 (ISBN ). CLSI, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania , USA NCCLS. Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard Fifth Edition. NCCLS document H4-A5 [ISBN ]. NCCLS, 940 West Valley Road, Suite 1400, Wayne, PA USA, NCCLS. Procedures for the Handling and Processing of Blood Specimens; Approved Guideline Second Edition. NCCLS document H18-A2 (ISBN ). NCCLS, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087, NCCLS. Internal Quality Control: Principles and Definitions; Approved Guideline. NCCLS document C24-A (ISBN ). CLSI, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087, CLSI. Statistical Quality Control for Quantitative Measurements: Principles and Definitions; Approved Guideline - Third Edition. CLSI document C24 A3 [ISBN ]. CLSI, 940 West Valley Road, Suite 1400, Wayne, PA USA, Powers, D M et. al. (August 1986) NCCLS document EP7-P Interference Testing In Clinical Chemistry. Volume 6 Number Levinson SS. The Nature of Heterophilic Antibodies and Their Role in Immunoassay Interference. J Clin Immunoassay. 15: ; NCCLS. Evaluation of Precision Performance of Clinical Chemistry Devices: Approved Guideline. NCCLS document EP5-A (ISBN X). CLSI, 940 West Valley Road, Suite 1400, Wayne, PA , USA, NCCLS. Evaluation of Precision Performance of Quantitative Measurement Methods; Approved Guideline - Second Edition. NCCLS document EP5 A2 [ISBN ]. CLSI, 940 West Valley Road, Suite 1400, Wayne, PA USA, of 21 Pub. No. GEM1211_US_EN Version 11.1

19 Glossary of Symbols Glossary of Symbols Revision History Date of Revision Version Description of Technical Changes* Address Block: CHIRON logo changed to GRIFOLS logo Warnings and Precautions: changed Kathon to Kathon or ProClin Warnings and Precautions: changed 'FDA approved methods' to 'approved methods' Updated Legal Manufacturer address Version 11.1 Pub. No. GEM1211_US_EN 19 of 21

20 INSTRUCTIONS FOR USE Revision History Date of Revision Version Description of Technical Changes* Warnings and Precautions: added reference updated Hazard and Precaution Statements to align with the new Safety Data Sheets added Globally Harmonized Symbol to comply with the Classification, Labelling and Packaging (CLP) Regulations Calibrator Storage and Preparation: clarification of the frozen storage temperature References: updated M29 added reference Glossary of Symbols: added Globally Harmonized Symbols to comply with the Classification, Labelling and Packaging (CLP) Regulations Glossary of Symbols: added Date of Manufacture Interpretation of Results: updated wording Handling and Storage Conditions: updated data Glossary of Symbols: updated New format that combines the following into one document: Anti HBc Reagent Pack (GEM1211), version 1.0 Anti HBc Calibrator (GEMC211), version 1.0 Added information for the VITROS 3600 Immunodiagnostic System and the VITROS 5600 Integrated System Updated risk and safety statements References: updated Glossary of Symbols: updated Formatting updates Updated NCCLS to CLSI Materials Required but not Provided: Add VITROS Immunodiagnostic Products High Sample Diluent B Assay Procedure: Add Sample Dilution section Interpretation of Results and Expected Results: Section updated to add instrument flag of Equivocal for samples with results Interpretation of Results: Removed upon completion of all testing steps required in the testing algorithm References: Updated reference 6 Address Block: Added Novartis Vaccines and Diagnostics, Inc. Emeryville, CA Registered address updated to Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4DP, United Kingdom Address Block: Added Novartis Vaccines and Diagnostics, Inc. Emeryville, CA Changed all occurrences of VITROS Immunodiagnostic System, VITROS ECi System and VITROS ECi Immunodiagnostic System to VITROS ECi/ ECiQ Immunodiagnostic System. Testing Algorithm: Modified algorithm for consistency with other hepatitis flowcharts Glossary of Symbols: Added new table. Table updated for the addition of n to the following symbols: Contains Sufficient for n Tests Consult Instructions for Use, n version Initial version of Instructions for Use * The change bars indicate the position of a technical amendment to the text with respect to the previous version of the document. 20 of 21 Pub. No. GEM1211_US_EN Version 11.1

21 Revision History When this Instructions For Use is replaced, sign and date below and retain as specified by local regulations or laboratory policies, as appropriate. Signature Obsolete Date Conditions of supply: all supplies are made subject to the standard terms and conditions of Ortho-Clinical Diagnostics or its distributors. Copies of these are available on request. Ortho-Clinical Diagnostics Felindre Meadows Pencoed Bridgend CF35 5PZ United Kingdom Distributed in the US by: Ortho-Clinical Diagnostics, Inc. 100 Indigo Creek Drive Rochester, NY VITROS is a trademark of Ortho-Clinical Diagnostics, Inc. Ortho-Clinical Diagnostics, Inc., Version 11.1 Pub. No. GEM1211_US_EN 21 of 21