1
|
Widyasari K, Kim S. Rapid Antigen Tests during the COVID-19 Era in Korea and Their Implementation as a Detection Tool for Other Infectious Diseases. Bioengineering (Basel) 2023; 10:322. [PMID: 36978713 PMCID: PMC10045740 DOI: 10.3390/bioengineering10030322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Rapid antigen tests (RATs) are diagnostic tools developed to specifically detect a certain protein of infectious agents (viruses, bacteria, or parasites). RATs are easily accessible due to their rapidity and simplicity. During the COVID-19 pandemic, RATs have been widely used in detecting the presence of the specific SARS-CoV-2 antigen in respiratory samples from suspected individuals. Here, the authors review the application of RATs as detection tools for COVID-19, particularly in Korea, as well as for several other infectious diseases. To address these issues, we present general knowledge on the design of RATs that adopt the lateral flow immunoassay for the detection of the analyte (antigen). The authors then discuss the clinical utilization of the authorized RATs amidst the battle against the COVID-19 pandemic in Korea and their role in comparison with other detection methods. We also discuss the implementation of RATs for other, non-COVID-19 infectious diseases, the challenges that may arise during the application, the limitations of RATs as clinical detection tools, as well as the possible problem solving for those challenges to maximize the performance of RATs and avoiding any misinterpretation of the test result.
Collapse
Affiliation(s)
- Kristin Widyasari
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Sunjoo Kim
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Republic of Korea
- Department of Laboratory Medicine, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
- Department of Laboratory Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| |
Collapse
|
2
|
Yang J, Li D, Wang J, Zhang R, Li J. Design, optimization, and application of multiplex rRT-PCR in the detection of respiratory viruses. Crit Rev Clin Lab Sci 2022:1-18. [PMID: 35559711 DOI: 10.1080/10408363.2022.2072467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Viral respiratory infections are common and serious diseases. Because there is no effective treatment method or vaccine for respiratory tract infection, early diagnosis is vital to identify the pathogen so as to determine the infectivity of the patient and to quickly take measures to curb the spread of the virus, if warranted, to avoid serious public health problems. Real-time reverse transcriptase PCR (rRT-PCR), which has high sensitivity and specificity, is the best approach for early diagnosis. Among rRT-PCR methods, multiplex rRT-PCR can resolve issues arising from various types of viruses, high mutation frequency, coinfection, and low concentrations of virus. However, the design, optimization, and validation of multiplex rRT-PCR are more complicated than singleplex rRT-PCR, and comprehensive research on multiplex rRT-PCR methodology is lacking. This review summarizes recent progress in multiplex rRT-PCR methodology, outlines the principles of design, optimization and validation, and describes a scheme to help diagnostic companies to design and optimize their multiplex rRT-PCR detection panel and to assist laboratory staff to solve problems in their daily work. In addition, the analytical validity, clinical validity and clinical utility of multiplex rRT-PCR in viral respiratory tract infection diagnosis are assessed to provide theoretical guidance and useful information for physicians to understand the test results.
Collapse
Affiliation(s)
- Jing Yang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/ National Center of Gerontology, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, P.R. China
| | - Dandan Li
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/ National Center of Gerontology, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, P.R. China
| | - Jie Wang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/ National Center of Gerontology, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, P.R. China
| | - Rui Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/ National Center of Gerontology, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, P.R. China
| | - Jinming Li
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/ National Center of Gerontology, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, P.R. China
| |
Collapse
|
3
|
Mak GCK, Lau SSY, Wong KKY, Chow NLS, Lau CS, Lam ETK, Ng KHL, Chan RCW. Evaluation of rapid antigen detection kits for detection of SARS-CoV-2 B.1.617.2 virus. Future Virol 2022. [PMID: 35432576 PMCID: PMC9006337 DOI: 10.2217/fvl-2021-0229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Abstract
Aim: Currently, there is lack of data regarding rapid antigen detection (RAD) kits to detect SARS-CoV-2 B.1.617.2 virus. Objective: The purpose of this evaluation is to assess analytical sensitivity of 12 RAD kits against SARS-CoV-2 B.1.617.2. Study design: Analytical sensitivity was determined by limit of detection (LOD). A serial tenfold dilution set from a respiratory specimen collected from a COVID-19 patient infected by SARS-CoV-2 B.1.617.2 was used. RT-PCR was used as a reference method. Results: The LOD results showed that 11 and one RAD kits were 100- and 1000-fold less sensitive than RT-PCR respectively. Conclusion: The results showed that the RAD kits evaluated in this study may be used for first-line screening of the SARS-CoV-2 B.1.617.2 variant.
Collapse
Affiliation(s)
- Gannon CK Mak
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Stephen SY Lau
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Kitty KY Wong
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Nancy LS Chow
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Chi-Shan Lau
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Edman TK Lam
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Ken HL Ng
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| | - Rickjason CW Chan
- Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
| |
Collapse
|
4
|
Chen PZ, Bobrovitz N, Premji Z, Koopmans M, Fisman DN, Gu FX. Heterogeneity in transmissibility and shedding SARS-CoV-2 via droplets and aerosols. eLife 2021; 10:e65774. [PMID: 33861198 PMCID: PMC8139838 DOI: 10.7554/elife.65774] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background Which virological factors mediate overdispersion in the transmissibility of emerging viruses remains a long-standing question in infectious disease epidemiology. Methods Here, we use systematic review to develop a comprehensive dataset of respiratory viral loads (rVLs) of SARS-CoV-2, SARS-CoV-1 and influenza A(H1N1)pdm09. We then comparatively meta-analyze the data and model individual infectiousness by shedding viable virus via respiratory droplets and aerosols. Results The analyses indicate heterogeneity in rVL as an intrinsic virological factor facilitating greater overdispersion for SARS-CoV-2 in the COVID-19 pandemic than A(H1N1)pdm09 in the 2009 influenza pandemic. For COVID-19, case heterogeneity remains broad throughout the infectious period, including for pediatric and asymptomatic infections. Hence, many COVID-19 cases inherently present minimal transmission risk, whereas highly infectious individuals shed tens to thousands of SARS-CoV-2 virions/min via droplets and aerosols while breathing, talking and singing. Coughing increases the contagiousness, especially in close contact, of symptomatic cases relative to asymptomatic ones. Infectiousness tends to be elevated between 1 and 5 days post-symptom onset. Conclusions Intrinsic case variation in rVL facilitates overdispersion in the transmissibility of emerging respiratory viruses. Our findings present considerations for disease control in the COVID-19 pandemic as well as future outbreaks of novel viruses. Funding Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant program, NSERC Senior Industrial Research Chair program and the Toronto COVID-19 Action Fund.
Collapse
Affiliation(s)
- Paul Z Chen
- Department of Chemical Engineering & Applied Chemistry, University of TorontoTorontoCanada
| | - Niklas Bobrovitz
- Temerty Faculty of Medicine, University of TorontoTorontoCanada
- Department of Critical Care Medicine, Cumming School of Medicine, University of CalgaryCalgaryCanada
- O'Brien Institute of Public Health, University of CalgaryCalgaryCanada
| | - Zahra Premji
- Libraries & Cultural Resources, University of CalgaryCalgaryCanada
| | - Marion Koopmans
- Department of Viroscience, Erasmus University Medical CenterRotterdamNetherlands
| | - David N Fisman
- Division of Epidemiology, Dalla Lana School of Public Health, University of TorontoTorontoCanada
- Division of Infectious Diseases, Temerty Faculty of Medicine, University of TorontoTorontoCanada
| | - Frank X Gu
- Department of Chemical Engineering & Applied Chemistry, University of TorontoTorontoCanada
- Institute of Biomedical Engineering, University of TorontoTorontoCanada
| |
Collapse
|
5
|
van Doorn E, Darvishian M, Dijkstra F, Donker GA, Overduin P, Meijer A, Hak E. Influenza vaccine effectiveness estimates in the Dutch population from 2003 to 2014: The test-negative design case-control study with different control groups. Vaccine 2017; 35:2831-2839. [PMID: 28412077 PMCID: PMC7126814 DOI: 10.1016/j.vaccine.2017.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
Information about influenza vaccine effectiveness (IVE) is important for vaccine strain selection and immunization policy decisions. The test-negative design (TND) case-control study is commonly used to obtain IVE estimates. However, the definition of the control patients may influence IVE estimates. We have conducted a TND study using the Dutch Sentinel Practices of NIVEL Primary Care Database which includes data from patients who consulted the General Practitioner (GP) for an episode of acute influenza-like illness (ILI) or acute respiratory infection (ARI) with known influenza vaccination status. Cases were patients tested positive for influenza virus. Controls were grouped into those who tested (1) negative for influenza virus (all influenza negative), (2) negative for influenza virus, but positive for respiratory syncytial virus, rhinovirus or enterovirus (non-influenza virus positive), and (3) negative for these four viruses (pan-negative). We estimated the IVE over all epidemic seasons from 2003/2004 through 2013/2014, pooled IVE for influenza vaccine partial/full matched and mismatched seasons and the individual seasons using generalized linear mixed-effect and multiple logistic regression models. The overall IVE adjusted for age, GP ILI/ARI diagnosis, chronic disease and respiratory allergy was 35% (95% CI: 15-48), 64% (95% CI: 49-75) and 21% (95% CI: -1 to 39) for all influenza negative, non-influenza virus positive and pan-negative controls, respectively. In both the main and subgroup analyses IVE estimates were the highest using non-influenza virus positive controls, likely due to limiting inclusion of controls without laboratory-confirmation of a virus causing the respiratory disease.
Collapse
Affiliation(s)
- Eva van Doorn
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Maryam Darvishian
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederika Dijkstra
- Infectious Disease Epidemiology and Surveillance, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gé A Donker
- Sentinel Practices, NIVEL Primary Care Database, Utrecht, The Netherlands
| | - Pieter Overduin
- Infectious Disease Research, Diagnostics and Screening, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Adam Meijer
- Infectious Disease Research, Diagnostics and Screening, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE(2)), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Lucero MG, Inobaya MT, Nillos LT, Tan AG, Arguelles VLF, Dureza CJC, Mercado ES, Bautista AN, Tallo VL, Barrientos AV, Rodriguez T, Olveda RM. National Influenza Surveillance in the Philippines from 2006 to 2012: seasonality and circulating strains. BMC Infect Dis 2016; 16:762. [PMID: 27993136 PMCID: PMC5168815 DOI: 10.1186/s12879-016-2087-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/01/2016] [Indexed: 11/15/2022] Open
Abstract
Background The results of routine influenza surveillance in 13 regions in the Philippines from 2006 to 2012 are presented, describing the annual seasonal epidemics of confirmed influenza virus infection, seasonal and alert thresholds, epidemic curve, and circulating influenza strains. Methods Retrospective analysis of Philippine influenza surveillance data from 2006 to 2012 was conducted to determine seasonality with the use of weekly influenza positivity rates and calculating epidemic curves and seasonal and alert thresholds using the World Health Organization (WHO) global epidemiological surveillance standards for influenza. Results Increased weekly influenza positive rates were observed from June to November, coinciding with the rainy season and school opening. Two or more peaks of influenza activity were observed with different dominant influenza types associated with each peak. A-H1N1, A-H3N2, and two types of B viruses circulated during the influenza season in varying proportions every year. Increased influenza activity for 2012 occurred 8 weeks late in week 29, rather than the expected week of rise of cases in week 21 as depicted in the established average epidemic curve and seasonal threshold. The intensity was severe going above the alert threshold but of short duration. Southern Hemisphere vaccine strains matched circulating influenza virus for more surveillance years than Northern Hemisphere vaccine strains. Conclusions Influenza seasonality in the Philippines is from June to November. The ideal time to administer Southern Hemisphere influenza vaccine should be from April to May. With two lineages of influenza B circulating annually, quadrivalent vaccine might have more impact on influenza control than trivalent vaccine. Establishment of thresholds and average epidemic curve provide a tool for policy-makers to assess the intensity or severity of the current influenza epidemic even early in its course, to help plan more precisely resources necessary to control the outbreak. Influenza surveillance activities should be continued in the Philippines and funding for such activities should already be incorporated into the Philippine health budget. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2087-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marilla G Lucero
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines.
| | - Marianette T Inobaya
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Leilani T Nillos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Alvin G Tan
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Vina Lea F Arguelles
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Christine Joy C Dureza
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Edelwisa S Mercado
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Analisa N Bautista
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Veronica L Tallo
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Agnes V Barrientos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Tomas Rodriguez
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| |
Collapse
|
7
|
Rodríguez AH, Avilés-Jurado FX, Díaz E, Schuetz P, Trefler SI, Solé-Violán J, Cordero L, Vidaur L, Estella Á, Pozo Laderas JC, Socias L, Vergara JC, Zaragoza R, Bonastre J, Guerrero JE, Suberviola B, Cilloniz C, Restrepo MI, Martín-Loeches I, Cobo P, Martins J, Carbayo C, Robles-Musso E, Cárdenas A, Fierro J, Fernández DO, Sierra R, Huertos MJ, Carmona Pérez ML, Pozo Laderas JC, Guerrero R, Robles JC, León ME, Gómez AB, Márquez E, Rodríguez-Carvajal M, Estella Á, Pomares J, Ballesteros JL, Romero OM, Fernández Y, Lobato F, Prieto JF, Albofedo-Sánchez J, Martínez P, de la Torre MV, Nieto M, Sola EC, Díaz Castellanos MA, Soler GS, Leyba CO, Garnacho-Montero J, Hinojosa R, Fernández E, Loza A, León C, López SG, Arenzana A, Ocaña D, Navarrete I, Beryanaki MZ, Sánchez I, Pérez Alé M, Poullet Brea AM, Machado Casas JF, Serón C, Avellanas ML, Lander A, de Arellano SGR, Lacueva MM, Luque P, Serrano EP, Martín Lázaro JF, Polo CS, Cia IG, Bartolomé BJ, Nuñez CL, González I, Tomás Marsilla JI, Andrés CJ, Ibañes PG, Aguilar PA, Montón JM, Regil PD, Iglesias L, González CP, Fernández BQ, Iglesias LM, Soria LV, Escudero RY, Revuelta MDRM, Quiroga, García-Rodríguez Á, Cuadrado MM, Balán Mariño AL, Socias L, Ibánez P, Borges-Sa M, Socias A, Del Castillo A, Marcos RJ, Muñoz C, Bonell JM, Amestarán I, López MAG, Pàmies CV, Bonell Goytisolo JM, Morales Carbonero JA, Bonell Goytisolo JM, Morales Carbonero JA, Senoff RP, López de Medrano MG, Ruiz-Santana S, Díaz JJ, Ramírez CS, Sisón M, Hernández D, Trujillo A, Regalado L, Fndez SR, Lorente L, Rivero JC, Mora Quintero ML, Martín M, Martínez S, Cáceres J, Sanchez Palacio M, Marcos, García Rodríguez D, Leria MR, Suberviola B, Ugarte P, García-López F, Iniesta RS, Alonso AÁ, Padilla A, Palacios BM, Grande MLG, Martín Rodríguez MC, Adbel-Hadi Álvarez H, Ambros Checa A, Hernández HM, Albaya A, Obregón AS, Crespo CM, Estrella CA, Benito Puncel C, Oyargue EQ, Canabal A, Marina L, López de Toro I, Simón A, Añón JM, López Messa JB, López Pueyo MJ, del valle Sergio Ossa Echeverri OM, Ferreras Z, Ballesteros Herraez JC, Macias S, Berezo JÁ, Varela JB, Schweizer PB, Salamanca AG, Lomas LT, Anzález AO, Cicuéndez Avila R, Francisco Javier PG, Terrero AÁ, Ezpeleta FT, Sala C, López O, Paez Z, García Á, Carriedo Ule D, Crespo MR, Rebolledo JP, Andrés NH, Zirena ACC, García BR, López Messa JB, del Valle Ortiz M, Echeverri SO, Catalán RM, Ferrer M, Torres A, Cilloniz C, Ansorregui SB, Cabré L, Baeza I, Rovira A, Álvarez-Lerma F, Vázquez A, Nolla J, Fernández F, Cervelló JR, Iglesia R, Mañéz R, Ballús J, Granada RM, Vallés J, Díaz E, Ortíz M, Guía C, Martín-Loeches I, Páez J, Almirall J, Balanzo X, Güell E, Yebenes JC, Rello J, Arnau E, Pérez M, Laborda C, Souto J, Lagunes L, Catalán I, Sirvent JM, de Arbina NL, Serra AB, Sánchez A, Cuenca; SM, Badía M, Baseda-Garrido B, Valverdú-Vidal M, Barcenilla F, Palomar M, Nuvials X, Benedicto PG, Campo FR, Esteban M, Luna J, Eixarch GM, Diago AP, Nava JM, González de Molina J, Trenado J, Ferrer R, Josic Z, Casanovas M, Gurri F, Rodríguez P, Rodríguez A, Claverias L, Trefler S, Bodí M, Magret M, Ferri C, Díaz RM, Mesalles E, Arméstar F, de Mendoza D, Fernández CL, Berrade JJ, Saris AB, Pechkova M, Jiménez CM, Gil SP, Juliá-Narváez J, Marcos MR, Mallqui VF, Santiago Triviño MA, García PM, Fernández-Zapata A, Recio T, Arrascaeta A, García-Ramos MJ, Gallego E, Rodrigo ES, Bueno F, Díaz M, Pérez NG, Hormigo DL, Delgado JDJ, Frutos P, Rivera Pinna M, Cordero ML, Pastor JA, Álvarez-Rocha L, Ceniceros Barros A, Pedreira AV, Vila D, González CF, Pérez JB, Piquer MO, Merayo E, López-Ciudad VJ, Cañones JC, Vilaboy E, Chao JV, Cid López FS, Cortés PV, Pérez Veloso MA, Saborido EM, Pardavila EA, Montes AO, González RJ, Freita S, Alemparte E, Ortega A, López AM, Canabal J, Ferres E, Pérez JB, Piquer MO, Ramos SF, Cendón LL, Casal VG, Adrio SV, Fernández EM, Prado SG, Franco AV, Monzón JL, Goñi F, Del Nogal Sáez F, Navalpotro MB, Abad RD, Lasierra JLF, García-Torrejón MC, Pérez–Calvo C, López D, Arnaiz L, Sánchez-Alonso S, Velayos C, del Río F, González MÁ, Nieto M, Cesteros CS, Martín MC, Molina JM, Montejo JC, Catalán M, Albert P, de Pablo A, Guerrero JE, Zurita; M, Peyrat JB, Cámara MD, Cerdá E, Alvarez M, Pey C, Riestra EM, Martinez-Fidalgo C, Rodríguez M, Palencia E, Caballero R, Vaquero C, Mariscal F, García S, Cepeda R, Carrasco N, Prieto I, Liétor A, Ramos R, Casas RC, Cuesta CS, Sánchez Alonso S, Galván B, Figueira JC, Soriano MC, Martín BC, Caballero AR, Galdós P, Moreno BB, Alcántara Carmona S, del Cabo F, Hermosa C, Gordo F, Algora A, Paredes A, Carmona TG, Cambroner J, Ramos EL, de Zárate YO, Gómez-Rosado S, Lodo MM, Garrobo NF, Hernández SÁ, Honrubia T, Prado López LM, Esteban A, Lorente J, Nin N, Sotomayor CJ, Arnaiz L, Silvero EM, de la Reguera EMF, de la Casa Monje RM, Serrano FM, Trasmonte Martínez MV, Martín Delgado MC, Martínez S, Abad FF, Navalon IC, Velis MV, Martínez M, Martínez Baño D, Andreu E, Butí SM, Rueda BG, García F, Fernández NL, Para LH, Freire AO, Nvarro Ruiz MR, Romero CH, Maraví-Poma E, Urra IJ, Redin LM, Tellería A, Insansti J, Garcia NA, Macaya L, Palanco JL, González N, Marco P, Vidaur L, Salas E, Udabe RS, Santamaría B, Rodríguez T, Vergara JC, Amiano JRI, Santos IG, Manzano A, Arenal CC, Olaechea PM, Hernández HM, López AM, San Miguel FF, Blanquer J, Carbonell N, Franco JF, Valero RR, Belenger A, Altaba S, Álvarez–Sánchez B, Robles JC, Francisco JS, Sánchez MR, Picos SA, Llanes AA, Gutiérrez EH, Zapata AF, Sánchez-Miralles Á, Antón Pascual JL, Bonastre J, Palamo M, Cebrian J, Cuñat J, Sahuquillo MG, Romero B, Pallé SB, de León Belmar J, Zaragoza R, Tormo C, Chinesta SS, Paricio V, Marques A, Sánchez-Morcillo S, Tormo S, Latour J, García MÁ, Palomo M, Royo FT, Hinojosa PM, Sánchez Pino MS, Ribes CM, Luis RG, Ribas A. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis. J Infect 2016; 72:143-51. [DOI: 10.1016/j.jinf.2015.11.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/12/2015] [Accepted: 11/28/2015] [Indexed: 01/22/2023]
|
8
|
Leonard DG. Respiratory Infections. MOLECULAR PATHOLOGY IN CLINICAL PRACTICE 2016. [PMCID: PMC7123443 DOI: 10.1007/978-3-319-19674-9_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The majority of respiratory tract infections (RTIs) are community acquired and are the single most common cause of physician office visits and among the most common causes of hospitalizations. The morbidity and mortality associated with RTIs are significant and the financial and social burden high due to lost time at work and school. The scope of clinical symptoms can significantly overlap among the respiratory pathogens, and the severity of disease can vary depending on patient age, underlying disease, and immune status, thereby leading to inaccurate presumptions about disease etiology. The rapid and accurate diagnosis of the causative agent of RTIs improves patient care, reduces morbidity and mortality, promotes effective hospital bed utilization and antibiotic stewardship, and reduces length of stay. This chapter focuses on the clinical utility, advantages, and disadvantages of viral and bacterial tests cleared by the Food and Drug Administration (FDA), and new promising technologies for the detection of bacterial agents of pneumonia currently in development or in US FDA clinical trials are briefly reviewed.
Collapse
Affiliation(s)
- Debra G.B. Leonard
- Pathology and Laboratory Medicine, University of Vermont College of Medicine and University of Vermont Medical Center, Burlington, Vermont USA
| |
Collapse
|
9
|
Sueki A, Matsuda K, Yamaguchi A, Uehara M, Sugano M, Uehara T, Honda T. Evaluation of saliva as diagnostic materials for influenza virus infection by PCR-based assays. Clin Chim Acta 2016; 453:71-4. [DOI: 10.1016/j.cca.2015.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 11/15/2022]
|
10
|
Claus JA, Hodowanec AC, Singh K. Poor positive predictive value of influenza-like illness criteria in adult transplant patients: a case for multiplex respiratory virus PCR testing. Clin Transplant 2015; 29:938-43. [PMID: 26338182 PMCID: PMC7162202 DOI: 10.1111/ctr.12600] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/27/2022]
Abstract
Background Respiratory viral infections (RVIs) are a significant cause of morbidity and mortality among transplant patients. The CDC's influenza‐like illness (ILI) criteria (fever ≥100°F with cough and/or sore throat) are a screening tool for influenza with unknown applicability to the transplant population. Methods We reviewed all respiratory virus PCR tests performed on adult patients with a history of solid organ (SOT) or stem cell transplantation (HSCT) during the 2012–2013 influenza season. The positive (PPV) and negative predictive values (NPV) of ILI criteria were calculated. Results Of 126 transplant patients (66 HSCT, 60 SOT), 54 (42.8%) tested positive for an RVI by PCR: 24 influenza and 30 non‐influenza. Of 30 patients who met ILI criteria, 12 (40%) were positive for influenza. The PPV and NPV of ILI for influenza were 50% and 82.4%, respectively. Mortality was low (3.7%), but morbidity was high (14.8% required ICU stay) among transplant patients diagnosed with RVI. Conclusions Influenza and non‐influenza RVIs are associated with significant morbidity among transplant patients. CDC ILI criteria correlate poorly with PCR‐positive cases of influenza in transplant patients, but may be useful in excluding the diagnosis. Routine RVI PCR testing is recommended for better diagnosis and improved antiviral use in transplant patients with suspected RVI.
Collapse
Affiliation(s)
- Jonathan A Claus
- Division of Infectious Diseases, Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Aimee C Hodowanec
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kamaljit Singh
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
11
|
Abstract
Household-based interventions are the mainstay of public health policy against epidemic respiratory pathogens when vaccination is not available. Although the efficacy of these interventions has traditionally been measured by their ability to reduce the proportion of household contacts who exhibit symptoms [household secondary attack rate (hSAR)], this metric is difficult to interpret and makes only partial use of data collected by modern field studies. Here, we use Bayesian transmission model inference to analyze jointly both symptom reporting and viral shedding data from a three-armed study of influenza interventions. The reduction in hazard of infection in the increased hand hygiene intervention arm was 37.0% [8.3%, 57.8%], whereas the equivalent reduction in the other intervention arm was 27.2% [-0.46%, 52.3%] (increased hand hygiene and face masks). By imputing the presence and timing of unobserved infection, we estimated that only 61.7% [43.1%, 76.9%] of infections met the case criteria and were thus detected by the study design. An assessment of interventions using inferred infections produced more intuitively consistent attack rates when households were stratified by the speed of intervention, compared with the crude hSAR. Compared with adults, children were 2.29 [1.66, 3.23] times as infectious and 3.36 [2.31, 4.82] times as susceptible. The mean generation time was 3.39 d [3.06, 3.70]. Laboratory confirmation of infections by RT-PCR was only able to detect 79.6% [76.5%, 83.0%] of symptomatic infections, even at the peak of shedding. Our results highlight the potential use of robust inference with well-designed mechanistic transmission models to improve the design of intervention studies.
Collapse
|
12
|
Dunn JJ, Ginocchio CC. Can newly developed, rapid immunochromatographic antigen detection tests be reliably used for the laboratory diagnosis of influenza virus infections? J Clin Microbiol 2015; 53:1790-6. [PMID: 25274999 PMCID: PMC4432049 DOI: 10.1128/jcm.02739-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Five years ago, the Point-Counterpoint series was launched. The initial article asked about the role of rapid immunochromatographic antigen testing in the diagnosis of influenza A virus 2009 H1N1 infection (D. F. Welch and C. C. Ginocchio, J Clin Microbiol 48:22-25, 2010, http://dx.doi.org/10.1128/JCM.02268-09). Since that article, not only have major changes been made in immunochromatographic antigen detection (IAD) testing for the influenza viruses, but there has also been rapid development of commercially available nucleic acid amplification tests (NAATs) for influenza virus detection. Further, a novel variant of influenza A, H7N9, has emerged in Asia, and H5N1 is also reemergent. In that initial article, the editor of this series, Peter Gilligan, identified two issues that required further consideration. One was how well IAD tests worked in clinical settings, especially in times of antigen drift and shift. The other was the role of future iterations of influenza NAATs and whether this testing would be available in a community hospital setting. James Dunn, who is Director of Medical Microbiology and Virology at Texas Children's Hospital, has extensive experience using IAD tests for diagnosing influenza. He will discuss the application and value of these tests in influenza diagnosis. Christine Ginocchio, who recently retired as the Senior Medical Director, Division of Infectious Disease Diagnostics, North Shore-LIJ Health System, and now is Vice President for Global Microbiology Affairs at bioMérieux, Durham, NC, wrote the initial counterpoint in this series, where she advocated the use of NAATs for influenza diagnosis. She will update us on the commercially available NAAT systems and explain what their role should be in the diagnosis of influenza infection.
Collapse
Affiliation(s)
- James J Dunn
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Christine C Ginocchio
- bioMérieux, Durham, North Carolina, USA Department of Pathology and Laboratory Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| |
Collapse
|
13
|
Comparison of diagnostic test performance in a population of high risk young adults versus a general population presenting with influenza. J Clin Virol 2015; 68:49-52. [PMID: 26071335 DOI: 10.1016/j.jcv.2015.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/16/2015] [Accepted: 04/25/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Upper respiratory tract infection (URI) is a well-documented cause of morbidity, extra expense and lost training time among basic military trainees (BMTs). OBJECTIVES The goal of this study is to better understand how influenza diagnostic tests perform in the BMT population, and how this performance differs from the general population. STUDY DESIGN Laboratory test data was collected in a prospective study that enrolled Department of Defense beneficiaries presenting to medical facilities in San Antonio, TX with URI symptoms between January 2005 and March 2011. Three laboratory tests for influenza were performed during the study period: polymerase chain reaction (PCR), enzyme immunoassay (EIA), and viral culture. Patients were grouped into BMT and non-BMT populations and the tests from each of these populations were compared for statistical differences. Similar comparisons were made with various sub-groups to include: influenza A versus influenza B, and influenza A subtypes: (H1N1) versus (H3N2) versus (H1N1)pdm09. RESULTS Among 4448 participants enrolled, 466 (10.5%) tested positive for influenza. Sensitivity of viral culture differed between BMTs and non-BMTs: 63% versus 41% (p<0.01). There was no difference in the sensitivity of PCR or EIA between the two populations. The sensitivities of viral culture, EIA and PCR were higher in those infected with influenza A than in those infected with influenza B. The sensitivity of viral culture was significantly higher in (H1N1)pdm09 subtype cases. CONCLUSIONS Viral culture performed better in BMTs than in non-BMTs. These differences are likely attributable to the younger age of the BMTs.
Collapse
|
14
|
Nelson EAS, Ip M, Tam JS, Mounts AW, Chau SL, Law SK, Goggins W, Simpson LA, Chan PKS. Burden of influenza infection in hospitalised children below 6 months of age and above in Hong Kong from 2005 to 2011. Vaccine 2014; 32:6692-8. [PMID: 24837762 PMCID: PMC5355210 DOI: 10.1016/j.vaccine.2014.04.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/14/2014] [Accepted: 04/21/2014] [Indexed: 11/19/2022]
Abstract
Incidence of hospital admission with a diagnosis of influenza was highest in infants aged 2 month to <6 months (1762 per 100,000 person-years). Incidence of hospital admission with a diagnosis of influenza for children <18 y.o. was highest when A(H1N1)pdm09 was circulating in Apr 09/Mar 10. Laboratory confirmed influenza at one sentinel site was obtained in 1.6% of admissions aged 6 days to <6 months and in 5.2% aged 6 days to <18 years.
The World Health Organization recommends vaccination of pregnant women for seasonal influenza that can also protect infants aged below 6 months. We estimated incidence and disease burden of influenza in hospitalised children below and above 6 months of age in Hong Kong during a 6 year period. Discharge diagnoses for all admissions to public Hong Kong Hospital Authority hospitals, recorded in a central computerised database (Clinical Management System, CMS), were analysed for the period April 2005 to March 2011. Incidence estimates of influenza disease by age group were derived from CMS ICD codes 487–487.99. Laboratory-confirmed influenza infections from a single surveillance hospital were then linked to the CMS entries to assess possible over- and under-diagnosis of influenza based on CMS codes alone. Influenza was recorded as any primary or any secondary diagnosis in 1.3% (1158/86,582) of infants aged above 6 days to below 6 months and 4.3% (20,230/471,482) of children above 6 days to below 18 years. The unadjusted incidence rates per 100,000 person-years based on any CMS diagnosis of influenza in all admission to Hong Kong public hospitals were 627 in the below 2 months of age group and 1762 in the 2 month to below 6 month group. Incidence of hospitalisation for influenza in children was highest from 2 months to below 6 months. In the absence of vaccines for children below 6 months of age, effective vaccination of pregnant women may have a significant impact on reducing influenza hospitalisations in this age group.
Collapse
Affiliation(s)
- E Anthony S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong,Hong Kong Special Administrative Region.
| | - John S Tam
- Initiative for Vaccine Research (IVR), Department of Immunization, Vaccines and Biologicals (IVB), Family and Community Health (FCH), Geneva, Switzerland.
| | - Anthony W Mounts
- Global Influenza Programme, Department of Pandemic and Epidemic Diseases (PED), World Health Organization, Geneva, Switzerland.
| | - Sze Lok Chau
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong,Hong Kong Special Administrative Region.
| | - Shu Kei Law
- Division of Biostatistics, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - William Goggins
- Division of Biostatistics, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Lucy A Simpson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Paul K S Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong,Hong Kong Special Administrative Region.
| |
Collapse
|
15
|
Accuracy of rapid influenza detection test in diagnosis of influenza A and B viruses in children less than 59 months old. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 788:71-6. [PMID: 23835961 DOI: 10.1007/978-94-007-6627-3_11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Influenza burden among children is underestimated. Rapid influenza diagnostic tests (RIDTs) may be helpful in the early diagnosis of the disease, but their results should be interpreted cautiously. The aim of our study was to estimate the accuracy of the rapid influenza detection test BD Directigen™ EZ Flu A+B (Becton, Dickinson and Company, Sparks, MD) used among children with influenza-like illness (ILI) consulted in the ambulatory care clinics. A total number of 150 patients were enrolled into the study. The inclusion criteria were: age of the child less than 59 months, presentation of ILI according to CDC definition (fever >37.8 °C, cough, and/or sore throat in the absence of another known cause of illness), and duration of symptoms shorter than 96 h. In all patients two nasal and one pharyngeal swab were obtained and tested by RIDT, RT-PCR, and real time RT-PCR. For or influenza A(H1N1)pdm09, virus sensitivity of RIDT was 62.2 % (95 %CI 53.4-66.5 %), specificity 97.1 % (95 %CI 93.4-99 %), positive predictive value (PPV) 90.3 % (95 %CI 77.5-96.5 %), and negative predictive value (NPV) 85.7 % (95 %CI 82.4-87.3 %). For influenza B, virus sensitivity was 36.8 % (95 %CI 23.3-41.1 %), specificity 99.2 % (95 %CI 97.3-99.9 %), PPV 87.5 % (95 %CI 55.4-97.7 %), and NPV 91.5 % (95 % CI 89.7-92.1 %). We conclude that the RIDT immunoassay is a specific, but moderately sensitive, method in the diagnosis of influenza type A and is of low sensitivity in the diagnosis of influenza B infections in infants and children.
Collapse
|
16
|
Fielding JE, Kelly HA, Mercer GN, Glass K. Systematic review of influenza A(H1N1)pdm09 virus shedding: duration is affected by severity, but not age. Influenza Other Respir Viruses 2013; 8:142-50. [PMID: 24299099 PMCID: PMC4186461 DOI: 10.1111/irv.12216] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 01/02/2023] Open
Abstract
Duration of viral shedding following infection is an important determinant of disease transmission, informing both control policies and disease modelling. We undertook a systematic literature review of the duration of influenza A(H1N1)pdm09 virus shedding to examine the effects of age, severity of illness and receipt of antiviral treatment. Studies were identified by searching the PubMed database using the keywords ‘H1N1’, ‘pandemic’, ‘pandemics’, ‘shed’ and ‘shedding’. Any study of humans with an outcome measure of viral shedding was eligible for inclusion in the review. Comparisons by age, degree of severity and antiviral treatment were made with forest plots. The search returned 214 articles of which 22 were eligible for the review. Significant statistical heterogeneity between studies precluded meta-analysis. The mean duration of viral shedding generally increased with severity of clinical presentation, but we found no evidence of longer shedding duration of influenza A(H1N1)pdm09 among children compared with adults. Shorter viral shedding duration was observed when oseltamivir treatment was administered within 48 hours of illness onset. Considerable differences in the design and analysis of viral shedding studies limit their comparison and highlight the need for a standardised approach. These insights have implications not only for pandemic planning, but also for informing responses and study of seasonal influenza now that the A(H1N1)pdm09 virus has become established as the seasonal H1N1 influenza virus.
Collapse
Affiliation(s)
- James E Fielding
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, Vic., Australia; National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, 0200, Australia
| | | | | | | |
Collapse
|
17
|
Goodell CK, Prickett J, Kittawornrat A, Zhou F, Rauh R, Nelson W, O'Connell C, Burrell A, Wang C, Yoon KJ, Zimmerman JJ. Probability of detecting influenza A virus subtypes H1N1 and H3N2 in individual pig nasal swabs and pen-based oral fluid specimens over time. Vet Microbiol 2013; 166:450-60. [PMID: 23910522 DOI: 10.1016/j.vetmic.2013.06.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 06/16/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
The probability of detecting influenza A virus (IAV) by virus isolation (VI), point-of-care (POC) antigen detection, and real-time reverse-transcription polymerase chain reaction (rRT-PCR) was estimated for pen-based oral fluid (OF) and individual pig nasal swab (NS) specimens. Piglets (n=82) were isolated for 30 days and confirmed negative for porcine reproductive and respiratory syndrome virus, Mycoplasma hyopneumoniae, and IAV infections. A subset (n=28) was vaccinated on day post inoculation (DPI) -42 and -21 with a commercial multivalent vaccine. On DPI 0, pigs were intratracheally inoculated with contemporary isolates of H1N1 (n=35) or H3N2 (n=35) or served as negative controls (n=12). OF (n=370) was collected DPI 0-16 and NS (n=924) DPI 0-6, 8, 10, 12, 14, 16. The association between IAV detection and variables of interest (specimen, virus subtype, assay, vaccination status, and DPI) was analyzed by mixed-effect repeated measures logistic regression and the results used to calculate the probability (pˆ) of detecting IAV in OF and NS over DPI by assay. Vaccination (p-value<0.0001), DPI (p-value<0.0001), and specimen-assay interaction (p-value<0.0001) were significant to IAV detection, but virus subtype was not (p-value=0.89). Vaccination and/or increasing DPI reduced pˆ for all assays. VI was more successful using NS than OF, but both VI and POC were generally unsuccessful after DPI 6. Overall, rRT-PCR on OF specimens provided the highest pˆ for the most DPIs, yet significantly different results were observed between the two laboratories independently performing rRT-PCR testing.
Collapse
Affiliation(s)
- Christa K Goodell
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50010, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Respiratory virus multiplex RT-PCR assay sensitivities and influence factors in hospitalized children with lower respiratory tract infections. Virol Sin 2013; 28:97-102. [PMID: 23575731 PMCID: PMC7090616 DOI: 10.1007/s12250-013-3312-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 03/18/2013] [Indexed: 01/18/2023] Open
Abstract
Multiplex RT-PCR assays have been widely used tools for detection and differentiation of a panel of respiratory viral pathogens. In this study, we evaluated the Qiagen ResPlex II V2.0 kit and explored factors influencing its sensitivity. Nasopharyngeal swab (NPS) specimens were prospectively collected from pediatric inpatients with lower respiratory tract infections at the time of admission in the Shenzhen Children’s Hospital from May 2009 to April 2010. Total nucleic acids were extracted using the EZ1 system (Qiagen, Germany) and 17 respiratory viruses and genotypes including influenza A virus (FluA), FluB, parainfluenza virus 1 (PIV1), PIV2, PIV3, PIV4, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), rhinoviruses (RhV), enteroviruses (EnV), human bocaviruses (hBoV), adenoviruses (AdV), four coronaviruses (229E, OC43, NL63 and HKU1), and FluA 2009 pandemic H1N1(H1N1-p) were detected and identified by the ResPlex II kit. In parallel, 16 real-time TaqMan quantitative RT-PCR assays were used to quantitatively detect each virus except for RhV. Influenza and parainfluenza viral cultures were also performed. Among the total 438 NPS specimens collected during the study period, one or more viral pathogens were detected in 274 (62.6%) and 201(45.9%) specimens by monoplex TaqMan RT-PCR and multiplex ResPlex, respectively. When results from monoplex PCR or cell culture were used as the reference standard, the multiplex PCR possessed specificities of 92.9–100.0%. The sensitivity of multiplex PCR for PIV3, hMPV, PIV1 and BoV were 73.1%, 70%, 66.7% and 55.6%, respectively, while low sensitivities (11.1%–40.0%) were observed for FluA, EnV, OC43, RSV and H1N1. Among the seven viruses/genotypes detected with higher frequencies, multiplex PCR sensitivities were correlated significantly with viral loads determined by the TaqMan RT-PCR in FluA, H1N1-p and RSV (p=0.011−0.000). The Qiagen ResPlex II multiplex RT-PCR kit possesses excellent specificity for simultaneous detection of 17 viral pathogens in NPS specimens in pediatric inpatients at the time of admission. The sensitivity of multiplex RT-PCR was influenced by viral loads, specimen process methods, primer and probe design and amplification condition.
Collapse
|
19
|
Lukšić I, Kearns PK, Scott F, Rudan I, Campbell H, Nair H. Viral etiology of hospitalized acute lower respiratory infections in children under 5 years of age -- a systematic review and meta-analysis. Croat Med J 2013; 54:122-34. [PMID: 23630140 PMCID: PMC3641872 DOI: 10.3325/cmj.2013.54.122] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/10/2013] [Indexed: 01/26/2023] Open
Abstract
AIM To estimate the proportional contribution of influenza viruses (IV), parainfluenza viruses (PIV), adenoviruses (AV), and coronaviruses (CV) to the burden of severe acute lower respiratory infections (ALRI). METHODS The review of the literature followed PRISMA guidelines. We included studies of hospitalized children aged 0-4 years with confirmed ALRI published between 1995 and 2011. A total of 51 studies were included in the final review, comprising 56091 hospitalized ALRI episodes. RESULTS IV was detected in 3.0% (2.2%-4.0%) of all hospitalized ALRI cases, PIV in 2.7% (1.9%-3.7%), and AV in 5.8% (3.4%-9.1%). CV are technically difficult to culture, and they were detected in 4.8% of all hospitalized ALRI patients in one study. When respiratory syncytial virus (RSV) and less common viruses were included, at least one virus was detected in 50.4% (40.0%-60.7%) of all hospitalized severe ALRI episodes. Moreover, 21.9% (17.7%-26.4%) of these viral ALRI were mixed, including more than one viral pathogen. Among all severe ALRI with confirmed viral etiology, IV accounted for 7.0% (5.5%-8.7%), PIV for 5.8% (4.1%-7.7%), and AV for 8.8% (5.3%-13.0%). CV was found in 10.6% of virus-positive pneumonia patients in one study. CONCLUSIONS This article provides the most comprehensive analysis of the contribution of four viral causes to severe ALRI to date. Our results can be used in further cost-effectiveness analyses of vaccine development and implementation for a number of respiratory viruses.
Collapse
Affiliation(s)
- Ivana Lukšić
- Ivana Luksic, Institute of Publich Health Dr. Andrija Štampar, Department of Microbiology, Mirogojska cesta 16, 10000 Zagreb, Croatia.
| | | | | | | | | | | |
Collapse
|
20
|
Mitamura K, Kawakami C, Shimizu H, Abe T, Konomi Y, Yasumi Y, Yamazaki M, Ichikawa M, Sugaya N. Evaluation of a new immunochromatographic assay for rapid identification of influenza A, B, and A(H1N1)2009 viruses. J Infect Chemother 2012; 19:633-8. [PMID: 23254398 PMCID: PMC3738839 DOI: 10.1007/s10156-012-0533-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/03/2012] [Indexed: 11/07/2022]
Abstract
We evaluated Clearline Influenza A/B/(H1N1)2009, a new multi-line immunochromatographic assay for rapid detection of antigens of influenza A (Flu A), B (Flu B), and A(H1N1)2009 viruses. Clearline detected Flu A, Flu B, and A(H1N1)2009 viruses with a detection limit of 4.6 × 103 to 7.5 × 104 pfu/assay. The sensitivity and specificity of detection of influenza virus by Clearline, using RT-PCR as reference standard, were determined for A(H1N1)2009, Flu A, and Flu B, in nasopharyngeal aspirate, nasopharyngeal swab, and self-blown nasal discharge specimens. Sensitivity for nasopharyngeal aspirate specimens was: A(H1N1)2009 = 97.3 %, Flu A = 94.5 %, and Flu B = 96.8 %, and specificity was Flu A = 99.1 % and Flu B = 100 %. Sensitivity for nasopharyngeal swab specimens was: A(H1N1)2009 = 91.9 %, Flu A = 92.8 %, and Flu B = 100 %, and specificity was Flu A = 98.2 % and Flu B = 100 %. Sensitivity for self-blown nasal discharge specimens was: A(H1N1)2009 = 75.7 %, Flu A = 86.5 %, and Flu B = 76.2 %, and specificity was Flu A = 98.4 % and Flu B = 100 %. Sensitivity and specificity of Clearline were sufficient for nasopharyngeal aspirate and swab specimens. For self-blown nasal discharge specimens, sensitivity was lower than for nasopharyngeal aspirates and nasopharyngeal swabs. The sensitivity of Clearline for A(H1N1)2009 was good even 6 h after the onset of symptoms. These findings suggest that Clearline may be useful for early clinical diagnosis of influenza.
Collapse
Affiliation(s)
- Keiko Mitamura
- Department of Pediatrics, Eiju General Hospital, 2-23-16 Higashi-Ueno, Taito-ku, Tokyo, 110-8645, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
The Role of Rapid Antigen Testing for Influenza in the Era of Molecular Diagnostics. Mol Diagn Ther 2012; 14:205-14. [DOI: 10.1007/bf03256375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
22
|
Escuret V, Cornu C, Boutitie F, Enouf V, Mosnier A, Bouscambert-Duchamp M, Gaillard S, Duval X, Blanchon T, Leport C, Gueyffier F, Van Der Werf S, Lina B. Oseltamivir-zanamivir bitherapy compared to oseltamivir monotherapy in the treatment of pandemic 2009 influenza A(H1N1) virus infections. Antiviral Res 2012; 96:130-7. [PMID: 22909899 DOI: 10.1016/j.antiviral.2012.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 08/02/2012] [Accepted: 08/04/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND The emergence of oseltamivir resistance in 2007 highlighted the need for alternative strategies against influenza. To limit the putative emergence of resistant viruses this clinical trial aimed to evaluate the antiviral efficacy and tolerability of oseltamivir-zanamivir (O+Z) bitherapy compared to oseltamivir monotherapy (O). This clinical trial was designed in 2008-2009 and was conducted during the A(H1N1) influenza virus pandemic in 2009-2010. The A(H1N1)pdm09 viruses were reported to be sensitive to oseltamivir and zanamivir but resistant to amantadine. METHODS During the pandemic phase in France, adults with influenza-like illness for less than 42h and who tested positive to influenza A were randomised into treatment groups: (O+Z) or (O). Patients had a nasal wash at day 0, before the beginning of treatment and daily at days 1 to 4. They also had a nasal swab at days 5 and 7 to check for the negativation of viral excretion. Virological response was assessed using the GAPDH adjusted M gene quantification. RESULTS Analysis was possible for 24 patients, 12 in the (O+Z) arm and 12 in the (O) arm. The mean viral load decreased at around 1 log(10)cgeq/μl per day regardless of allocated treatment group. We could not detect any significant difference between treatment groups in the duration needed to alleviate symptoms. All treatments were well tolerated. No oseltamivir-resistant H275Y NA mutated virus has been detected in patients of both treatment groups. CONCLUSIONS The sample size of our study is too limited to be fully informative and we could not detect whether combination therapy (O+Z) improves or reduces the effectiveness of oseltamivir in the treatment of influenza A(H1N1)pdm09 virus infection in community patients. Additional studies are needed to improve the antiviral treatment of patients infected with influenza virus.
Collapse
Affiliation(s)
- Vanessa Escuret
- Hospices Civils de Lyon, Centre National de Référence virus influenzae France Sud, Laboratoire de Virologie Est, F-69677 Bron, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Detection of influenza A viruses with a portable real-time PCR instrument. J Virol Methods 2012; 181:188-91. [DOI: 10.1016/j.jviromet.2012.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 02/03/2012] [Accepted: 02/13/2012] [Indexed: 11/23/2022]
|
24
|
Tai CF, Lu CY, Shao PL, Lee PI, Chang LY, Huang LM. Rapid-test sensitivity for novel swine-origin pandemic influenza A. J Formos Med Assoc 2012; 111:427-30. [PMID: 22939660 DOI: 10.1016/j.jfma.2011.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE Rapid diagnosis of influenza was important in the global pandemic influenza A/H1N1 outbreak. The QuickVue Influenza A+B test is one of the most common tests for rapid diagnosis of influenza. We evaluated the sensitivity and specificity of the test in children. METHODS We collected data from 970 patients with influenza-like illness who received rapid influenza antigen tests using the QuickVue Influenza A+B test as well as viral isolation. We compared the results with that of viral isolation and reverse-transcriptase polymerase chain reaction (RT-PCR) assays. RESULTS Based on viral culture, the QuickVue Influenza A+B test had an overall sensitivity of 0.82 (419/513) and specificity of 0.99 (70/71), with a positive predictive value (PPV) of 0.74 (419/563) and a negative predictive value (NPV) of 0.77 (313/407). The sensitivity of QuickVue was significantly higher in specimens with high viral loads. If the viral loads were less than 10(6), the sensitivity of QuickVue was 0.62, while the sensitivity of QuickVue was 0.88 if the viral loads were higher than 10(6) (p<0.001). Logistic regression analysis showed that higher viral loads correlated with positive QuickVue results (p<0.001). On the first day of fever, the sensitivity of QuickVue was only 0.67; on the second day, the sensitivity was 0.86; on the third day, the sensitivity was 0.98, and on the fourth day, the sensitivity was 0.90. The sensitivity is significantly higher on days 2-3 in comparison with the first day of fever (p<0.05). We calculated the correlation of viral load and fever days, and the result showed higher mean viral load on the second and third days of fever. Age did not affect the sensitivity. CONCLUSION In children, the sensitivity of QuickVue Influenza A+B test was 0.82. In addition, the sensitivity was significantly elevated in the higher viral load group and on the third day of fever.
Collapse
Affiliation(s)
- Chun-Fu Tai
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
25
|
Klick B, Nishiura H, Cowling BJ. Optimal design of intervention studies to prevent influenza in healthy cohorts. PLoS One 2012; 7:e35166. [PMID: 22514718 PMCID: PMC3325991 DOI: 10.1371/journal.pone.0035166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/13/2012] [Indexed: 11/19/2022] Open
Abstract
Background Influenza cohort studies, in which participants are monitored for infection over an epidemic period, are invaluable in assessing the effectiveness of control measures such as vaccination, antiviral prophylaxis and non-pharmaceutical interventions (NPIs). Influenza infections and illnesses can be identified through a number of approaches with different costs and logistical requirements. Methodology and Principal Findings In the context of a randomized controlled trial of an NPI with a constrained budget, we used a simulation approach to examine which approaches to measuring outcomes could provide greater statistical power to identify an effective intervention against confirmed influenza. We found that for a short epidemic season, the optimal design was to collect respiratory specimens at biweekly intervals, as well as following report of acute respiratory illness (ARI), for virologic testing by reverse transcription polymerase chain reaction (RT-PCR). Collection of respiratory specimens only from individuals reporting ARI was also an efficient design particularly for studies in settings with longer periods of influenza activity. Collection of specimens only from individuals reporting a febrile ARI was less efficient. Collection and testing of sera before and after influenza activity appeared to be inferior to collection of respiratory specimens for RT-PCR confirmation of acute infections. The performance of RT-PCR was robust to uncertainty in the costs and diagnostic performance of RT-PCR and serological tests. Conclusions and Significance Our results suggest that unless the sensitivity or specificity of serology can be increased RT-PCR will remain as the preferable outcome measure in NPI studies. Routine collection of specimens for RT-PCR testing even when study participants do not report acute respiratory illness appears to be the most cost efficient design under most scenarios.
Collapse
Affiliation(s)
- Brendan Klick
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - Hiroshi Nishiura
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
- PRESTO, Japan Science and Technology Agency, Saitama, Japan
| | - Benjamin J. Cowling
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
- * E-mail:
| |
Collapse
|
26
|
You JHS, Chan ESK, Leung MYK, Ip M, Lee NLS. A cost-effectiveness analysis of "test" versus "treat" patients hospitalized with suspected influenza in Hong Kong. PLoS One 2012; 7:e33123. [PMID: 22479363 PMCID: PMC3315544 DOI: 10.1371/journal.pone.0033123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 02/04/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Seasonal and 2009 H1N1 influenza viruses may cause severe diseases and result in excess hospitalization and mortality in the older and younger adults, respectively. Early antiviral treatment may improve clinical outcomes. We examined potential outcomes and costs of test-guided versus empirical treatment in patients hospitalized for suspected influenza in Hong Kong. METHODS We designed a decision tree to simulate potential outcomes of four management strategies in adults hospitalized for severe respiratory infection suspected of influenza: "immunofluorescence-assay" (IFA) or "polymerase-chain-reaction" (PCR)-guided oseltamivir treatment, "empirical treatment plus PCR" and "empirical treatment alone". Model inputs were derived from literature. The average prevalence (11%) of influenza in 2010-2011 (58% being 2009 H1N1) among cases of respiratory infections was used in the base-case analysis. Primary outcome simulated was cost per quality-adjusted life-year (QALY) expected (ICER) from the Hong Kong healthcare providers' perspective. RESULTS In base-case analysis, "empirical treatment alone" was shown to be the most cost-effective strategy and dominated the other three options. Sensitivity analyses showed that "PCR-guided treatment" would dominate "empirical treatment alone" when the daily cost of oseltamivir exceeded USD18, or when influenza prevalence was <2.5% and the predominant circulating viruses were not 2009 H1N1. Using USD50,000 as the threshold of willingness-to-pay, "empirical treatment alone" and "PCR-guided treatment" were cost-effective 97% and 3% of time, respectively, in 10,000 Monte-Carlo simulations. CONCLUSIONS During influenza epidemics, empirical antiviral treatment appears to be a cost-effective strategy in managing patients hospitalized with severe respiratory infection suspected of influenza, from the perspective of healthcare providers in Hong Kong.
Collapse
Affiliation(s)
- Joyce H. S. You
- School of Pharmacy, Faculty of Medicine, Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eva S. K. Chan
- School of Pharmacy, Faculty of Medicine, Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Maggie Y. K. Leung
- School of Pharmacy, Faculty of Medicine, Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Margaret Ip
- Faculty of Medicine, Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Nelson L. S. Lee
- Division of Infectious Diseases, Faculty of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- * E-mail:
| |
Collapse
|
27
|
Rodríguez A, Alvarez-Rocha L, Sirvent JM, Zaragoza R, Nieto M, Arenzana A, Luque P, Socías L, Martín M, Navarro D, Camarena J, Lorente L, Trefler S, Vidaur L, Solé-Violán J, Barcenilla F, Pobo A, Vallés J, Ferri C, Martín-Loeches I, Díaz E, López D, López-Pueyo MJ, Gordo F, del Nogal F, Marqués A, Tormo S, Fuset MP, Pérez F, Bonastre J, Suberviola B, Navas E, León C. [Recommendations of the Infectious Diseases Work Group (GTEI) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Infections in Critically Ill Patients Study Group (GEIPC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) for the diagnosis and treatment of influenza A/H1N1 in seriously ill adults admitted to the Intensive Care Unit]. Med Intensiva 2012; 36:103-37. [PMID: 22245450 DOI: 10.1016/j.medin.2011.11.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/20/2011] [Indexed: 02/08/2023]
Abstract
The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1. Immunochromatographic methods have low sensitivity; a negative result therefore does not rule out active infection. Classical culture is slow and has low sensitivity. Direct immunofluorescence offers a sensitivity of 90%, but requires a sample of high quality. Indirect methods for detecting antibodies are only of epidemiological interest. Patients with A/H1N1 flu may have relative leukopenia and elevated serum levels of LDH, CPK and CRP, but none of these variables are independently associated to the prognosis. However, plasma LDH> 1500 IU/L, and the presence of thrombocytopenia <150 x 10(9)/L, could define a patient population at risk of suffering serious complications. Antiviral administration (oseltamivir) should start early (<48 h from the onset of symptoms), with a dose of 75 mg every 12h, and with a duration of at least 7 days or until clinical improvement is observed. Early antiviral administration is associated to improved survival in critically ill patients. New antiviral drugs, especially those formulated for intravenous administration, may be the best choice in future epidemics. Patients with a high suspicion of influenza A/H1N1 infection must continue with antiviral treatment, regardless of the negative results of initial tests, unless an alternative diagnosis can be established or clinical criteria suggest a low probability of influenza. In patients with influenza A/H1N1 pneumonia, empirical antibiotic therapy should be provided due to the possibility of bacterial coinfection. A beta-lactam plus a macrolide should be administered as soon as possible. The microbiological findings and clinical or laboratory test variables may decide withdrawal or not of antibiotic treatment. Pneumococcal vaccination is recommended as a preventive measure in the population at risk of suffering severe complications. Although the use of moderate- or low-dose corticosteroids has been proposed for the treatment of influenza A/H1N1 pneumonia, the existing scientific evidence is not sufficient to recommend the use of corticosteroids in these patients. The treatment of acute respiratory distress syndrome in patients with influenza A/H1N1 must be based on the use of a protective ventilatory strategy (tidal volume <10 ml / kg and plateau pressure <35 mmHg) and positive end-expiratory pressure set to high patient lung mechanics, combined with the use of prone ventilation, muscle relaxation and recruitment maneuvers. Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, though it may be useful in experienced centers and in cases of respiratory failure associated with chronic obstructive pulmonary disease exacerbation or heart failure. Extracorporeal membrane oxygenation is a rescue technique in refractory acute respiratory distress syndrome due to influenza A/H1N1 infection. The scientific evidence is weak, however, and extracorporeal membrane oxygenation is not the technique of choice. Extracorporeal membrane oxygenation will be advisable if all other options have failed to improve oxygenation. The centralization of extracorporeal membrane oxygenation in referral hospitals is recommended. Clinical findings show 50-60% survival rates in patients treated with this technique. Cardiovascular complications of influenza A/H1N1 are common. Such problems may appear due to the deterioration of pre-existing cardiomyopathy, myocarditis, ischemic heart disease and right ventricular dysfunction. Early diagnosis and adequate monitoring allow the start of effective treatment, and in severe cases help decide the use of circulatory support systems. Influenza vaccination is recommended for all patients at risk. This indication in turn could be extended to all subjects over 6 months of age, unless contraindicated. Children should receive two doses (one per month). Immunocompromised patients and the population at risk should receive one dose and another dose annually. The frequency of adverse effects of the vaccine against A/H1N1 flu is similar to that of seasonal flu. Chemoprophylaxis must always be considered a supplement to vaccination, and is indicated in people at high risk of complications, as well in healthcare personnel who have been exposed.
Collapse
Affiliation(s)
- A Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, IISPV - URV - CIBER Enfermedades Respiratorias, Tarragona, España.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Mak GC, Wong AH, Ho WYY, Lim W. The impact of pandemic influenza A (H1N1) 2009 on the circulation of respiratory viruses 2009-2011. Influenza Other Respir Viruses 2012; 6:e6-10. [PMID: 22212717 PMCID: PMC5657134 DOI: 10.1111/j.1750-2659.2011.00323.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Surveillance of respiratory viruses has been conducted for many years at the public health laboratory in Hong Kong. With the occurrence of pandemic influenza A (H1N1) 2009, we observed a change in the seasonality of influenza activity with a seemingly corresponding change in the activity of respiratory syncytial virus, parainfluenza virus, and adenovirus during 2009-2011. This phenomenon could most likely be explained by virus interference.
Collapse
Affiliation(s)
- Gannon C Mak
- Virology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong, China.
| | | | | | | |
Collapse
|
29
|
Evaluation of the ESPLINE® Influenza A & B-N assay for the detection of influenza A and B in nasopharyngeal aspirates. Eur J Clin Microbiol Infect Dis 2011; 31:761-6. [PMID: 21953031 DOI: 10.1007/s10096-011-1372-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
Abstract
Several direct antigen tests for the detection of influenza often lack sensitivity compared to immunofluorescence (IF) on the specimens and viral culture (VC). We evaluated the performance of a rapid test, the ESPLINE® Influenza A & B-N assay. A total of 302 respiratory specimens were collected at the University Hospital of Antwerp. A first group of 60 samples taken during the H1N1 outbreak (2009-2010) and a second group of 242 samples stored during the seasonal influenza epidemics (2000-2009) were analyzed with the ESPLINE® test. A subset of samples were also evaluated with the BinaxNOW Influenza and the Clearview Exact Influenza. The results were compared to IF on the specimens, VC with IF, and the combination of both, which was considered as the gold standard. The ESPLINE® test's overall sensitivity and specificity were 91% and 97%, during the H1N1 season 80% and 93%, and for the detection of seasonal influenza 93% and 97%, respectively. In comparison to the BinaxNOW Influenza and the Clearview Exact Influenza, all tests demonstrated a similar specificity of 92.0-100% but a significantly different sensitivity of 44.4-86.0%, with the ESPLINE® test being significantly more sensitive. Due to its very good performance and simplicity, the ESPLINE® test facilitates urgent testing. The test seems less sensitive to detect H1N1 compared to seasonal influenza, although the difference is borderline not significant (p = 0.067).
Collapse
|
30
|
Abstract
ABSTRACT
Diagnostic testing for respiratory viruses has been revolutionized by recent advances that have made rapid and highly accurate tests accessible to clinical laboratories, and it is important that these improved methods be utilized. Accurate detection of respiratory viruses is important in patient care, as it guides both therapy and infection control measures. On a larger scale, the CDC and its collaborating laboratories collect both data and isolates from clinical laboratories for national surveillance, and the use of high-quality tests in clinical laboratories can improve the quality of these data.
Collapse
|
31
|
Chu H, Lofgren ET, Halloran ME, Kuan PF, Hudgens M, Cole SR. Performance of rapid influenza H1N1 diagnostic tests: a meta-analysis. Influenza Other Respir Viruses 2011; 6:80-6. [PMID: 21883964 PMCID: PMC3288365 DOI: 10.1111/j.1750-2659.2011.00284.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Please cite this paper as: Chu et al. (2011) Performance of rapid influenza H1N1 diagnostic tests: a meta‐analysis. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2011.00284.x. Background Following the outbreaks of 2009 pandemic H1N1 infection, rapid influenza diagnostic tests have been used to detect H1N1 infection. However, no meta‐analysis has been undertaken to assess the diagnostic accuracy when this manuscript was drafted. Methods The literature was systematically searched to identify studies that reported the performance of rapid tests. Random effects meta‐analyses were conducted to summarize the overall performance. Results Seventeen studies were selected with 1879 cases and 3477 non‐cases. The overall sensitivity and specificity estimates of the rapid tests were 0·51 (95%CI: 0·41, 0·60) and 0·98 (95%CI: 0·94, 0·99). Studies reported heterogeneous sensitivity estimates, ranging from 0·11 to 0·88. If the prevalence was 30%, the overall positive and negative predictive values were 0·94 (95%CI: 0·85, 0·98) and 0·82 (95%CI: 0·79, 0·85). The overall specificities from different manufacturers were comparable, while there were some differences for the overall sensitivity estimates. BinaxNOW had a lower overall sensitivity of 0·39 (95%CI: 0·24, 0·57) compared with all the others (P‐value <0·001), whereas QuickVue had a higher overall sensitivity of 0·57 (95%CI: 0·50, 0·63) compared with all the others (P‐value = 0·005). Conclusions Rapid tests have high specificity but low sensitivity and thus limited usefulness.
Collapse
Affiliation(s)
- Haitao Chu
- Division of Biostatistics, School of Public Health, The University of Minnesota at Twin Cities, Minneapolis, MN 55455, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Multicenter prospective evaluation of a novel rapid immunochromatographic diagnostic kit specifically detecting influenza A H1N1 2009 virus. J Clin Virol 2011; 51:68-72. [DOI: 10.1016/j.jcv.2011.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 01/17/2011] [Accepted: 01/17/2011] [Indexed: 11/27/2022]
|
33
|
Evaluation of Qiagen Resplex II for the detection of pandemic influenza A (H1N1) 2009 and influenza A (H3N2) virus. J Clin Virol 2011; 51:88-9. [PMID: 21377411 DOI: 10.1016/j.jcv.2011.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 02/07/2011] [Indexed: 11/21/2022]
|
34
|
Validation and diagnostic application of NS and HA gene-specific real-time reverse transcription-PCR assays for detection of 2009 pandemic influenza A (H1N1) viruses in clinical specimens. J Clin Microbiol 2011; 49:2009-11. [PMID: 21367994 DOI: 10.1128/jcm.00259-11] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Real-time reverse transcription-PCR assays specific for the nonstructural (NS) and hemagglutinin (HA) genes of the 2009 pandemic influenza A (H1N1) virus were developed and evaluated with clinical samples from infected patients. The tests are characterized by high sensitivity and specificity and performed well throughout the first year of the 2009 pandemic.
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW The 2009 H1N1 pandemic focused attention on the speed and accuracy of influenza diagnostic methods. This review provides an update on current tests and new developments. RECENT FINDINGS Widely used rapid antigen tests and immunofluorescence tests were generally less sensitive for 2009 H1N1 influenza than for seasonal influenza. In addition, marked variability was reported for the same tests in different settings and patient groups. The advantages of molecular testing gained wide recognition, namely high sensitivity, speed compared with culture, ability to assess viral load and to identify subtype. Although adoption of influenza molecular testing can be expected to accelerate, immunoassays and rapid cultures performed on site retain advantages for many facilities. Falsely negative results were seen with all methods, especially for samples collected very early or late. SUMMARY Influenza diagnostic test performance can be adversely affected by viral genetic and antigenic changes and should be re-assessed annually. Variability in sensitivity and specificity of the same test in different settings highlights the need for each laboratory to ensure optimal procedures and work with clinicians to improve sample quality. Manufacturers have been motivated to improve immunoassays and develop simpler and faster multiplex molecular tests, hopefully in advance of the next pandemic.
Collapse
|
36
|
Mak GC, Choy PWW, Lee WY, Wong AH, Ng KC, Lim W. Sero-immunity and serologic response to pandemic influenza A (H1N1) 2009 virus in Hong Kong. J Med Virol 2011; 82:1809-15. [PMID: 20872705 DOI: 10.1002/jmv.21895] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
To study the serologic response to the new pandemic influenza A (H1N1) 2009 virus in Hong Kong, the level of immunity was measured before and after the occurrence of the outbreak, and the titer of antibody to the pandemic influenza A (H1N1) 2009 virus in serum samples of laboratory confirmed cases. The presence of pre-outbreak pandemic influenza A (H1N1) 2009 virus antibodies in 37% of individuals older than >65 years suggested previous exposures to heterologous virus strains may have elicited cross-reacting antibody. Following large outbreaks of pandemic influenza A 2009 virus that peaked in September 2009, there is a change in immunity level in various age groups consistent with the attack rates among population in Hong Kong. Among individuals with mild clinical presentation, the antibody response to pandemic influenza A (H1N1) 2009 virus was stronger in those individuals aged ≤ 24 years but took more time to reach a titer of 40 when compared with those aged >24 years; however, the antibody level declined slower among individuals aged ≤ 24 years. Regardless of age, the antibody response rose rapidly and reached much higher titer among individuals with severe clinical presentation. Further study is required to collect additional data on antibody persistence and determine how much protection is conferred by previous exposure to seasonal influenza A (H1N1) viruses.
Collapse
Affiliation(s)
- Gannon C Mak
- Virology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Kowloon, Hong Kong
| | | | | | | | | | | |
Collapse
|
37
|
Hayden RT, Wick MT, Rodriguez AB, Caliendo AM, Mitchell MJ, Ginocchio CC. A survey-based assessment of United States clinical laboratory response to the 2009 H1N1 influenza outbreak. Arch Pathol Lab Med 2010; 134:1671-8. [PMID: 21043821 DOI: 10.5858/2010-0134-cpr.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The recent outbreak of pandemic influenza created enormous economic, logistical, and analytical challenges for clinical laboratories. Laboratory response represented a critical element in the care of affected patients, but little has been published regarding this aspect of the pandemic. OBJECTIVE To assess the overall response of clinical diagnostic laboratories across the United States to the initial phase of the 2009 H1N1 influenza A pandemic. DESIGN A 24-question survey was developed and distributed by e-mail to determine current influenza testing practices and how those practices were changed in response to the outbreak of 2009 H1N1 influenza. The survey was distributed to participants in the College of American Pathologists proficiency testing programs related to viral diagnostics. Survey questions focused on laboratory safety, communication of results, testing volume and resources, and whether changes in resource allocation or laboratory practice were anticipated in preparation for the 2009-2010 influenza season. RESULTS A total of 24.3% (931) of laboratories responded to the survey. Overall, few laboratories reported changes in methodology in response to the 2009 H1N1 influenza outbreak, although, notably, the number of centers using molecular amplification methods more than doubled, from 41 to 91. Turn-around time for result reporting and safety methods used were largely as expected for individual testing modalities. Shortages in staffing, testing supplies, and personal protective equipment were reported, but most sites were able to maintain operations and did not feel that patient care was negatively affected. CONCLUSION This report provides a comprehensive picture of clinical laboratory responses in the early stages of the 2009 H1N1 influenza pandemic. These data should assist in the continued laboratory management of this outbreak and in planning for future emerging infections.
Collapse
Affiliation(s)
- Randall T Hayden
- Department of Pathology, St JudeChildren's Research Hospital, Memphis, TN 38105-2794, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Kao TM, Wu UI, Chen YC. Rapid diagnostic tests and severity of illness in pandemic (H1N1) 2009, Taiwan. Emerg Infect Dis 2010; 16:1181-3. [PMID: 20587206 PMCID: PMC3321915 DOI: 10.3201/eid1607.100105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
39
|
Yang JR, Lo J, Ho YL, Wu HS, Liu MT. Pandemic H1N1 and seasonal H3N2 influenza infection in the human population show different distributions of viral loads, which substantially affect the performance of rapid influenza tests. Virus Res 2010; 155:163-7. [PMID: 20875469 DOI: 10.1016/j.virusres.2010.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/21/2010] [Accepted: 09/21/2010] [Indexed: 11/18/2022]
Abstract
A wide range of sensitivity has been reported for rapid influenza antigen tests (RIAT). In this study, we analyzed the viral loads of 778 pandemic H1N1- and 227 seasonal H3N2-virus positive clinical specimens collected during the same period and found that viral loads in pandemic H1N1 viruses was characterized by lower copy numbers than seasonal H3N2 viruses. Among various factors including the timing of specimen collection, patient age, patient gender and subtype of influenza, we found that the subtype of influenza was the most important determinant of viral load. To investigate whether these different patterns of viral load distribution affect the clinical performance of RIAT, the RIAT reagent itself and the various virus subtypes were considered and analyzed further. Based on three strategies, including cut-off values, performance on a subset of clinical specimens and evaluated performance curve of the Espline influenza A&B-N RIAT, the clinical sensitivities were 48.7-55.9% for pandemic H1N1 and 64.0-70.5% for seasonal H3N2 viruses in this study. These results indicate that the distributions of viral loads of different influenza A subtypes substantially influence the sensitivity of RIAT for clinical specimens. The lower sensitivity of RIAT for pandemic H1N1 than seasonal H3N2 virus is mainly due to differences in viral load in clinical samples rather than a diminished capacity of RIAT itself to detect these two subtypes of influenza A viruses.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Female
- Humans
- Infant
- Infant, Newborn
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza A Virus, H3N2 Subtype/pathogenicity
- Influenza, Human/diagnosis
- Influenza, Human/virology
- Male
- Middle Aged
- Reagent Kits, Diagnostic
- Sensitivity and Specificity
- Viral Load
- Virology/methods
- Young Adult
Collapse
Affiliation(s)
- Ji-Rong Yang
- National Influenza Center, Centers for Disease Control, Taipei, Taiwan, ROC
| | | | | | | | | |
Collapse
|
40
|
Kim YK, Uh Y, Chun JK, Kim C, Kim HY. Evaluation of new hemagglutinin-based rapid antigen test for influenza A pandemic (H1N1) 2009. J Clin Virol 2010; 49:69-72. [DOI: 10.1016/j.jcv.2010.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 06/22/2010] [Accepted: 06/28/2010] [Indexed: 11/15/2022]
|
41
|
Domínguez-Cherit G, Ñamendys-Silva SA, de la Torre A, Macias AE, Cordova-Villalobos JA. H1N1 Influenza Pandemic of 2009 Compared With Other Influenza Pandemics: Epidemiology, Diagnosis, Management, Pulmonary Complications, and Outcomes. Curr Infect Dis Rep 2010; 12:204-10. [PMID: 21308531 PMCID: PMC7101813 DOI: 10.1007/s11908-010-0097-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Influenza pandemics are complex events that have occurred frequently throughout human history, three during the past century alone. Now the world is facing the first 21st century pandemic, and the comparison among them is essential to identify common epidemiologic patterns, clinical characteristics, and outcomes. The evolution of medicine, including diagnostic and treatment options, the critical care advances, and global responses are new interventions that could modify the general outcome of the pandemic. Learning from past and current events could lead to a plan for prompt and efficient response in future pandemics and may be help us to predict the unpredictable.
Collapse
Affiliation(s)
- Guillermo Domínguez-Cherit
- Division of Pulmonary and Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan, CP 14000 México DF, México
| | - Silvio A. Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan, CP 14000 México DF, México
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. sección XVI Delegación Tlalpan, CP 14080 México, DF, México
| | - Alethse de la Torre
- Hospital Epidemiology Division, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan, CP 14000 México DF, México
| | - Alejandro E. Macias
- Hospital Epidemiology Division, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan, CP 14000 México DF, México
| | | |
Collapse
|