Table of Content

i. Market Guides......................................................................................................................20
iA. Situation Analysis & COVID Impact Overview ...................................................................... 21 iB. Guide for Executives and Marketing Staff ............................................................................. 24 iC. Guide for Investment Analysts and Management Consultants.......................................... 26 iD. Market Shares of Leading Companies – Table and Chart ................................................. 27
1. Introduction and Market Definition ...................................................................................28
1.1 What are Syndromic Multiplex Tests?.................................................................................... 29 1.2 Syndromic Testing – the quiet revolution in diagnostics ...................................................... 30
1.2.1 Syndromic Testing – more than Panels. .......................................................................... 31 1.3 Market Definition .................................................................................................................... 32 1.3.1 Multiplex Market Size ........................................................................................................ 32 1.3.2 Panel Market Size ............................................................................................................. 32 1.3.2 Currency ........................................................................................................................... 33 1.3.3 Years .................................................................................................................................. 33 1.4 Methodology .......................................................................................................................... 34 1.4.1 Authors .............................................................................................................................. 34 1.4.2 Sources.............................................................................................................................. 34 1.5 U.S. Medical Market and Clinical Laboratory Testing - Perspective................................... 35 1.5.1 U.S. Medicare Expenditures for Clinical Testing ............................................................. 36
2. The Infectious Diseases – Guide to the Pathogens ..........................................................38
2.0 The Coronavirus ...................................................................................................................... 39 2.0.1 Severe acute respiratory syndrome (SARS).................................................................... 41 2.0.2 Middle East respiratory syndrome (MERS) ...................................................................... 44
 
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2.0.3 COVID-19. The SARS CoV 2 Virus.................................................................................... 45 2.0.3.1 Signs and symptoms................................................................................................. 46 2.0.3.2 Transmission............................................................................................................... 47 2.0.3.3 Diagnosis ................................................................................................................... 48 2.0.3.4 Prevention................................................................................................................. 50 2.0.3.5 Management ........................................................................................................... 51 2.0.3.6 Prognosis ................................................................................................................... 52
2.1 HIV - Human Immunodeficiency Virus (AIDS)....................................................................... 53 2.1.1 Virology ............................................................................................................................. 53 2.1.1.1 Classification............................................................................................................. 53 2.1.1.2 Structure and genome ............................................................................................ 54 2.1.1.3 Tropism ...................................................................................................................... 56 2.1.1.4 Replication cycle ..................................................................................................... 58 2.1.1.5 Genetic variability .................................................................................................... 64 2.1.2 Diagnosis ........................................................................................................................... 66 2.1.3 Testing................................................................................................................................ 67 2.1.3.1 Antibody tests ........................................................................................................... 67 2.1.3.2 Point of Care Tests (POCT)....................................................................................... 70 2.1.3.4 Antigen Tests ............................................................................................................. 72 2.1.3.5 Nucleic acid-based tests (NAT)............................................................................... 73 2.1.3.6 Other tests used in HIV treatment ........................................................................... 74 2.2 HBV – Hepatitis B ..................................................................................................................... 76 2.2.1 Virology ............................................................................................................................. 77 2.2.1.1 Genome.................................................................................................................... 78 2.2.1.2 Pathogenesis ............................................................................................................ 79 2.2.1.3 Hepatitis B virus replication ...................................................................................... 79
 
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2.2.1.4 Serotypes and genotypes ....................................................................................... 80 2.2.2 Mechanisms...................................................................................................................... 80 2.2.3 Diagnosis ........................................................................................................................... 81 2.2.4 Market Opportunity Analysis............................................................................................ 82
2.3 HCV – Hepatitis C ................................................................................................................... 84 2.3.1 Taxonomy.......................................................................................................................... 85 2.3.2.1 Structure .................................................................................................................... 85 2.3.2.2 Genome.................................................................................................................... 86 2.3.3 Molecular biology ............................................................................................................ 87 2.3.4 Replication........................................................................................................................ 88 2.3.5 Genotypes ........................................................................................................................ 90 2.3.5.1 Clinical importance ................................................................................................. 90 2.3.6 Market Opportunity Analysis............................................................................................ 91 2.4 HPV - Human papillomavirus ................................................................................................. 93 2.4.1 Virology ............................................................................................................................. 95 2.4.1.1 E6/E7 proteins ........................................................................................................... 95 2.4.1.2 Role in cancer .......................................................................................................... 95 2.4.1.3 E2 research ............................................................................................................... 96 2.4.1.4 Latency period ......................................................................................................... 97 2.4.1.5 Clearance................................................................................................................. 97 2.4.2 Diagnosis ........................................................................................................................... 98 2.4.2.1 Cervical testing......................................................................................................... 98 2.4.2.2 Oral testing.............................................................................................................. 100 2.4.2.3 Testing men............................................................................................................. 100 2.4.2.4 Other testing ........................................................................................................... 101 2.4.3 Market Opportunity Analysis.......................................................................................... 102
 
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2.5 Influenza ................................................................................................................................ 108 2.5.1 Virology ........................................................................................................................... 109 2.5.1.1 Types of virus ........................................................................................................... 109 2.5.1.2 Influenzavirus A ....................................................................................................... 109 2.5.1.3 Influenzavirus B........................................................................................................ 110 2.5.1.4 Influenzavirus C....................................................................................................... 110 2.5.1.5 Structure, properties, and subtype nomenclature .............................................. 111 2.5.1.6 Replication.............................................................................................................. 112 2.5.2 Testing.............................................................................................................................. 114 2.5.2.1 Advantages/Disadvantages of Molecular Assays .............................................. 116 2.5.3 Market Opportunity Analysis.......................................................................................... 117 2.6 CTGC - Chlamydia/Gonorhea............................................................................................ 126 2.6.1 Gonorrhea ...................................................................................................................... 126 2.6.1.1 Diagnosis ................................................................................................................. 127 2.6.1.2 Screening ................................................................................................................ 127 2.6.2 Chlamydia ...................................................................................................................... 127 2.6.2.1 Diagnosis ................................................................................................................. 128 2.6.2.2 Screening ................................................................................................................ 129 2.6.3 Testing.............................................................................................................................. 130 2.6.3.1 Nucleic acid amplification tests (NAATs). ............................................................ 130 2.6.3.2 Performance of NAAT Tests ................................................................................... 138 2.6.4 Market Opportunity Analysis.......................................................................................... 139 2.7 Tuberculosis ........................................................................................................................... 142 2.7.1 Mycobacteria................................................................................................................. 143 2.7.2 Diagnosis ......................................................................................................................... 144 2.7.2.1 Active tuberculosis ................................................................................................. 144
 
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2.7.2.2 Latent tuberculosis ................................................................................................. 145 2.7.3 Epidemiology.................................................................................................................. 145 2.7.4 Molecular Diagnostic Tests ............................................................................................ 147 2.7.5 Market Opportunity Analysis.......................................................................................... 148
2.8 MRSA - Methicillin-resistant Staphylococcus aureus.......................................................... 150 2.8.1 Diagnosis ......................................................................................................................... 150 2.8.2 FDA Approved Molecular Tests ..................................................................................... 151 2.8.3 Market Opportunity Analysis......................................................................................... 152
2.9 VRE - Vancomycin-resistant Enterococcus ........................................................................ 153 2.9.1 FDA Approved MDx Tests for VRE.................................................................................. 154 2.9.2 Market Opportunity Analysis.......................................................................................... 155
2.10 VRE - Vancomycin-resistant Enterococcus ...................................................................... 156 2.9.1 FDA Approved MDx Tests for VRE.................................................................................. 156 2.9.2 Market Opportunity Analysis.......................................................................................... 157
3. Industry Overview .............................................................................................................159
3.1 Industry Participants ............................................................................................................. 160 3.1.1 IVD Supplier..................................................................................................................... 160 3.1.2 Independent lab specialized/esoteric ......................................................................... 161 3.1.3 Independent lab national/regional.............................................................................. 161 3.1.4 Independent lab analytical .......................................................................................... 162 3.1.5 Public National/regional lab ......................................................................................... 162 3.1.6 Hospital lab ..................................................................................................................... 162 3.1.7 Physician lab................................................................................................................... 163 3.1.8 Audit body ...................................................................................................................... 163 3.2 The Clinical Laboratory Market Segments.......................................................................... 165 3.2.1 Traditional Market Segmentation.................................................................................. 165
 
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3.2.2 Laboratory Focus and Segmentation........................................................................... 166
3.2.3 Segmenting the Syndromic Testing Market.................................................................. 168 3.3 Industry Structure .................................................................................................................. 170 3.3.1 Hospital Testing Share .................................................................................................... 170 3.3.2 Economies of Scale........................................................................................................ 170 3.3.2.1 Hospital vs. Central Lab ......................................................................................... 171 3.3.3 Physician Office Lab’s.................................................................................................... 172 3.3.4 Physician’s and POCT .................................................................................................... 172
4. Market Trends....................................................................................................................174
4.1 Factors Driving Growth......................................................................................................... 175 4.1.1 Speed of Diagnosis......................................................................................................... 175 4.1.2 Effect of Syndromic Testing on Costs. ........................................................................... 176 4.1.3 Point of Care Advantage. ............................................................................................. 176 4.1.4 Syndrome Testing, Accuracy and Diagnostic Risk....................................................... 176 4.1.5 Single Visits ...................................................................................................................... 176 4.1.6 Improvement in Outcomes. .......................................................................................... 177 4.1.7 Impact of the COVID-19 Pandemic. ............................................................................ 177 4.2 Factors Limiting Growth........................................................................................................ 179 4.2.1 Lower Prices .................................................................................................................... 179 4.2.2 Administration/reimbursement...................................................................................... 180 4.2.3 Infectious Disease is Declining But................................................................................ 182 4.2.4 Wellness Hurts.................................................................................................................. 182 4.2.5 Economic Growth improves Living Standards ............................................................. 182 4.2.6 Impact of the Pandemic Recession ............................................................................. 183 4.3 Instrumentation and Automation........................................................................................ 184 4.3.1 Instruments Key to Market Share................................................................................... 184
 
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4.3.2 The Shrinking Machine. .................................................................................................. 184
4.3.3 Syndrome Testing Moving to Big Instruments? ............................................................. 185 4.4 Diagnostic Technology Development................................................................................ 185 4.4.1 Comparing Syndrome and Targeted Testing .............................................................. 186 4.4.2 The Multiplex Paradigm Shift.......................................................................................... 187 4.4.2 The Sepsis Testing Market – Bellwether for Syndromics................................................ 188 4.4.3 The Single Visit and AntiMicrobial Resistance .............................................................. 188 4.4.4 Syndromics drives POCT adoption................................................................................ 189 4.4.5 A Big Future for PCR? ..................................................................................................... 189
5. Syndromic Testing Recent Developments......................................................................191 Recent Developments – Importance and How to Use This Section....................................... 192 Importance of These Developments ..................................................................................... 192 How to Use This Section .......................................................................................................... 192 BioMérieux's BioFire SARS-CoV-2 Respiratory Panel Wins FDA EAU......................................... 192 Infectious Disease Testing Firm Curative Acquires KorvaLabs ................................................ 193 ChromaCode Raises Additional $10M ..................................................................................... 193 COVID-19 Patients Need Syndromic Testing............................................................................ 194 GenMark Diagnostics – New Respiratory Panel due in June.................................................. 196 Qiagen Respiratory Panel with Coronavirus Targets Receives CE Mark ................................ 197 Exact Diagnostics launches respiratory panel control ............................................................ 198 bioMérieux submits enhanced BIOFIRE® BCID2 Panel to FDA ............................................... 199 Nanomix Receives CE Mark for Diagnostic.............................................................................. 200 Applied BioCode Applies to FDA for Syndromic Respiratory Panel ....................................... 201 Expedeon AG and Sona Nanotech to Collaborate on Multiplex POC................................. 203 QIAGEN’s New GI Panel Performance Assessed..................................................................... 203 McKesson to Distribute QIAstat-Dx Syndromic Testing Solution in USA................................... 205
 
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Applied BioCode Obtains FDA Clearance .............................................................................. 205 Meridian Bioscience to Acquire GenePOC Inc....................................................................... 206 Curetis Introduces Rapid DNA Testing for Antibiotic Resistance ............................................ 207 Qiagen gets FDA clearance for syndromic testing system..................................................... 209 Entasis Therapeutics Signs Rapid Diagnostic Agreement with bioMérieux............................ 210 Akonni Biosystems Submits Multiplex Diagnostics System to FDA ........................................... 210 Ador Diagnostic to receive $30M in Funding for 100-Plex PoC .............................................. 211 SAW Diagnostics Receives Funding for Commercialisation of PoC Platform........................ 213 QuantuMDx and Molbio announce MoU ................................................................................ 215 Immunexpress Wins $745K Contract for Rapid Sepsis Assay ................................................... 216 Mobidiag Inks European, Middle Eastern Distribution Deals ................................................... 217 BIOFIRE® FILMARRAY® System chosen for Phase 3 clinical trial.............................................. 217 5.1 Profiles of Key Syndromic Testing Companies.................................................................... 219 Abbott Diagnostics (Alere) ........................................................................................................ 220 Accelerate Diagnostics ............................................................................................................. 221 Ador Diagnostics ........................................................................................................................ 222 Akkoni Biosystems ....................................................................................................................... 223 Alveo Technologies.................................................................................................................... 224 Applied BioCode........................................................................................................................ 225 Atlas Genetics............................................................................................................................. 227 Aus Diagnostics........................................................................................................................... 228 BD Diagnostics ............................................................................................................................ 230 Biocartis ....................................................................................................................................... 232 BioFire Diagnostics...................................................................................................................... 233 bioMérieux .................................................................................................................................. 235 Bio-Rad Laboratories.................................................................................................................. 236
 
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Bosch Healthcare Solutions GmbH ........................................................................................... 238 Cepheid ...................................................................................................................................... 239 Cue Health.................................................................................................................................. 240 Curetis.......................................................................................................................................... 241 Diagenode Diagnostics ............................................................................................................. 242 Diasorin........................................................................................................................................ 243 Expedeon.................................................................................................................................... 244 Fusion Genomics. ....................................................................................................................... 245 GenePOC Diagnostics............................................................................................................... 247 Genetic Signatures..................................................................................................................... 248 GenMark Dx................................................................................................................................ 249 Hologic ........................................................................................................................................ 250 Immunexpress............................................................................................................................. 252 Inflammatix ................................................................................................................................. 253 Invetech ...................................................................................................................................... 254 Janssen Diagnostics ................................................................................................................... 255 Karius ........................................................................................................................................... 256 Lexigene...................................................................................................................................... 257 Luminex ....................................................................................................................................... 258 Mbio Diagnostics ........................................................................................................................ 260 Meridian Bioscience................................................................................................................... 261 Mesa Biotech.............................................................................................................................. 263 Mobidiag..................................................................................................................................... 264 Nanomix ...................................................................................................................................... 265 Oxford Nanopore ....................................................................................................................... 266 Panagene ................................................................................................................................... 267
 
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Primerdesign ............................................................................................................................... 268 Prominex...................................................................................................................................... 269 Qiagen (Statdx).......................................................................................................................... 270 Quantumdx................................................................................................................................. 272 Quidel.......................................................................................................................................... 273 Roche Molecular Diagnostics ................................................................................................... 275 Saw Diagnostics.......................................................................................................................... 277 Seegene...................................................................................................................................... 278 Sensovation................................................................................................................................. 279 Siemens Healthineers (Fast Track Diagnostics)......................................................................... 280 SkylineDx...................................................................................................................................... 286 Sona Nanotech .......................................................................................................................... 287 T2 Biosystems............................................................................................................................... 288 Thermo Fisher .............................................................................................................................. 289 Veramarx .................................................................................................................................... 291 XCR Diagnostics.......................................................................................................................... 292
6. The Global Market for Syndromic Multiplex Diagnostics ..............................................293
6.1 Global Market Overview by Country.................................................................................. 294 6.1.1 Table – Global Market by Country................................................................................ 294 6.1.2 Chart - Global Market by Country................................................................................ 295 6.2 Global Market by Syndrome - Overview............................................................................ 296 6.2.1 Table – Global Market by Syndrome ............................................................................ 296 6.2.2 Chart – Global Market by Syndrome – Base/Final Year Comparison ........................ 297 6.2.3 Chart – Global Market by Syndrome – Base Year ....................................................... 298 6.2.4 Chart – Global Market by Syndrome – End Year......................................................... 299 6.2.5 Chart – Global Market by Syndrome – Share by Year ................................................ 300
  
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6.2.6 Chart – Global Market by Syndrome – Segments Growth.......................................... 301 6.3 Global Market by Place - Overview ................................................................................... 302 6.3.1 Table – Global Market by Place.................................................................................... 302 6.3.2 Chart – Global Market by Place – Base/Final Year Comparison ............................... 303 6.3.3 Chart – Global Market by Place – Base Year............................................................... 304 6.3.4 Chart – Global Market by Place – End Year ................................................................ 305 6.3.5 Chart – Global Market by Place – Share by Year........................................................ 306 6.3.6 Chart – Global Market by Place – Segments Growth ................................................. 307
7. Global Syndromic Multiplex Dx Markets – By Syndrome................................................308
7.1 Respiratory ............................................................................................................................ 309 7.1.1 Table Respiratory – by Country ..................................................................................... 309 7.1.2 Chart - Respiratory Growth............................................................................................ 310 7.2 Gastrointestinal ..................................................................................................................... 311 7.2.1 Table Gastrointestinal – by Country.............................................................................. 311 7.2.2 Chart - Gastrointestinal Growth .................................................................................... 312 7.3 Blood...................................................................................................................................... 313 7.3.1 Table Blood – by Country .............................................................................................. 313 7.3.2 Chart - Blood Growth..................................................................................................... 314 7.4 Meningitis/Encephalitis......................................................................................................... 315 7.4.1 Table Meningitis/Encephalitis – by Country.................................................................. 315 7.4.2 Chart - Meningitis/Encephalitis Growth ........................................................................ 316 7.5 Sexually Transmitted Disease ............................................................................................... 317 7.5.1 Table Sexually Transmitted Disease – by Country ........................................................ 317 7.5.2 Chart – Sexually Transmitted Disease Growth.............................................................. 318 7.6 Other...................................................................................................................................... 319 7.6.1 Table Other – by Country .............................................................................................. 319
 
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7.6.2 Chart - Other Growth..................................................................................................... 320 8. Global Syndromic Multiples Dx Markets – by Place.......................................................321
8.1 Hospital Lab .......................................................................................................................... 322 8.1.1 Table Hospital Lab – by Country ................................................................................... 322 8.1.2 Chart - Hospital Lab Growth.......................................................................................... 323
8.2 Outpatient Lab ..................................................................................................................... 324 8.2.1 Table Outpatient Lab – by Country .............................................................................. 324 8.2.2 Chart - Outpatient Lab Growth .................................................................................... 325
8.3 POC ....................................................................................................................................... 326 8.3.1 Table POC – by Country ................................................................................................ 326 8.3.2 Chart - POC Growth....................................................................................................... 327
8.4 Other Technology................................................................................................................. 328 8.4.1 Table Other – by Country .............................................................................................. 328 8.4.2 Chart - Other Growth..................................................................................................... 329
Appendices ..........................................................................................................................330
I. United States Medicare System: 2020 Clinical Laboratory Fees Schedule ......................... 330 II. COVID-19 Approved Assays .................................................................................................. 375
Table of Tables
Table 1 Market Share of Leading Companies .............................................................................. 27 Table 2 Medicare Clinical Lab Expenditures Actual & Forecast 2014 to 2024 ($Billion) ............ 37 Table 3 Characteristics of Coronavirus Pandemic Infections ...................................................... 45 Table 4 COVID-19 Symptoms.......................................................................................................... 47 Table 5 Classification of HIV Species.............................................................................................. 54 Table 6 HBV Tests - CMS Codes & Prices........................................................................................ 84
 
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Table 7 HCV Tests - CMS Codes & Prices ....................................................................................... 91 Table 8 HPV Clearance Rates ........................................................................................................ 98 Table 9 HPV Tests - CMS Codes & Prices...................................................................................... 103 Table 10 HPV Tests, Technology, Types ........................................................................................ 104 Table 11 Types of Influenza Tests .................................................................................................. 114 Table 12 Influenza Tests - CMS Codes & Prices............................................................................ 117 Table 13 FDA Cleared Molecular Assays for Influenza ............................................................... 119 Table 14 FDA Cleared NAAT CTGC Tests ..................................................................................... 131 Table 15 CTGC NAAT Target Sequences and Possible False Reactions ................................... 136 Table 16 Influenza Tests - CMS Codes & Prices............................................................................ 140 Table 17 FDA Approved MDx Tests for Tuberculosis.................................................................... 147 Table 18 Tuberculosis Tests - CMS Codes & Prices....................................................................... 148 Table 19 FDA Approved Tests for MRSA....................................................................................... 151 Table 20 MRSA Tests - CMS Codes & Prices ................................................................................. 153 Table 21 FDA Approved Tests for VRE .......................................................................................... 154 Table 22 VRE Tests - CMS Codes & Prices .................................................................................... 155 Table 23 FDA Approved Tests for VRE .......................................................................................... 156 Table 24 VRE Tests - CMS Codes & Prices .................................................................................... 158 Table 25 Market Players by Type ................................................................................................. 160 Table 26 Clinical Laboratory Departments and Segments ........................................................ 165 Table 27 Laboratory Management Focus – Different Approaches .......................................... 166 Table 28 Key Segmentation Variables Going Forward............................................................... 168 Table 29 Possible Market Segments of Syndromic Multiplex Market ......................................... 168 Table 30 Five Factors Driving Growth ........................................................................................... 175 Table 31 How SMT Improves Outcomes....................................................................................... 177 Table 32 Four Factors Limiting Growth ......................................................................................... 179
 
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Table 33 - Global Market by Region ............................................................................................ 294 Table 34 Global Market by Syndrome ......................................................................................... 296 Table 35 Global Market by Place................................................................................................. 302 Table 36 Respiratory by Country................................................................................................... 309 Table 37 Gastrointestinal by Country .......................................................................................... 311 Table 38 Blood by Country............................................................................................................ 313 Table 39 Meningitis/Encephalitis by Country............................................................................... 315 Table 40 Sexually Transmitted Disease by Country ..................................................................... 317 Table 41 Other by Country............................................................................................................ 319 Table 42 Hospital Lab by Country ............................................................................................... 322 Table 43 Outpatient Lab by Country ........................................................................................... 324 Table 44 POC by Country ............................................................................................................ 326 Table 45 Other by Country........................................................................................................... 328 Table 46 2020 Clinical Lab Fee Schedule .................................................................................... 330 Table 47 COVID -19 Approved Assays......................................................................................... 375
Table of Figures
Figure 1 Market Share of Leading Companies Chart................................................................... 27 Figure 2 Medicare Clinical Lab Expenditures 2014 to 2024 ($Million).......................................... 36 FIGURE 3 STRUCTURE OF CORONAVIRUSES ............................................................................................... 40 Figure 4 HIV Virion ............................................................................................................................ 55 Figure 5 Diagram of the HIV Replication Cycle ............................................................................ 59 Figure 6 The Structure of the HBV Virus........................................................................................... 78 Figure 7 Hepatitis B Replication ...................................................................................................... 79
 
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Figure 8 Structure of the HCV Virus................................................................................................. 86 Figure 9 HCV Replication Cycle ..................................................................................................... 89 Figure 10 Structure of the Influenza Virion ................................................................................... 111 Figure 11 Influenza Replication..................................................................................................... 112 Figure 12 Scanning Electronmicrograph of Tuberculosis............................................................ 143 Figure 13 Chart Death Rates and Infectious Disease Decline ................................................... 181 Figure 14 Comparing Syndromic and Targeted Testing............................................................. 186 Figure 15 The Multiplex Paradigm Shift......................................................................................... 187 Figure 16 Global Market Density Chart....................................................................................... 295 Figure 17 Global Market by Syndrome - Base vs. Final ............................................................... 297 Figure 18 Global Market by Syndrome Base Year ...................................................................... 298 Figure 19 Global Market by Syndrome End Year ........................................................................ 299 Figure 20 Syndrome Share by Year .............................................................................................. 300 Figure 21 Syndrome Segments Growth........................................................................................ 301 Figure 22 Global Market by Place - Base vs. Final....................................................................... 303 Figure 23 Global Market by Place Base Year.............................................................................. 304 Figure 24 Global Market by Place End Year ............................................................................... 305 Figure 25 Place Share by Year...................................................................................................... 306 Figure 26 Place Segments Growth ............................................................................................... 307 Figure 27 Respiratory Growth........................................................................................................ 310 Figure 28 Gastrointestinal Diagnostics Growth............................................................................ 312 Figure 29 Blood Growth................................................................................................................. 314 Figure 30 Meningitis/Encephalitis Growth.................................................................................... 316 Figure 31 Sexually Transmitted Disease Growth .......................................................................... 318 Figure 32 Other Growth................................................................................................................. 320 Figure 33 Hospital Lab Growth...................................................................................................... 323
 
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Figure 34 Outpatient Lab Growth ................................................................................................ 325 Figure 35 POC Growth................................................................................................................... 327 Figure 36 Other Growth................................................................................................................. 329