1
|
Chao S, Wang Y, Wu B, Li R, Dong J, Ji L, Li X, Li R, Yin X, Zhao X, Liang W. Characterization of viral infections in children with influenza-like-illness during December 2018-January 2019. Front Cell Infect Microbiol 2024; 13:1351814. [PMID: 38304460 PMCID: PMC10830827 DOI: 10.3389/fcimb.2023.1351814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
Introduction Respiratory viral infection (RVI) is of very concern after the outbreak of COVID-19, especially in pediatric departments. Learning pathogen spectrum of RVI in children previous the epidemic of COVID-19 could provide another perspective for understanding RVI under current situation and help to prepare for the post COVID-19 infection control. Methods A nucleic acid sequence-based amplification (NASBA) assay, with 19 pairs of primers targeting various respiratory viruses, was used for multi-pathogen screening of viral infections in children presenting influenza-like illness (ILI) symptoms. Children with ILI at the outpatient department of Beijing Tsinghua Changgung Hospital during the influenza epidemic from 12/2018 to 01/2019 were included. Throat swabs were obtained for both the influenza rapid diagnostic test (IRDT) based on the colloidal gold immunochromatographic assay and the NASBA assay, targeting various respiratory viruses with an integrated chip technology. Results and discussion Of 519 patients, 430 (82.9%) were positive in the NASBA assay. The predominant viral pathogens were influenza A H1N1 pdm1/2009 (pH1N1) (48.4%) and influenza A (H3N2) (18.1%), followed by human metapneumovirus (hMPV) (8.8%) and respiratory syncytial virus (RSV) (6.1%). Of the 320 cases identified with influenza A by NASBA, only 128 (40.0%) were positive in the IRDT. The IRDT missed pH1N1 significantly more frequently than A (H3N2) (P<0.01). Influenza A pH1N1 and A (H3N2) were the major pathogens in <6 years and 6-15 years old individuals respectively (P<0.05). In summary, influenza viruses were the major pathogens in children with ILI during the 2018-2019 winter influenza epidemic, while hMPV and RSV were non-negligible. The coexistence of multiple pathogen leading to respiratory infections is the normalcy in winter ILI cases.
Collapse
Affiliation(s)
- Shuang Chao
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuejiao Wang
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Baolei Wu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Runqing Li
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingxiao Dong
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lina Ji
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xuejun Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ran Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaomei Yin
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiuying Zhao
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| |
Collapse
|
2
|
Rankin DA, Peetluk LS, Deppen S, Slaughter JC, Katz S, Halasa NB, Khankari NK. Diagnostic models predicting paediatric viral acute respiratory infections: a systematic review. BMJ Open 2023; 13:e067878. [PMID: 37085296 PMCID: PMC10124282 DOI: 10.1136/bmjopen-2022-067878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/03/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To systematically review and evaluate diagnostic models used to predict viral acute respiratory infections (ARIs) in children. DESIGN Systematic review. DATA SOURCES PubMed and Embase were searched from 1 January 1975 to 3 February 2022. ELIGIBILITY CRITERIA We included diagnostic models predicting viral ARIs in children (<18 years) who sought medical attention from a healthcare setting and were written in English. Prediction model studies specific to SARS-CoV-2, COVID-19 or multisystem inflammatory syndrome in children were excluded. DATA EXTRACTION AND SYNTHESIS Study screening, data extraction and quality assessment were performed by two independent reviewers. Study characteristics, including population, methods and results, were extracted and evaluated for bias and applicability using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and PROBAST (Prediction model Risk Of Bias Assessment Tool). RESULTS Of 7049 unique studies screened, 196 underwent full text review and 18 were included. The most common outcome was viral-specific influenza (n=7; 58%). Internal validation was performed in 8 studies (44%), 10 studies (56%) reported discrimination measures, 4 studies (22%) reported calibration measures and none performed external validation. According to PROBAST, a high risk of bias was identified in the analytic aspects in all studies. However, the existing studies had minimal bias concerns related to the study populations, inclusion and modelling of predictors, and outcome ascertainment. CONCLUSIONS Diagnostic prediction can aid clinicians in aetiological diagnoses of viral ARIs. External validation should be performed on rigorously internally validated models with populations intended for model application. PROSPERO REGISTRATION NUMBER CRD42022308917.
Collapse
Affiliation(s)
- Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lauren S Peetluk
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Deppen
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Sophie Katz
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nikhil K Khankari
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
3
|
Lim NWH, Lim JT, Dickens BL. Border Control for Infectious Respiratory Disease Pandemics: A Modelling Study for H1N1 and Four Strains of SARS-CoV-2. Viruses 2023; 15:v15040978. [PMID: 37112958 PMCID: PMC10144227 DOI: 10.3390/v15040978] [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: 03/22/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Post-pandemic economic recovery relies on border control for safe cross-border movement. Following the COVID-19 pandemic, we investigate whether effective strategies generalize across diseases and variants. For four SARS-CoV-2 variants and influenza A-H1N1, we simulated 21 strategy families of varying test types and frequencies, quantifying expected transmission risk, relative to no control, by strategy family and quarantine length. We also determined minimum quarantine lengths to suppress relative risk below given thresholds. SARS-CoV-2 variants showed similar relative risk across strategy families and quarantine lengths, with at most 2 days' between-variant difference in minimum quarantine lengths. ART-based and PCR-based strategies showed comparable effectiveness, with regular testing strategies requiring at most 9 days. For influenza A-H1N1, ART-based strategies were ineffective. Daily ART testing reduced relative risk only 9% faster than without regular testing. PCR-based strategies were moderately effective, with daily PCR (0-day delay) testing requiring 16 days for the second-most stringent threshold. Viruses with high typical viral loads and low transmission risk given low viral loads, such as SARS-CoV-2, are effectively controlled with moderate-sensitivity tests (ARTs) and modest quarantine periods. Viruses with low typical viral loads and substantial transmission risk at low viral loads, such as influenza A-H1N1, require high-sensitivity tests (PCR) and longer quarantine periods.
Collapse
Affiliation(s)
- Nigel Wei-Han Lim
- Saw Swee Hock School of Public Health, National University of Singapore 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University Experimental Medicine Building, 59 Nanyang Drive, Singapore 636921, Singapore
| | - Borame Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| |
Collapse
|
4
|
Mikamo H, Koizumi Y, Yamagishi Y, Asai N, Miyazono Y, Shinbo T, Horie M, Togashi K, Robbins EM, Hirotsu N. Comparing the cobas Influenza A/B Nucleic acid test for use on the cobas Liat System (Liat) with rapid antigen tests for clinical management of Japanese patients at the point of care. PLoS One 2022; 17:e0276099. [PMID: 36301841 PMCID: PMC9612487 DOI: 10.1371/journal.pone.0276099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background Rapid diagnosis of influenza is critical in preventing the spread of infection and ensuring patients quickly receive antiviral medication to reduce the severity and duration of influenza symptoms, whilst controlling the spread of the causative virus. In Japan patients are often administered anti-influenza medication following a positive rapid antigen detection test (RADT) result. However, the sensitivity of RADTs can lead to false negative results. The cobas® Influenza A/B Nucleic acid test for use on the cobas Liat® System (Liat) is a molecular point-of-care method that can provide a more sensitive alternative to RADTs for rapid influenza diagnosis and treatment. Methods In this prospective multicenter study, diagnostic performance of the Liat test was compared with RADTs in patients presenting with influenza-like-illness. Test performance was also assessed by time since symptom onset. Results Of 419 patients enrolled, 413 were evaluable for all designated tests. Most patients had type-A infection, and only one patient had influenza type B. In 413 patients, the sensitivity and specificity (95% CI) of the Liat test were 99.5% (97.2–99.9%) and 99.5% (97.4–99.9%), respectively, and were 79.7% (73.5–84.7%) and 95.4% (91.7–97.5%) for RADTs. For patients tested <12 hours from symptom onset, the Liat test had significantly higher sensitivity than RADTs (p<0.0001). Conclusion Overall, compared with standard of care RADTs, the Liat test was more sensitive and specific in children and adults, particularly in the early stages of infection. Greater sensitivity can enable earlier diagnosis and may better inform appropriate antiviral treatment decisions.
Collapse
Affiliation(s)
| | - Yusuke Koizumi
- Aichi Medical University, Nagakute, Aichi, Japan
- Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Yuka Yamagishi
- Aichi Medical University, Nagakute, Aichi, Japan
- Kochi University, Nankoku, Kochi, Japan
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Hagiwara Y, Harada K, Nealon J, Okumura Y, Kimura T, Chaves SS. Seasonal influenza, its complications and related healthcare resource utilization among people 60 years and older: A descriptive retrospective study in Japan. PLoS One 2022; 17:e0272795. [PMID: 36191012 PMCID: PMC9529100 DOI: 10.1371/journal.pone.0272795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/26/2022] [Indexed: 11/06/2022] Open
Abstract
Evidence suggests that older people aged ≥65 years and those aged 60–64 years with chronic medical conditions are at higher risk of developing severe complications due to influenza virus infection when compared with young, healthy adults. Although seasonal influenza is monitored through a nationwide passive surveillance in Japan, influenza related outcomes and medical resource consumption have not been fully documented. This retrospective database study aimed to describe the epidemiological and clinical characteristics of medically attended influenza cases aged ≥60 years and the associated medical resource consumption in Japan. We used clinically diagnosed influenza (CDI) based on the international classification of disease codes, and laboratory-confirmed influenza (LCI) based on influenza test results, to identify the patient population during a total of nine seasons (2010/2011 to 2018/2019). A total of 372,356 CDI and 31,122 LCI cases were identified from 77 medical institutions. The highest numbers of medically-attended influenza episodes were in patients aged 65–74 years and 75–84 years. On average, across seasons, 5.9% of all-cause hospitalizations were attributable to CDI and 0.4% were LCI. Influenza viruses type A and B co-circulated annually in varying degree of intensity and were associated with similar level of complications, including cardiovascular-related. Oxygen therapy increased with age; by contrast, mechanical ventilation, dialysis, blood transfusion, and intensive care unit admission were higher in the younger groups. In-hospital mortality for inpatients aged ≥ 85 years with CDI and LCI were 18.6% and 15.5%, respectively. Considering the burden associated with medically-attended influenza in this population, influenza prevention, laboratory confirmation and clinical management should be emphasized by general practicians and specialists like cardiologists to protect this aging population.
Collapse
Affiliation(s)
- Yuriko Hagiwara
- Medical Evidence Generation, Medical Affairs, Sanofi, Tokyo, Japan
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Joshua Nealon
- Medical Evidence Generation, Medical Affairs, Sanofi, Lyon, France
- Li Ka Shing Faculty of Medicine, World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- * E-mail:
| | - Yasuyuki Okumura
- Research and Analytics Department, Real World Data, Co., Ltd., Kyoto, Japan
- The Initiative for Clinical Epidemiological Research, Tokyo, Japan
| | - Takeshi Kimura
- Research and Analytics Department, Real World Data, Co., Ltd., Kyoto, Japan
| | - Sandra S. Chaves
- Department of Modelling, Epidemiology and Data Science, Sanofi Pasteur, Lyon, France
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
| |
Collapse
|
6
|
Flu@home: The comparative accuracy of an at-home influenza rapid diagnostic test, using a pre-positioned test kit, mobile app, mail-in reference sample, and symptom-based testing trigger. J Clin Microbiol 2022; 60:e0207021. [PMID: 35107302 PMCID: PMC8925896 DOI: 10.1128/jcm.02070-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
At-home testing with rapid diagnostic tests (RDTs) for respiratory viruses could facilitate early diagnosis, guide patient care, and prevent transmission. Such RDTs are best used near the onset of illness when viral load is highest and clinical action will be most impactful, which may be achieved by at-home testing. We evaluated the diagnostic accuracy of the QuickVue Influenza A + B RDT in an at-home setting. A convenience sample of 5,229 individuals who were engaged with an on-line health research platform were prospectively recruited throughout the United States. "flu@home" test kits containing a QuickVue RDT and reference sample collection and shipping materials were pre-positioned with participants at the beginning of the study. Participants responded to daily symptom surveys. If they reported experiencing cough along with aches, fever, chills, and/or sweats, they used their flu@home kit following instructions on a mobile app and indicated what lines they saw on the RDT. Of the 976 participants who met criteria to use their self-collection kit and completed study procedures, 202 (20.7%) were positive for influenza by qPCR. The RDT had a sensitivity of 28% (95% CI: 21-36) and specificity of 99% (98-99) for influenza A, and 32% (95% CI: 20-46) and 99% (95% CI: 98-99), for influenza B. Our results support the concept of app-supported, pre-positioned at-home RDT kits using symptom-based triggers, although it cannot be recommended with the RDT used in this study. Further research is needed to determine ways to improve the accuracy and utility of home-based testing for influenza.
Collapse
|
7
|
Phetcharakupt V, Pasomsub E, Kiertiburanakul S. Clinical manifestations of influenza and performance of rapid influenza diagnostic test: A university hospital setting. Health Sci Rep 2021; 4:e408. [PMID: 34622032 PMCID: PMC8485631 DOI: 10.1002/hsr2.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rapid influenza diagnostic test (RIDT) is a diagnostic tool that detects the influenza virus nucleoprotein antigen. The RIDT is widely used in clinical practice because it is simple and cost-effective, and provides results within 10-15 minutes. OBJECTIVE We aimed at evaluating the sensitivity and specificity of the Sofia® RIDT compared with the Luminex® multiplex polymerase chain reaction (PCR). The other goal was to determine the predicting factors for diagnosing influenza among individuals with influenza-like illness (ILI). METHOD Patients with ILI who had the results of both tests were retrospectively reviewed. We determined the performances of the RIDT. RESULTS A total of 473 patients were included with a median age of 58 (interquartile range 41-74) years. Of these, 47.1% were male, and 16.2% were diagnosed with influenza by the RIDT or RT-PCR's positive test. For influenza A, the RIDT showed a sensitivity of 76.3% (95% confidence interval [CI] 59.8-88.6) and a specificity of 97.9% (95% CI 96.1-99.0), whereas for influenza B, it showed a sensitivity of 47.1% (95% CI 23.0-72.2) and a specificity of 97.1% (95% CI 95.2-98.5). Patients with influenza were more likely to present with fever (81.8% vs 63.1%), cough (81.8% vs 66.1%), and rhinorrhea (41.6% vs 26.5%) compared to those without influenza (P < 0.05, all), and had a higher proportion of pneumonia (19.5% vs 10.6%, P = 0.029) and acute respiratory distress syndrome (5.2% vs 1.5%, P = 0.063). The predicting factors for influenza among patients presented with ILI were cough (odds ratio [OR] 2.77; 95% CI 0.21-0.81, P = 0.010), rhinorrhea (OR 1.87; 95% CI 1.03-3.36, P = 0.037), and higher body temperature (OR 1.64; 95% CI 1.23-2.19, P = 0.001). CONCLUSIONS The sensitivity of the RIDT for the diagnosis of influenza is fair in contrast to the specificity. Among patients with ILI, cough, rhinorrhea, and higher body temperature might be factors for predicting influenza.
Collapse
Affiliation(s)
- Varistha Phetcharakupt
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Ekawat Pasomsub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| |
Collapse
|
8
|
Kim S, Martínez Dibildox A, Aguirre-Soto A, Sikes HD. Exponential Amplification Using Photoredox Autocatalysis. J Am Chem Soc 2021; 143:11544-11553. [PMID: 34288684 DOI: 10.1021/jacs.1c04236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Exponential molecular amplification such as the polymerase chain reaction is a powerful tool that allows ultrasensitive biodetection. Here, we report a new exponential amplification strategy based on photoredox autocatalysis, where eosin Y, a photocatalyst, amplifies itself by activating a nonfluorescent eosin Y derivative (EYH3-) under green light. The deactivated photocatalyst is stable and rapidly activated under low-intensity light, making the eosin Y amplification suitable for resource-limited settings. Through steady-state kinetic studies and reaction modeling, we found that EYH3- is either oxidized to eosin Y via one-electron oxidation by triplet eosin Y and subsequent 1e-/H+ transfer, or activated by singlet oxygen with the risk of degradation. By reducing the rate of the EYH3- degradation, we successfully improved EYH3--to-eosin Y recovery, achieving efficient autocatalytic eosin Y amplification. Additionally, to demonstrate its flexibility in output signals, we coupled the eosin Y amplification with photoinduced chromogenic polymerization, enabling sensitive visual detection of analytes. Finally, we applied the exponential amplification methods in developing bioassays for detection of biomarkers including SARS-CoV-2 nucleocapsid protein, an antigen used in the diagnosis of COVID-19.
Collapse
Affiliation(s)
- Seunghyeon Kim
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | | | - Alan Aguirre-Soto
- School of Engineering and Sciences, Tecnologico de Monterrey, Monterrey, N.L. 64849, Mexico
| | - Hadley D Sikes
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Antimicrobial Resistance Integrated Research Group, Singapore-MIT Alliance for Research and Technology, 1 CREATE Way, Singapore 138602, Singapore
| |
Collapse
|
9
|
Zigman Suchsland ML, Rahmatullah I, Lutz B, Lyon V, Huang S, Kline E, Graham C, Cooper S, Su P, Smedinghoff S, Chu HY, Sewalk K, Brownstein JS, Thompson MJ. Evaluating an app-guided self-test for influenza: lessons learned for improving the feasibility of study designs to evaluate self-tests for respiratory viruses. BMC Infect Dis 2021; 21:617. [PMID: 34187397 PMCID: PMC8240430 DOI: 10.1186/s12879-021-06314-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
Background Seasonal influenza leads to significant morbidity and mortality. Rapid self-tests could improve access to influenza testing in community settings. We aimed to evaluate the diagnostic accuracy of a mobile app-guided influenza rapid self-test for adults with influenza like illness (ILI), and identify optimal methods for conducting accuracy studies for home-based assays for influenza and other respiratory viruses. Methods This cross-sectional study recruited adults who self-reported ILI online. Participants downloaded a mobile app, which guided them through two low nasal swab self-samples. Participants tested the index swab using a lateral flow assay. Test accuracy results were compared to the reference swab tested in a research laboratory for influenza A/B using a molecular assay. Results Analysis included 739 participants, 80% were 25–64 years of age, 79% female, and 73% white. Influenza positivity was 5.9% based on the laboratory reference test. Of those who started their test, 92% reported a self-test result. The sensitivity and specificity of participants’ interpretation of the test result compared to the laboratory reference standard were 14% (95%CI 5–28%) and 90% (95%CI 87–92%), respectively. Conclusions A mobile app facilitated study procedures to determine the accuracy of a home based test for influenza, however, test sensitivity was low. Recruiting individuals outside clinical settings who self-report ILI symptoms may lead to lower rates of influenza and/or less severe disease. Earlier identification of study subjects within 48 h of symptom onset through inclusion criteria and rapid shipping of tests or pre-positioning tests is needed to allow self-testing earlier in the course of illness, when viral load is higher. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06314-1.
Collapse
Affiliation(s)
| | - Ivan Rahmatullah
- University of Washington, 4225 Roosevelt Way NE Ste 308, Seattle, WA, 98105-6099, USA
| | - Barry Lutz
- University of Washington, 4225 Roosevelt Way NE Ste 308, Seattle, WA, 98105-6099, USA
| | - Victoria Lyon
- University of Washington, 4225 Roosevelt Way NE Ste 308, Seattle, WA, 98105-6099, USA
| | - Shichu Huang
- University of Washington, 4225 Roosevelt Way NE Ste 308, Seattle, WA, 98105-6099, USA
| | - Enos Kline
- University of Washington, 4225 Roosevelt Way NE Ste 308, Seattle, WA, 98105-6099, USA
| | - Chelsey Graham
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | | | - Helen Y Chu
- University of Washington, 4225 Roosevelt Way NE Ste 308, Seattle, WA, 98105-6099, USA
| | | | | | - Matthew J Thompson
- University of Washington, 4225 Roosevelt Way NE Ste 308, Seattle, WA, 98105-6099, USA
| | | |
Collapse
|
10
|
McIlwain DR, Chen H, Apkarian M, Affrime M, Bock B, Kim K, Mukherjee N, Nolan GP, McNeal MM. Performance of BioFire array or QuickVue influenza A + B test versus a validation qPCR assay for detection of influenza A during a volunteer A/California/2009/H1N1 challenge study. Virol J 2021; 18:45. [PMID: 33632249 PMCID: PMC7905982 DOI: 10.1186/s12985-021-01516-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/18/2021] [Indexed: 01/01/2023] Open
Abstract
Background Influenza places a significant burden on global health and economics. Individual case management and public health efforts to mitigate the spread of influenza are both strongly impacted by our ability to accurately and efficiently detect influenza viruses in clinical samples. Therefore, it is important to understand the performance characteristics of available assays to detect influenza in a variety of settings. We provide the first report of relative performance between two products marketed to streamline detection of influenza virus in the context of a highly controlled volunteer influenza challenge study. Methods Nasopharyngeal swab samples were collected during a controlled A/California/2009/H1N1 influenza challenge study and analyzed for detection of virus shedding using a validated qRT-PCR (qPCR) assay, a sample-to-answer qRT-PCR device (BioMerieux BioFire FilmArray RP), and an immunoassay based rapid test kit (Quidel QuickVue Influenza A + B Test). Results Relative to qPCR, the sensitivity and specificity of the BioFire assay was 72.1% [63.7–79.5%, 95% confidence interval (CI)] and 93.5% (89.3–96.4%, 95% CI) respectively. For the QuickVue rapid test the sensitivity was 8.5% (4.8–13.7%, 95% CI) and specificity was 99.2% (95.6–100%, 95% CI). Conclusion Relative to qPCR, the BioFire assay had superior performance compared to rapid test in the context of a controlled influenza challenge study. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-021-01516-0.
Collapse
Affiliation(s)
- David R McIlwain
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA. .,WCCT Global, Cypress, CA, USA.
| | - Han Chen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Nilanjan Mukherjee
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Garry P Nolan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Monica M McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
11
|
Velasco JM, Valderama MT, Diones PC, Navarro FC, Develos M, Lopez MN, Liao C, Chua D, Macareo L, Fernandez S. Performance of a Rapid Diagnostic Test for Influenza in a Tertiary Military Hospital, Philippines. Mil Med 2021; 187:e197-e200. [PMID: 33480421 DOI: 10.1093/milmed/usab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/03/2020] [Accepted: 01/12/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION It is important to evaluate the performance of existing rapid influenza diagnostic tests (RIDTs) and the factors that can affect performance especially when the circulation dynamics of influenza strains change such as the displacement and replacement of the circulating seasonal influenza strains. MATERIALS AND METHODS Nasal swabs were collected from patients presenting at V Luna Medical Center, Armed Forces of the Philippines Health Service Command, with influenza-like illness (ILI) with one swab tested using Quickvue (QV) influenza A+B RIDT (Quidel) and the other swab tested using the ABI 7500 (Applied Biosystems) real-time reverse transcriptase-polymerase chain reaction. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated. We identified clinical symptoms predictive of influenza subtype and evaluated the independence of QV sensitivity on (1) Cycle threshold (Ct) value, controlling for timing of collection; (2) timing of collection, controlling for Ct value; and (3) Ct value and timing of collection taken together. RESULTS Between August 2011 and October 2016, patients presenting with ILI (n = 2333) underwent testing. Quickvue sensitivity across all subtypes was significantly correlated with lower Ct values (higher virus titers) (P <.001) and, except for flu A/H3 (P = .974), was also significantly associated with timing of specimen collection (P <.05). No statistically significant difference was noted in QV sensitivity for Flu A/H3 (P = .130), pandemic H1/N1 (P = .207), Flu A/H3 + pandemic H1/N1 (P = .341), and Flu B (P = .103) across different age groups but sensitivity of QV significantly differed (P <.001) across the different influenza subtypes. CONCLUSION Overall specificity of QV was high across all flu subtypes, but overall sensitivity was low (Flu A/pdm H1) to moderate (Flu A/H3 and Flu B). The findings highlight the need to develop more sensitive influenza RDTs to detect circulating influenza strains and the use of the quadrivalent flu vaccine during the annual influenza vaccination.
Collapse
Affiliation(s)
- John Mark Velasco
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand.,University of the Philippines Manila, Ermita, Manila, 1000, Philippines
| | - Maria Theresa Valderama
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Paula Corazon Diones
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Fatima Claire Navarro
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Maribel Develos
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Ma Nila Lopez
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Cynthia Liao
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Domingo Chua
- V Luna Medical Center, Armed Forces of the Philippines Health Service Command, Quezon City, 0840, Philippines
| | - Louis Macareo
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Stefan Fernandez
- Department of Virology, U.S. Army Medical Directorate-Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| |
Collapse
|
12
|
Choo H, Kim M, Choi J, Shin J, Shin SY. Influenza Screening via Deep Learning Using a Combination of Epidemiological and Patient-Generated Health Data: Development and Validation Study. J Med Internet Res 2020; 22:e21369. [PMID: 33118941 PMCID: PMC7661232 DOI: 10.2196/21369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/16/2023] Open
Abstract
Background Screening for influenza in primary care is challenging due to the low sensitivity of rapid antigen tests and the lack of proper screening tests. Objective The aim of this study was to develop a machine learning–based screening tool using patient-generated health data (PGHD) obtained from a mobile health (mHealth) app. Methods We trained a deep learning model based on a gated recurrent unit to screen influenza using PGHD, including each patient’s fever pattern and drug administration records. We used meteorological data and app-based surveillance of the weekly number of patients with influenza. We defined a single episode as the set of consecutive days, including the day the user was diagnosed with influenza or another disease. Any record a user entered 24 hours after his or her last record was considered to be the start of a new episode. Each episode contained data on the user’s age, gender, weight, and at least one body temperature record. The total number of episodes was 6657. Of these, there were 3326 episodes within which influenza was diagnosed. We divided these episodes into 80% training sets (2664/3330) and 20% test sets (666/3330). A 5-fold cross-validation was used on the training set. Results We achieved reliable performance with an accuracy of 82%, a sensitivity of 84%, and a specificity of 80% in the test set. After the effect of each input variable was evaluated, app-based surveillance was observed to be the most influential variable. The correlation between the duration of input data and performance was not statistically significant (P=.09). Conclusions These findings suggest that PGHD from an mHealth app could be a complementary tool for influenza screening. In addition, PGHD, along with traditional clinical data, could be used to improve health conditions.
Collapse
Affiliation(s)
- Hyunwoo Choo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | | | | | | | - Soo-Yong Shin
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Big Data Research Center, Samsung Medical Center, Seoul, Republic of Korea
| |
Collapse
|
13
|
KARALI E, SEBİT T, ARSLAN N. Akut Solunum Yolu Enfeksiyonu Olan Hastalarda Hızlı İnfluenza Tanı Testi ile İnfluenza A ve B Antijenlerinin Araştırılması. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.755738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
Ginn C, Ateh D, Martin J. The use of point-of-care testing to establish cause of death in the autopsy setting. J Forensic Leg Med 2020; 71:101933. [DOI: 10.1016/j.jflm.2020.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
|
15
|
Paxton R, Munson E, Barta K. Update in the Molecular Diagnostics of Sexually Transmitted Infections. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Ishiguro T, Kobayashi Y, Uozumi R, Takata N, Takaku Y, Kagiyama N, Kanauchi T, Shimizu Y, Takayanagi N. Viral Pneumonia Requiring Differentiation from Acute and Progressive Diffuse Interstitial Lung Diseases. Intern Med 2019; 58:3509-3519. [PMID: 31839671 PMCID: PMC6949447 DOI: 10.2169/internalmedicine.2696-19] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective The clinical characteristics and chest imaging findings of viral pneumonia and several interstitial lung diseases (ILDs) overlap, and viral pneumonia may be underrecognized and misdiagnosed as certain ILDs. To clarify the frequency of viral pneumonia among patients with acute progressive clinical courses that required a differential diagnosis between ILDs and pneumonia, and to determine the most frequent ILDs misdiagnosed in cases of viral pneumonia. Patients and Methods We retrospectively analyzed patients hospitalized from 2010 to 2017 with an acute clinical course (≤30 days) who underwent bronchoalveolar lavage (BAL) for the differential diagnosis of infection and ILDs. We performed a multiplex PCR for respiratory viruses using the patients' preserved BAL fluid. The final diagnosis was made by a multidisciplinary approach and after considering the PCR results. The diagnosis at discharge was compared to the final diagnosis. Results Among the 109 patients, 53 were diagnosed with viral pneumonia. Viral pneumonia and other diseases showed some differences in symptoms and laboratory data; however, the differences were small or overlapped. Viral pneumonia was misdiagnosed on discharge as acute fibrinous organizing pneumonia, cryptogenic organizing pneumonia, or chronic eosinophilic pneumonia (AFOP/COP/CEP) (n=22), acute interstitial pneumonia (n=5), connective tissue disease-related ILDs (n=3), unclassifiable interstitial pneumonia (n=2), drug-induced ILD (n=1), and pneumonia (n=20). Conclusion Approximately half of the patients who underwent BAL had viral pneumonia. The most common ILD-related misdiagnoses were AFOP/COP/CEP. Differences in symptoms and laboratory findings between viral pneumonia and other diseases were small, and viral pneumonia should be included in the differential diagnosis when physicians encounter cases in which the abovementioned ILDs are suspected.
Collapse
Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yasuhito Kobayashi
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Japan
| | - Naomi Takata
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yotaro Takaku
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Naho Kagiyama
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Tetsu Kanauchi
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| |
Collapse
|
17
|
Fu E. Paper Microfluidics for POC Testing in Low-Resource Settings. Bioanalysis 2019. [DOI: 10.1007/978-981-13-6229-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
18
|
Zhang J, Gui X, Zheng Q, Chen Y, Ge S, Zhang J, Xia N. An HRP-labeled lateral flow immunoassay for rapid simultaneous detection and differentiation of influenza A and B viruses. J Med Virol 2018; 91:503-507. [PMID: 30238471 DOI: 10.1002/jmv.25322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/16/2018] [Indexed: 11/09/2022]
Abstract
Rapid and sensitive diagnosis of influenza is urgently needed to address the limitations of low sensitivity associated with current rapid tests available for clinics and on-site monitoring. A novel horseradish peroxidase (HRP)-labeled lateral flow immunoassay strip (HRP-LFIA) for rapid simultaneous detection and differentiation of influenza A (INF A) and influenza B (INF B) viruses were developed. This immunoassay was based on the signal amplification by the HRP-catalyzed oxidation of 3, 3', 5, 5'-tetramethylbenzidine forming a colored insoluble product, which was proportional to the analyte concentration. Compared with conventional gold-colloidal based strips, an analytical sensitivity enhancement of more than one order of magnitude for thirteen INF virus isolates was observed. A total of 1487 swabs obtained from persons with influenza-like illnesses were tested for the presence of INF A and B viruses using real-time reverse transcription polymerase chain reaction (rRT-PCR) as the reference criterion. The overall sensitivities of HRP-LFIA were 77.5% (100/129) and 71.2% (116/163) for INF A and INF B, respectively. The overall specificities were 99.8% (1144/1146) and 99.8% (918/920), respectively. The nasopharyngeal sampling method yielded higher sensitivity rates of 90.2% (55/61) and 82.6% (71/86). In conclusion, this user-friendly assay could be a promising rapid detection method for rapid screening of INF A and INF B viruses.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Biomedical Science, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, China
| | - Xun Gui
- Department of Experimental Medicine, State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Qingbing Zheng
- Department of Experimental Medicine, State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Yixin Chen
- Department of Experimental Medicine, State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Shengxiang Ge
- Department of Experimental Medicine, State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Jun Zhang
- Department of Experimental Medicine, State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Ningshao Xia
- Department of Experimental Medicine, State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| |
Collapse
|
19
|
Sun N, Wang W, Wang J, Yao X, Chen F, Li X, Yinglei Y, Chen B. Reverse transcription recombinase polymerase amplification with lateral flow dipsticks for detection of influenza A virus and subtyping of H1 and H3. Mol Cell Probes 2018; 42:25-31. [PMID: 30394299 PMCID: PMC7127182 DOI: 10.1016/j.mcp.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/29/2022]
Abstract
Three reverse transcription recombinase polymerase amplification assays with lateral flow dipsticks (RT-RPA-LFD) were developed for identification of the matrix and hemagglutinin (HA) genes to detect influenza A virus and distinguish subtypes H1 and H3. Assessment of the assays’ specificity showed that there was no cross-reactivity with other targets. Their limits of detection were 123.6 copies per reaction for the matrix gene, 677.1 copies per reaction for the H1 HA gene, and 112.2 copies/reaction for the H3 HA gene. Of 111 samples tested by RT-RPA-LFD assays, 27 were positive for influenza A virus, 14 were positive for H1, and 10 were positive for H3. Compared to the results obtained from real-time RT-PCR assays, the sensitivity of RT-RPA-LFD assays was 75%, 93.33% and 71.43% for the matrix, H1, and H3, with 100% specificity. The sensitivity of RT-RPA-LFD assays is lower than that of real-time RT-PCR, comparable or better than that of conventional RT-PCR, and much better than that of RIDTs. In conclusion, these assays offer an efficient and reliable tool for identification and subtyping of influenza A virus (subtype H1 and H3) in the resource-limited setting. Three RT-RPA-LFD assays are developed for the detection and subtyping of influenza A virus. RT-RPA-LFD assays used for the detection of influenza A virus is rapid and sensitive. The results from RT-RPA-LFD assays are in a good agreement with those from real-time RT-PCR assays.
Collapse
Affiliation(s)
- Ning Sun
- Institute of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Weiping Wang
- Institute of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jie Wang
- Institute of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xinyue Yao
- Institute of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Fangfang Chen
- Institute of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiaojun Li
- Institute of Clinical Laboratory Science, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China; State Key Laboratory of Analytical Chemistry for Life Science, Department of Chemistry, Nanjing University, Nanjing, China.
| | - Yi Yinglei
- Shanghai Institute of Biological Products Co., Ltd, Shanghai, China
| | - Bo Chen
- Ningbo Health BioMed Co., Ltd, Ning Bo, China
| |
Collapse
|
20
|
Rapid Antigen Tests for Influenza: Rationale and Significance of the FDA Reclassification. J Clin Microbiol 2018; 56:JCM.00711-18. [PMID: 29899007 DOI: 10.1128/jcm.00711-18] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rapid antigen tests for influenza, here referred to as rapid influenza diagnostic tests (RIDTs), have been widely used for the diagnosis of influenza since their introduction in the 1990s due to their ease of use, rapid results, and suitability for point of care (POC) testing. However, issues related to the diagnostic sensitivity of these assays have been known for decades, and these issues gained greater attention following reports of their poor performance during the 2009 influenza A(H1N1) pandemic. In turn, significant concerns arose about the consequences of false-negative results, which could pose significant risks to both individual patient care and to public health efforts. In response to these concerns, the FDA convened an advisory panel in June 2013 to discuss options to improve the regulation of the performance of RIDTs. A proposed order was published on 22 May 2014, and the final order published on 12 January 2017, reclassifying RIDTs from class I to class II medical devices, with additional requirements to comply with four new special controls. This reclassification is a landmark achievement in the regulation of diagnostic devices for infectious diseases and has important consequences for the future of diagnostic influenza testing with commercial tests, warranting the prompt attention of clinical laboratories, health care systems, and health care providers.
Collapse
|
21
|
Chan M, Koo SH, Jiang B, Lim PQ, Tan TY. Comparison of the Biofire FilmArray Respiratory Panel, Seegene AnyplexII RV16, and Argene for the detection of respiratory viruses. J Clin Virol 2018; 106:13-17. [PMID: 30007137 PMCID: PMC7185839 DOI: 10.1016/j.jcv.2018.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/18/2018] [Accepted: 07/05/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Respiratory infections are common reasons for hospital admission, and are associated with enormous economic burden due to significant morbidity and mortality. The wide spectrum of microbial agents underlying the pathology renders the diagnosis of respiratory infections challenging. Molecular diagnostics offer an advantage to the current serological and culture-based methods in terms of sensitivity, coverage, hands-on time, and time to results. OBJECTIVES This study aimed to compare the clinical performance of three commercial kits for respiratory viral detection. STUDY DESIGN The performance of FilmArray Respiratory Panel, AnyplexII RV16, and Argene was compared using clinical respiratory samples (n = 224, comprising 189 nasopharyngeal swabs in Universal Transport Medium (UTM) and 35 endotracheal aspirates), based on common overlapping targets across the platforms. Influenza A "equivocal" and "no-subtype" samples by FilmArray were further compared to a laboratory-developed Influenza A/B test. RESULTS AND CONCLUSIONS The overall performance of all three platforms appeared to be comparable with regards to sensitivities (95.8-97.9%) and specificities (96.1-98.0%), detection of coinfections, and distinguishment of influenza from non-influenza cases. "Equivocal" and "no-subtype" samples by FilmArray mostly represented weak Influenza A by laboratory-developed test. Lower respiratory tract samples had comparable final-run success-rates and discordant-rates as compared to UTM. Coronavirus HKU1, which was not targeted by AnyplexII RV16, were detected as OC43. The expected test volume would be the main determinant for the selection of platform. Among the platforms, the FilmArray is the most automated but is of the lowest-throughput and has the highest reagent cost.
Collapse
Affiliation(s)
- Maurice Chan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Seok Hwee Koo
- Clinical Trials & Research Unit, Changi General Hospital, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Pei Qi Lim
- Clinical Trials & Research Unit, Changi General Hospital, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore.
| |
Collapse
|
22
|
A comparative molecular characterization of AMDV strains isolated from cases of clinical and subclinical infection. Virus Genes 2018; 54:561-569. [PMID: 29845505 DOI: 10.1007/s11262-018-1576-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/23/2018] [Indexed: 10/16/2022]
Abstract
The Aleutian mink disease virus (AMDV) is one of the most serious threats to modern mink breeding. The disease can have various courses, from progressive to subclinical infections. The objective of the study was to provide a comparative molecular characterization of isolates of AMDV from farms with a clinical and subclinical course of the disease. The qPCR analysis showed a difference of two orders of magnitude between the number of copies of the viral DNA on the farm with the clinical course of the disease (105) and the farm with the subclinical course (103). The sequencing results confirm a high level of homogeneity within each farm and variation between them. The phylogenetic analysis indicates that the variants belonging to different farms are closely related and occupy different branches of the same clade. The in silico analysis of the effect of differences in the sequence encoding the VP2 protein between the farms revealed no effect of the polymorphism on its functionality. The close phylogenetic relationship between the isolates from the two farms, the synonymous nature of most of the polymorphisms and the potentially minor effect on the functionality of the protein indicate that the differences in the clinical picture may be due not only to polymorphisms in the nucleotide and amino acid sequences, but also to the stage of infection on the farm and the degree of stabilization of the pathogen-host relationship.
Collapse
|
23
|
Yang JH, Huang PY, Shie SS, Yang S, Tsao KC, Wu TL, Wu TS, Huang CT. Diagnostic performance of the Sofia® influenza A+B fluorescent immunoassay in adult outpatients in Northern Taiwan. J Med Virol 2018; 90:1010-1018. [PMID: 29424435 DOI: 10.1002/jmv.25043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/27/2018] [Indexed: 11/09/2022]
Abstract
To evaluate the diagnostic performance of the Sofia influenza A+B fluorescent immunoassay (Sofia FIA), we performed a prospective study at the Chang Gung Memorial Hospital in Taiwan from January 2012 to December 2013. Patients who presented at out-patient clinics or the emergency department with influenza-like illness were included. Upper respiratory tract specimens were collected from oropharynx or nasopharynx. Performance of the Sofia FIA was compared to that of the Formosa One Sure Flu A/B Rapid Test. A Real-time reverse transcriptase-polymerase chain reaction assay (RT-PCR) and/or virus culture were used as reference standards. Of the 109 enrolled patients, the sensitivity, specificity, positive, and negative predictive values of the Sofia FIA to detect influenza A virus were 82%, 89%, 77%, and 89%, respectively. These parameters were 100% when the samples were from nasopharynx. The positive predictive value for influenza B virus detection was 29%. The sensitivity of the Sofia FIA for detection of influenza A virus was 93% between days 2 and 4 after onset of symptoms. For specimens with low viral loads (RT-PCR cycle threshold between 30 and 34.9), the sensitivity of The Sofia FIA was 83% (10/12). The Sofia FIA performed effectively in detecting influenza A virus infection. With nasopharyngeal samples, the performance was comparable to RT-PCR. Although influenza viral load typically decreases with time, the Sofia FIA was sensitive enough to identify influenza infecting patients presenting after several days of illness. However, a high false positive rate limits the assay's usefulness to identify influenza B virus infection.
Collapse
Affiliation(s)
- Jeng-How Yang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Yen Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shuan Yang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsu-Lan Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
24
|
Dahlgren FS, Shay DK, Izurieta HS, Forshee RA, Wernecke M, Chillarige Y, Lu Y, Kelman JA, Reed C. Evaluating oseltamivir prescriptions in Centers for Medicare and Medicaid Services medical claims records as an indicator of seasonal influenza in the United States. Influenza Other Respir Viruses 2018; 12:465-474. [PMID: 29505168 PMCID: PMC6005588 DOI: 10.1111/irv.12552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Over 34 million residents of the United States aged 65 years and older are also Medicare prescription drug beneficiaries. Medical claims records for this age group potentially provide a wealth of data for better understanding influenza epidemiology. Objective The purpose of this study was to evaluate data on oseltamivir dispensing extracted from medical claims records as an indicator of influenza activity in the United States for the 2010‐11 through 2014‐15 influenza seasons. Methods We used Centers for Medicare and Medicaid Services (CMS) medical claims data to evaluate the weekly number of therapeutic oseltamivir prescriptions dispensed following a rapid influenza diagnostic test among beneficiaries 65 years old and older as an indicator of influenza timing and intensity. We compared the temporal changes in this indicator to changes in the proportion of influenza‐like illnesses among outpatient visits in the US Outpatient Influenza‐like Illness Surveillance Network (ILINet) by administrative regions defined by the US Department of Health and Human Services. Using the moving epidemic method, we determined intensity thresholds and categorized the severity of seasons for both CMS and ILINet data. Results Centers for Medicare and Medicaid Services oseltamivir data and ILINet data were strongly correlated by administrative region (median Spearman's ρ = 0.78; interquartile range = 0.73‐0.80). CMS oseltamivir data and ILINet data substantially agreed (Cohen's weighted κ = 0.62) as to the seasonal severity across administrative regions. Conclusions Our results support the use of oseltamivir dispensing in medical claims data as an indicator of US influenza activity.
Collapse
Affiliation(s)
- F Scott Dahlgren
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
| | - David K Shay
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Yun Lu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carrie Reed
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA, USA
| |
Collapse
|
25
|
Abstract
Introduction: Successful treatment outcomes for viral respiratory tract infections presenting from primary health care to quaternary hospitals will only be achieved with rapid, sensitive and specific identification of pathogens to allow effective pathogen-specific antiviral therapy and infection control measures. Areas covered: This review aims to explore the different point-of-care tests currently available to diagnose viral respiratory tract infections, discuss the advantages and limitations of point-of-care testing, and provide insights into the future of point-of-care tests. The following databases were searched: Medline (January 1996 to 30 September 2017) and Embase (1988 to 30 September 2017), using the following keywords: ‘point of care’, ‘respiratory virus’, ‘influenza’, ‘RSV’, ‘diagnostics’, ‘nucleic acid test’ and ‘PCR’. Expert commentary: Viral respiratory tract infections cause significant morbidity and mortality worldwide, and point-of-care tests are facilitating the rapid identification of the pathogen responsible given the similarities in clinical presentation.
Collapse
Affiliation(s)
- Kerri Basile
- a Centre for Infectious Diseases and Microbiology Laboratory Services , Institute of Clinical Pathology and Medical Research, NSW Health Pathology , Westmead , Australia.,b Marie Bashir Institute for Emerging Infections and Biosecurity , University of Sydney, Westmead Hospital , Westmead , Australia
| | - Jen Kok
- a Centre for Infectious Diseases and Microbiology Laboratory Services , Institute of Clinical Pathology and Medical Research, NSW Health Pathology , Westmead , Australia.,b Marie Bashir Institute for Emerging Infections and Biosecurity , University of Sydney, Westmead Hospital , Westmead , Australia
| | - Dominic E Dwyer
- a Centre for Infectious Diseases and Microbiology Laboratory Services , Institute of Clinical Pathology and Medical Research, NSW Health Pathology , Westmead , Australia.,b Marie Bashir Institute for Emerging Infections and Biosecurity , University of Sydney, Westmead Hospital , Westmead , Australia
| |
Collapse
|
26
|
Self WH, Rosen J, Sharp SC, Filbin MR, Hou PC, Parekh AD, Kurz MC, Shapiro NI. Diagnostic Accuracy of FebriDx: A Rapid Test to Detect Immune Responses to Viral and Bacterial Upper Respiratory Infections. J Clin Med 2017; 6:jcm6100094. [PMID: 28991170 PMCID: PMC5664009 DOI: 10.3390/jcm6100094] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 12/16/2022] Open
Abstract
C-reactive protein (CRP) and myxovirus resistance protein A (MxA) are associated with bacterial and viral infections, respectively. We conducted a prospective, multicenter, cross-sectional study of adults and children with febrile upper respiratory tract infections (URIs) to evaluate the diagnostic accuracy of a rapid CRP/MxA immunoassay to identify clinically significant bacterial infection with host response and acute pathogenic viral infection. The reference standard for classifying URI etiology was an algorithm that included throat bacterial culture, upper respiratory PCR for viral and atypical pathogens, procalcitonin, white blood cell count, and bandemia. The algorithm also allowed for physician override. Among 205 patients, 25 (12.2%) were classified as bacterial, 53 (25.9%) as viral, and 127 (62.0%) negative by the reference standard. For bacterial detection, agreement between FebriDx and the reference standard was 91.7%, with FebriDx having a sensitivity of 80% (95% CI: 59–93%), specificity of 93% (89–97%), positive predictive value (PPV) of 63% (45–79%), and a negative predictive value (NPV) of 97% (94–99%). For viral detection, agreement was 84%, with a sensitivity of 87% (75–95%), specificity of 83% (76–89%), PPV of 64% (63–75%), and NPV of 95% (90–98%). FebriDx may help to identify clinically significant immune responses associated with bacterial and viral URIs that are more likely to require clinical management or therapeutic intervention, and has potential to assist with antibiotic stewardship.
Collapse
Affiliation(s)
- Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Jeffrey Rosen
- Clinical Research of South Florida, Coral Gables, FL 33134, USA.
| | - Stephan C Sharp
- Clinical Research Associates, Inc., Nashville, TN 37203, USA.
| | - Michael R Filbin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Peter C Hou
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Amisha D Parekh
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA.
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL 35233, USA.
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
| |
Collapse
|
27
|
Stellrecht KA, Nattanmai SM, Butt J, Maceira VP, Espino AA, Castro AJ, Landes A, Dresser N, Butt SA. Effect of genomic drift of influenza PCR tests. J Clin Virol 2017; 93:25-29. [PMID: 28600949 PMCID: PMC7173001 DOI: 10.1016/j.jcv.2017.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nucleic acid amplification assays have become the method of choice for influenza (Flu) testing due to superior accuracy and faster turnaround time. Although assays are designed to detect highly conserved genomic targets, mutations can influence test sensitivity. Most of the circulating viruses in the United States during the 2014-2015 season were associated with significant genetic drift; however, the effect on testing was unknown. OBJECTIVES AND STUDY DESIGN We compared the performance of Prodesse ProFlu+/ProFAST+ (PFlu/PFAST), FilmArray Respiratory Panel (RP), cobas® Influenza A/B test (cIAB), and Xpert® Flu (Xpt) in a retrospective analysis of consecutive nasopharyngeal specimens received for a two-week period during the winter of 2015. Furthermore, limits of detection (LOD) were determined with six isolates of Flu. RESULTS Of the 275 specimens, 63 were positive for FluA by PFAST, 60 were positive by RP, 58 were positive by cIAB and 52 were positive by Xpt. Only a subset of 135 specimens was tested by PFlu, of which 32 were positive. The sensitivity/specificity for PFAST, RP, cIAB, Xpt and PFlu was 100/99.1%, 96.7/99.5%, 91.8/99.1%, 85.2%/100%, and 75.6%/98.9%, respectively. LOD analyses demonstrated assay performance variations were strain associated. Specifically, PFlu's and cIAB's LODs were higher with A/Texas/50/2012-like and A/Switzerland/9715293/2013-like strains, while Xpt's highest LOD was with the Swiss strain. CONCLUSIONS Strain-associated assay performance variation is known to occur with other Flu test methods; hence, it is not surprising that such variation would be observed with molecular tests. Careful monitoring and reporting for strain-associated variances are warranted for all test methods.
Collapse
Affiliation(s)
- Kathleen A Stellrecht
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States; Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, United States.
| | - Seela M Nattanmai
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| | - Jumshan Butt
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| | - Vincente P Maceira
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| | - Alvin A Espino
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| | - Allan J Castro
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| | - Allen Landes
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| | - Nicolas Dresser
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| | - Shafiq A Butt
- Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, United States
| |
Collapse
|
28
|
Melchers WJG, Kuijpers J, Sickler JJ, Rahamat-Langendoen J. Lab-in-a-tube: Real-time molecular point-of-care diagnostics for influenza A and B using the cobas® Liat® system. J Med Virol 2017; 89:1382-1386. [PMID: 28213975 DOI: 10.1002/jmv.24796] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/06/2017] [Indexed: 11/10/2022]
Abstract
Rapid diagnosis of influenza A and B is important for direct treatment decisions in patient care and for the reduction of in-hospital transmissions. The new real-time PCR based molecular point-of-care (POC) assay, the cobas® Influenza A/B test on the cobas® Liat® System (cobas® Liat® Influenza A/B assay), generated a PCR result in less than 20 min, was evaluated for the detection of influenza A and B. One hundred twenty-one retrospectively collected respiratory specimens, previously analyzed with a routine influenza A/B test (Diagenode) were tested using the cobas® Liat® Influenza A/B assay. The cobas® Liat® Influenza A/B assay allows influenza A and B testing by RT-PCR within 20 min. This assay detected influenza A in 51 of 56 samples positive by the Diagenode test. The five discrepant results were retested with the Cepheid Influenza A/B test, confirming two positive cases. All 30 influenza B Diagenode positive samples were found positive by the cobas® Liat® Influenza A/B assay. Control samples (viral negative and non-influenza pathogens) were all negative by the cobas® Liat® Influenza A/B assay. The cobas® Liat® Influenza A/B assay showed a sensitivity for influenza A/B of 96% and 100%, respectively, and 100% specificity for both targets. The cobas® Liat® Influenza A/B assay is a useful tool for accurate, rapid, and sensitive detection of influenza A and B, offering timely and personalized patient management and infection control when implemented at the point-of-care.
Collapse
Affiliation(s)
- Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Judith Kuijpers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | |
Collapse
|
29
|
The use of saliva specimens for detection of influenza A and B viruses by rapid influenza diagnostic tests. J Virol Methods 2017; 243:15-19. [PMID: 28111058 DOI: 10.1016/j.jviromet.2017.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Diagnostic tests for influenza infection commonly use nasopharyngeal swabs (NPS) even though these are invasive to obtain. As an alternative specimen, we evaluated the diagnostic usefulness of saliva samples with rapid influenza diagnostic tests (RIDTs). STUDY DESIGN Both NPS and saliva samples were collected from 385 influenza suspected patients and analyzed using Sofia Influenza A+B Fluorescence Immunoassay (Quidel Corporation, San Diego, CA, USA), ichroma TRIAS Influenza A+B (Boditech, Chuncheon, Korea), SD Bioline Influenza Ag (Standard Diagnostic, Yonggin, Korea), BinaxNOW Influenza A/B antigen kit (Alere Inc., Waltham, MA, USA), and real-time reverse transcriptase PCR (RT-PCR). RESULTS Of the 385 patients, 31.2% (120/385) were positive for influenza A, and 7.5% (29/385) were positive for influenza B virus with saliva or NPS by RT-PCR. The diagnostic sensitivity was slightly higher in NPS than in saliva samples for both influenza A and B by all of the four RIDTs. The diagnostic sensitivities of Sofia and ichroma TRIAS were significantly superior to those of the other conventional influenza RIDTs with both types of sample. The sensitivities of Sofia and ichroma TRIAS with saliva specimens were comparable to the sensitivities of the other two conventional RIDTs with NPS specimens. The simultaneous use of saliva and NPS samples exhibited improved sensitivity from 10.0% to 13.3% for influenza A and from 10.3% to 17.2% for influenza B compared to using NPS alone. CONCLUSIONS This study demonstrates that saliva is a useful specimen for influenza detection, and that the combination of saliva and NPS could improve the sensitivities of influenza RIDTs.
Collapse
|
30
|
Ndegwa LK, Emukule G, Uyeki TM, Mailu E, Chaves SS, Widdowson MA, Lewa BV, Muiruri FK, Omoth P, Fields B, Mott JA. Evaluation of the point-of-care Becton Dickinson Veritor™ Rapid influenza diagnostic test in Kenya, 2013-2014. BMC Infect Dis 2017; 17:60. [PMID: 28077093 PMCID: PMC5225564 DOI: 10.1186/s12879-016-2131-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/15/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We evaluated the performance of the Becton Dickinson Veritor™ System Flu A + B rapid influenza diagnostic test (RIDT) to detect influenza viruses in respiratory specimens from patients enrolled at five surveillance sites in Kenya, a tropical country where influenza seasonality is variable. METHODS Nasal swab (NS) and nasopharyngeal (NP)/oropharyngeal (OP) swabs were collected from patients with influenza like illness and/or severe acute respiratory infection. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the RIDT using NS specimens were evaluated against nasal swabs tested by real time reverse transcription polymerase chain reaction (rRT-PCR). The performance parameter results were expressed as 95% confidence intervals (CI) calculated using binomial exact methods, with P < 0.05 considered significant. Two-sample Z tests were used to test for differences in sample proportions. Analysis was performed using SAS software version 9.3. RESULTS From July 2013 to July 2014, 3,569 patients were recruited, of which 78.7% were aged <5 years. Overall, 14.4% of NS specimens were influenza-positive by RIDT. RIDT overall sensitivity was 77.1% (95% CI 72.8-81.0%) and specificity was 94.9% (95% CI 94.0-95.7%) compared to rRT-PCR using NS specimens. RIDT sensitivity for influenza A virus compared to rRT-PCR using NS specimens was 71.8% (95% CI 66.7-76.4%) and was significantly higher than for influenza B which was 43.8% (95% CI 33.8-54.2%). PPV ranged from 30%-80% depending on background prevalence of influenza. CONCLUSION Although the variable seasonality of influenza in tropical Africa presents unique challenges, RIDTs may have a role in making influenza surveillance sustainable in more remote areas of Africa, where laboratory capacity is limited.
Collapse
Affiliation(s)
- Linus K. Ndegwa
- DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya
- Infection Control African Network (ICAN), Infection prevention network-Kenya (IPNET-K), Mbagathi Road off Mbagathi way, Village Market, PO Box 606, 00621 Nairobi, Kenya
| | - Gideon Emukule
- DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Timothy M. Uyeki
- Influenza Division, Centers for Disease Control and Prevention-Atlanta, Georgia, USA
| | - Eunice Mailu
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Sandra S. Chaves
- DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | | | | | - Barry Fields
- DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joshua A. Mott
- Influenza Division, Centers for Disease Control and Prevention-Atlanta, Georgia, USA
| |
Collapse
|
31
|
|
32
|
|
33
|
Park HJ, Yang SC, Choo J. Early Diagnosis of Influenza Virus A Using Surface-enhanced Raman Scattering-based Lateral Flow Assay. B KOREAN CHEM SOC 2016. [DOI: 10.1002/bkcs.11021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hyun Ji Park
- Department of Bionano Technology; Hanyang University; Ansan South Korea
| | - Sung Chul Yang
- School of Architectural Engineering; Hongik University; Sejong South Korea
| | - Jaebum Choo
- Department of Bionano Technology; Hanyang University; Ansan South Korea
| |
Collapse
|
34
|
Zhao J, Liu J, Vemula SV, Lin C, Tan J, Ragupathy V, Wang X, Mbondji-wonje C, Ye Z, Landry ML, Hewlett I. Sensitive Detection and Simultaneous Discrimination of Influenza A and B Viruses in Nasopharyngeal Swabs in a Single Assay Using Next-Generation Sequencing-Based Diagnostics. PLoS One 2016; 11:e0163175. [PMID: 27658193 PMCID: PMC5033603 DOI: 10.1371/journal.pone.0163175] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022] Open
Abstract
Reassortment of 2009 (H1N1) pandemic influenza virus (pdH1N1) with other strains may produce more virulent and pathogenic forms, detection and their rapid characterization is critical. In this study, we reported a “one-size-fits-all” approach using a next-generation sequencing (NGS) detection platform to extensively identify influenza viral genomes for diagnosis and determination of novel virulence and drug resistance markers. A de novo module and other bioinformatics tools were used to generate contiguous sequence and identify influenza types/subtypes. Of 162 archived influenza-positive patient specimens, 161(99.4%) were positive for either influenza A or B viruses determined using the NGS assay. Among these, 135(83.3%) were A(H3N2), 14(8.6%) were A(pdH1N1), 2(1.2%) were A(H3N2) and A(pdH1N1) virus co-infections and 10(6.2%) were influenza B viruses. Of the influenza A viruses, 66.7% of A(H3N2) viruses tested had a E627K mutation in the PB2 protein, and 87.8% of the influenza A viruses contained the S31N mutation in the M2 protein. Further studies demonstrated that the NGS assay could achieve a high level of sensitivity and reveal adequate genetic information for final laboratory confirmation. The current diagnostic platform allows for simultaneous identification of a broad range of influenza viruses, monitoring emerging influenza strains with pandemic potential that facilitating diagnostics and antiviral treatment in the clinical setting and protection of the public health.
Collapse
Affiliation(s)
- Jiangqin Zhao
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
- * E-mail: (JZ); (IH)
| | - Jikun Liu
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Sai Vikram Vemula
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Corinna Lin
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Jiying Tan
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Viswanath Ragupathy
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Xue Wang
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Christelle Mbondji-wonje
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Zhiping Ye
- DVP/OVRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
| | - Marie L. Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, 06520, United States of America
| | - Indira Hewlett
- DETTD/OBRR/CBER, Food and Drug Administration, Silver Spring, MD, 20993, United States of America
- * E-mail: (JZ); (IH)
| |
Collapse
|
35
|
Millman AJ, Reed C, Kirley PD, Aragon D, Meek J, Farley MM, Ryan P, Collins J, Lynfield R, Baumbach J, Zansky S, Bennett NM, Fowler B, Thomas A, Lindegren ML, Atkinson A, Finelli L, Chaves SS. Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates. Emerg Infect Dis 2016; 21:1595-601. [PMID: 26292017 PMCID: PMC4550134 DOI: 10.3201/eid2109.141665] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Adjusting for diagnostic test sensitivity enables more accurate and timely comparisons over time. Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from <10% during 2003–2008 to ≈70% during 2009–2013. Observed hospitalization rates per 100,000 persons varied by season: 7.3–50.5 for children <18 years of age, 3.0–30.3 for adults 18–64 years, and 13.6–181.8 for adults >65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children <18 years, ≈20% higher for adults 18–64 years, and ≈55% for adults >65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates.
Collapse
|
36
|
Moesker FM, van Kampen JJA, Aron G, Schutten M, van de Vijver DAMC, Koopmans MPG, Osterhaus ADME, Fraaij PLA. Diagnostic performance of influenza viruses and RSV rapid antigen detection tests in children in tertiary care. J Clin Virol 2016; 79:12-17. [PMID: 27045454 PMCID: PMC7185377 DOI: 10.1016/j.jcv.2016.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Abstract
The here studied rapid antigen detection test (RADT) BinaxNOW RSV has a high sensitivity and positive predictive value. RADT BinaxNOW Influenza A&B has a relatively low sensitivity and positive predictive value. We advise a restricted use of RADT BinaxNOW Influenza A&B in a tertiary paediatric care setting.
Background Rapid antigen detection tests (RADTs) are increasingly used to detect influenza viruses and respiratory syncytial virus (RSV). However, their sensitivity and specificity are a matter of debate, challenging their clinical usefulness. Objectives Comparing diagnostic performances of BinaxNow Influenza AB® (BNI) and BinaxNow RSV® (BNR), to those of real-time reverse transcriptase PCR (RT-PCR), virus isolation and direct immunofluorescence (D-IF) in paediatric patients. Study design Between November 2005 and September 2013, 521 nasal washings from symptomatic children (age <5 years) attending our tertiary care centre were tested, with a combination of the respective assays using RT-PCR as gold standard. Results Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BNI were 69% (confidence interval [CI] [51–83]), 96% [94–97], 55% [39–70] and 98% [96–99] respectively. Of eleven false-negative samples, RT-PCR Ct-values were higher than all RT-PCR positive test results (27 vs 22, p = 0.012). Of twenty false-positive samples, none were culture positive and two tested positive in D-IF. Sensitivity, specificity, PPV and NPV for BNR were 79% [73–85], 98% [96–99], 97% [93–99] and 88% [84–91]. Of the 42 false-negative samples the median Ct-value was higher than that of all RT-PCR positive samples (31 vs 23, p < 0.0001). Five false-positive samples were detected. Three of these tested positive for RSV in virus isolation and D-IF. Conclusions RADTs have a high specificity with BNR being superior to BNI. However, their relative low sensitivity limits their usefulness for clinical decision making in a tertiary care paediatric hospital.
Collapse
Affiliation(s)
- F M Moesker
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - J J A van Kampen
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - G Aron
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - M Schutten
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Viroclinics Biosciences BV, Rotterdam, The Netherlands
| | | | - M P G Koopmans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - A D M E Osterhaus
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Viroclinics Biosciences BV, Rotterdam, The Netherlands; Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine, Hannover, Germany.
| | - P L A Fraaij
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands; Department of Paediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands
| |
Collapse
|
37
|
Kammerer PE, Radin JM, Hawksworth AW, Myers CA, Brice GT. Performance of the Quidel Sofia rapid influenza diagnostic test during the 2012-2013 and 2013-2014 influenza seasons. Influenza Other Respir Viruses 2016; 10:220-3. [PMID: 26920652 PMCID: PMC4814867 DOI: 10.1111/irv.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/29/2022] Open
Abstract
The Quidel Sofia Influenza A+B Fluorescent Immunoassay was used to test nasal swab specimens from patients with influenza‐like illness at US–Mexico border‐area clinics in the 2012–2013 and 2013–2014 influenza seasons. Compared with real‐time reverse transcription polymerase chain reaction, the overall sensitivities and specificities were 83% and 81%, and 62% and 93%, respectively.
Collapse
Affiliation(s)
- Peter E Kammerer
- Operational Infectious Diseases Department, Naval Health Research Center, San Diego, CA, USA
| | - Jennifer M Radin
- Operational Infectious Diseases Department, Naval Health Research Center, San Diego, CA, USA
| | - Anthony W Hawksworth
- Operational Infectious Diseases Department, Naval Health Research Center, San Diego, CA, USA
| | - Chris A Myers
- Operational Infectious Diseases Department, Naval Health Research Center, San Diego, CA, USA
| | - Gary T Brice
- Operational Infectious Diseases Department, Naval Health Research Center, San Diego, CA, USA
| |
Collapse
|
38
|
Gomez S, Prieto C, Folgueira L. A prospective study to assess the diagnostic performance of the Sofia(®) Immunoassay for Influenza and RSV detection. J Clin Virol 2016; 77:1-4. [PMID: 26872325 DOI: 10.1016/j.jcv.2016.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/14/2016] [Accepted: 01/30/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Respiratory viruses RSV and influenza A and B viruses are responsible for important disease outbreaks during the winter season in temperate climate regions. Rapid diagnostic tests (RDTs) are assays designed to yield a rapid diagnosis, which facilitates patient management. The Sofia Influenza A+B Fluorescence Immunoassay and Sofia RSV Fluorescence Immunoassay are RDTs for Influenza and RSV detection that employ a new technology to enhance their sensitivity. OBJECTIVES Sensitivity, specificity and positive and negative predictive values of the assays were calculated compared with the reference diagnostic method: real-time RT-PCR. STUDY DESIGN A prospective evaluation was carried out on 1065 respiratory samples for Sofia Influenza A+B FIA and on 261 samples for Sofia RSV FIA from November 2013 to April 2014. RESULTS The sensitivities of the Sofia Influenza A+B FIA for influenza A and influenza B detection were, respectively, 75.3% (244/324) and 50.0% (8/16). The sensitivity of the Sofia RSV FIA was 92.1% (128/139). There were no differences in Sofia FIA performance depending on the virus subtype. CONCLUSIONS The results showed high sensitivity and specificity values for influenza A and RSV detection, but values were lower for influenza B. More information is needed regarding the performance for influenza B given the small number of positive samples assessed.
Collapse
Affiliation(s)
- Sara Gomez
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Columbiana Prieto
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lola Folgueira
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
39
|
Bowman AS, Nolting JM, Workman JD, Cooper M, Fisher AE, Marsh B, Forshey T. The Inability to Screen Exhibition Swine for Influenza A Virus Using Body Temperature. Zoonoses Public Health 2016; 63:34-9. [PMID: 25884907 PMCID: PMC4609228 DOI: 10.1111/zph.12201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Indexed: 11/28/2022]
Abstract
Agricultural fairs create an unconventional animal-human interface that has been associated with swine-to-human transmission of influenza A virus (IAV) in recent years. Early detection of IAV-infected pigs at agricultural fairs would allow veterinarians to better protect swine and human health during these swine exhibitions. This study assessed the use of swine body temperature measurement, recorded by infrared and rectal thermometers, as a practical method to detect IAV-infected swine at agricultural fairs. In our first objective, infrared thermometers were used to record the body surface temperature of 1,092 pigs at the time of IAV nasal swab collection at the end of the exhibition period of 55 agricultural fairs. IAV was recovered from 212 (19.4%) pigs, and the difference in mean infrared body temperature measurement of IAV-positive and IAV-negative pigs was 0.83°C. In a second objective, snout wipes were collected from 1,948 pigs immediately prior to the unloading of the animals at a single large swine exhibition. Concurrent to the snout wipe collection, owners took the rectal temperatures of his/her pigs. In this case, 47 (2.4%) pigs tested positive for IAV before they entered the swine barn. The mean rectal temperatures differed by only 0.19°C between IAV-positive and IAV-negative pigs. The low prevalence of IAV among the pigs upon entry to the fair in the second objective provides evidence that limiting intraspecies spread of IAV during the fairs will likely have significant impacts on the zoonotic transmission. However, in both objectives, the high degree of similarity in the body temperature measurements between the IAV-positive and IAV-negative pigs made it impossible to set a diagnostically meaningful cut point to differentiate IAV status of the individual animals. Unfortunately, body temperature measurement cannot be used to accurately screen exhibition swine for IAV.
Collapse
Affiliation(s)
- Andrew S. Bowman
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Jacqueline M. Nolting
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Jeffrey D. Workman
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
- Ohio State University Extension, The Ohio State University, Columbus, OH, USA
| | - Maria Cooper
- Indiana State Board of Animal Health, Indianapolis, IN, USA
| | - Aaron E Fisher
- Indiana 4-H Youth Development, Purdue University, West Lafayette, IN, USA
| | - Bret Marsh
- Indiana State Board of Animal Health, Indianapolis, IN, USA
| | - Tony Forshey
- Ohio Department of Agriculture, Reynoldsburg, OH, USA
| |
Collapse
|
40
|
Su S, Fry AM, Kirley PD, Aragon D, Yousey-Hindes K, Meek J, Openo K, Oni O, Sharangpani R, Morin C, Hollick G, Lung K, Laidler M, Lindegren ML, Schaffner W, Atkinson A, Chaves SS. Survey of influenza and other respiratory viruses diagnostic testing in US hospitals, 2012-2013. Influenza Other Respir Viruses 2016; 10:86-90. [PMID: 26505742 PMCID: PMC4746564 DOI: 10.1111/irv.12355] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 11/29/2022] Open
Abstract
Background Little is known about laboratory capacity to routinely diagnose influenza and other respiratory viruses at clinical laboratories and hospitals. Aims We sought to assess diagnostic practices for influenza and other respiratory virus in a survey of hospitals and laboratories participating in the US Influenza Hospitalization Surveillance Network in 2012–2013. Materials and Methods All hospitals and their associated laboratories participating in the Influenza Hospitalization Surveillance Network (FluSurv‐NET) were included in this evaluation. The network covers more than 80 counties in 15 states, CA, CO, CT, GA, MD, MN, NM, NY, OR, TN, IA, MI, OH, RI, and UT, with a catchment population of ~28 million people. We administered a standardized questionnaire to key personnel, including infection control practitioners and laboratory departments, at each hospital through telephone interviews. Results Of the 240 participating laboratories, 67% relied only on commercially available rapid influenza diagnostic tests to diagnose influenza. Few reported the availability of molecular diagnostic assays for detection of influenza (26%) and other viral pathogens (≤20%) in hospitals and commercial laboratories. Conclusion Reliance on insensitive assays to detect influenza may detract from optimal clinical management of influenza infections in hospitals.
Collapse
Affiliation(s)
- Su Su
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Atlanta Research and Education Foundation, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infectious Program, Yale School of Public Health, New Haven, CT, USA
| | - James Meek
- Connecticut Emerging Infectious Program, Yale School of Public Health, New Haven, CT, USA
| | - Kyle Openo
- Georgia Emerging Infections Program and the Atlanta Research and Education Foundation, Atlanta, GA, USA
| | - Oluwakemi Oni
- Iowa Department of Public Health, Des Moines, IA, USA
| | - Ruta Sharangpani
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Craig Morin
- Minnesota Department of Health, St. Paul, MN, USA
| | - Gary Hollick
- University of Rochester Center for Community Health, Minneapolis, MN, USA
| | - Krista Lung
- Ohio Department of Health, Columbus, OH, USA
| | - Matt Laidler
- Oregon Public Health Division, Portland, OR, USA
| | | | | | | | - Sandra S Chaves
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
41
|
Priest PC, Jennings LC, Duncan AR, Brunton CR, Baker MG. Effectiveness of border screening for detecting influenza in arriving airline travelers. Am J Public Health 2015; 105 Suppl 4:S607-13, S600-6. [PMID: 26313050 DOI: 10.2105/ajph.2012.300761r] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We measured symptom and influenza prevalence, and the effectiveness of symptom and temperature screening for identifying influenza, in arriving international airline travelers. METHODS This cross-sectional study collected data from travelers to Christchurch International Airport, New Zealand, in winter 2008, via a health questionnaire, temperature testing, and respiratory sampling. RESULTS Forms were returned by 15 976 (68%) travelers. Of these, 17% reported at least 1 influenza symptom, with runny or blocked nose (10%) and cough (8%) most common. Respiratory specimens were obtained from 3769 travelers. Estimated prevalence of influenza was 1.1% (4% among symptomatic, 0.2% among asymptomatic). The sensitivity of screening criteria ranged from 84% for "any symptom" to 3% for a fever of 37.8 °C or greater. The positive predictive value was low for all criteria. CONCLUSIONS Border screening using self-reported symptoms and temperature testing has limitations for preventing pandemic influenza from entering a country. Using "any symptom" or cough would lead to many uninfected people being investigated, yet some infected people would remain undetected. If more specific criteria such as fever were used, most infected people would enter the country despite screening.
Collapse
Affiliation(s)
- Patricia C Priest
- Patricia C. Priest is with the Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. Lance C. Jennings is with the Department of Pathology, University of Otago Christchurch and Canterbury Health Laboratories, Christchurch, New Zealand. Alasdair R. Duncan and Cheryl R. Brunton are with the Department of Public Health and General Practice, University of Otago Christchurch. Michael G. Baker is with the Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Lance C Jennings
- Patricia C. Priest is with the Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. Lance C. Jennings is with the Department of Pathology, University of Otago Christchurch and Canterbury Health Laboratories, Christchurch, New Zealand. Alasdair R. Duncan and Cheryl R. Brunton are with the Department of Public Health and General Practice, University of Otago Christchurch. Michael G. Baker is with the Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Alasdair R Duncan
- Patricia C. Priest is with the Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. Lance C. Jennings is with the Department of Pathology, University of Otago Christchurch and Canterbury Health Laboratories, Christchurch, New Zealand. Alasdair R. Duncan and Cheryl R. Brunton are with the Department of Public Health and General Practice, University of Otago Christchurch. Michael G. Baker is with the Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Cheryl R Brunton
- Patricia C. Priest is with the Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. Lance C. Jennings is with the Department of Pathology, University of Otago Christchurch and Canterbury Health Laboratories, Christchurch, New Zealand. Alasdair R. Duncan and Cheryl R. Brunton are with the Department of Public Health and General Practice, University of Otago Christchurch. Michael G. Baker is with the Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Michael G Baker
- Patricia C. Priest is with the Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. Lance C. Jennings is with the Department of Pathology, University of Otago Christchurch and Canterbury Health Laboratories, Christchurch, New Zealand. Alasdair R. Duncan and Cheryl R. Brunton are with the Department of Public Health and General Practice, University of Otago Christchurch. Michael G. Baker is with the Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| |
Collapse
|
42
|
A reagent-ready-on-chip microfluidic immunoassay system for rapid detection of influenza A H1N1 and H3N2 viruses. BIOCHIP JOURNAL 2015. [DOI: 10.1007/s13206-016-0105-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
43
|
Chiu RYT, Thach AV, Wu CM, Wu BM, Kamei DT. An Aqueous Two-Phase System for the Concentration and Extraction of Proteins from the Interface for Detection Using the Lateral-Flow Immunoassay. PLoS One 2015; 10:e0142654. [PMID: 26556593 PMCID: PMC4640584 DOI: 10.1371/journal.pone.0142654] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022] Open
Abstract
The paper-based immunoassay for point-of-care diagnostics is widely used due to its low cost and portability over traditional lab-based assays. Lateral-flow immunoassay (LFA) is the most well-established paper-based assay since it is rapid and easy to use. However, the disadvantage of LFA is its lack of sensitivity in some cases where a large sample volume is required, limiting its use as a diagnostic tool. To improve the sensitivity of LFA, we previously reported on the concentration of analytes into one of the two bulk phases of an aqueous two-phase system (ATPS) prior to detection. In this study, we preserved the advantages of LFA while significantly improving upon our previous proof-of-concept studies by employing a novel approach of concentrating gold nanoparticles, a common LFA colorimetric indicator. By conjugating specific antibodies and polymers to the surfaces of the particles, these gold nanoprobes (GNPs) were able to capture target proteins in the sample and subsequently be concentrated within 10 min at the interface of an ATPS solution comprised of polyethylene glycol, potassium phosphate, and phosphate-buffered saline. These GNPs were then extracted and applied directly to LFA. By combining this prior ATPS interface extraction with LFA, the detection limit of LFA for a model protein was improved by 100-fold from 1 ng/μL to 0.01 ng/μL. Additionally, we examined the behavior of the ATPS system in fetal bovine serum and synthetic urine to more closely approach real-world applications. Despite using more complex matrices, ATPS interface extraction still improved the detection limit by 100-fold within 15 to 25 min, demonstrating the system’s potential to be applied to patient samples.
Collapse
Affiliation(s)
- Ricky Y. T. Chiu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Alison V. Thach
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Chloe M. Wu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Benjamin M. Wu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, United States of America
- Division of Advanced Prosthodontics & Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Daniel T. Kamei
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| |
Collapse
|
44
|
Yang JH, Huang PY, Shie SS, Yang S, Tsao KC, Wu TL, Leu HS, Huang CT. Predictive Symptoms and Signs of Laboratory-confirmed Influenza: A Prospective Surveillance Study of Two Metropolitan Areas in Taiwan. Medicine (Baltimore) 2015; 94:e1952. [PMID: 26554802 PMCID: PMC4915903 DOI: 10.1097/md.0000000000001952] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Influenza infection poses annual threats and leads to significant morbidity and mortality. Early diagnosis is the key to successful treatment. Laboratory-based diagnosis has various limitations. Diagnosis based on symptoms or signs is still indispensable in clinical practice. We investigated the symptoms or signs associated with laboratory-confirmed influenza.A prospective study across 2 influenza seasons was performed from June 2010 to June 2012 at 2 branches (Taipei and Lin-Kou) of Chang Gung Memorial Hospital. Patients who visited outpatient clinics with suspected acute respiratory tract infection were sampled by throat swab or nasopharyngeal swab. RT-PCR and/or virus culture were used as a reference standard. We used logistic regression to identify the symptoms or signs associated with laboratory-confirmed influenza infection. We also evaluated the performance metrics of different influenza-like illness used in Taiwan, the USA, and WHO.A total of 158 patients were included in the study. The prevalence of influenza infection was 45% (71/158). Fever, cough, rhinorrhea, sneezing, and nasal congestion were significant predictors for influenza infection. Whereas fever + cough had a best sensitivity (86%; confidence interval [CI] 76%-93%), fever + cough and sneezing had a best specificity (77%; CI 62%-88%). Different case definitions of influenza-like illness had comparable accuracy in sensitivity and specificity.Clinical diagnosis based on symptoms and signs is useful for allocating resources, identifying those who may benefit from early antiviral therapy and providing valuable information for surveillance purpose.
Collapse
Affiliation(s)
- Jeng-How Yang
- From the Division of Infectious Diseases, Department of Medicine (J-HY, P-YH, S-SS, H-SL, C-TH); and Department of Laboratory Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (YS, K-CT, T-LW)
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Piché-Renaud PP, Turcot J, Chartrand C, Gravel J, Labrecque M, Vallières É, Renaud C. Evaluation of a fluorescent immunoassay rapid test (Sofia™) for detection of influenza A+B and RSV in a tertiary pediatric setting. Diagn Microbiol Infect Dis 2015; 84:304-8. [PMID: 26827091 DOI: 10.1016/j.diagmicrobio.2015.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/17/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022]
Abstract
In response to the lack of sensitivity and reproducibility of previously marketed rapid antigen detection tests, a novel fluorescent immunoassay was recently developed. This new assay offers rapidity and automated reading. More characterization of this assay is needed. The aim of this study was to assess diagnostic performance of Sofia influenza A+B and respiratory syncytial virus (RSV) while compared to traditional viral cell culture. A total of 416 respiratory samples were analyzed prospectively with both methods in a tertiary pediatric center. Sensitivity and specificity of the Sofia™ test were 90.0% and 98.0% for influenza A, 90.9% and 98.9% for influenza B, and 87.7% and 94.7% for RSV compared to traditional cell culture. Overall, Sofia influenza A+B and RSV assays performed well in comparison to culture in a pediatric population.
Collapse
Affiliation(s)
- Pierre-Philippe Piché-Renaud
- Département de pédiatrie, Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, H3T 1C4, QC, Canada
| | - Jonathan Turcot
- Département de microbiologie et immunologie, Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, H3T 1C4, QC, Canada
| | - Caroline Chartrand
- Département de pédiatrie, Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, H3T 1C4, QC, Canada
| | - Jocelyn Gravel
- Département de pédiatrie, Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, H3T 1C4, QC, Canada
| | - Manon Labrecque
- Département de microbiologie et immunologie, Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, H3T 1C4, QC, Canada
| | - Émilie Vallières
- Département de microbiologie et immunologie, Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, H3T 1C4, QC, Canada
| | - Christian Renaud
- Département de microbiologie et immunologie, Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, H3T 1C4, QC, Canada.
| |
Collapse
|
46
|
Hansen KB, Westin J, Andersson LM, Lindh M, Widell A, Nilsson AC. Flocked nasal swab versus nasopharyngeal aspirate in adult emergency room patients: similar multiplex PCR respiratory pathogen results and patient discomfort. Infect Dis (Lond) 2015; 48:246-50. [DOI: 10.3109/23744235.2015.1096956] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Koul PA, Mir H, Bhat MA, Khan UH, Khan MM, Chadha MS, Lal RB. Performance of rapid influenza diagnostic tests (QuickVue) for influenza A and B Infection in India. Indian J Med Microbiol 2015; 33 Suppl:26-31. [PMID: 25657152 DOI: 10.4103/0255-0857.148831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rapid point-of-care (POC) tests provide an economical alternative for rapid diagnosis and treatment of influenza, especially in public health emergency situations. OBJECTIVES To test the performance of a rapid influenza diagnostic test, QuickVue (Quidel) as a POC test against a real-time polymerase chain reaction (RT-PCR) assay for detection of influenza A and B in a developing country setting. STUDY DESIGN In a prospective observational design, 600 patients with influenza-like illness (ILI) or with severe acute respiratory illness (SARI) who were referred to the Influenza Clinic of a tertiary care hospital in Srinagar, India from September 2012 to April 2013, were enrolled for diagnostic testing for influenza using QuickVue or RT-PCR. All influenza A-positive patients by RT-PCR were further subtyped using primers and probes for A/H1pdm09 and A/H3. RESULTS Of the 600 patients, 186 tested positive for influenza A or B by RT-PCR (90 A/H1N1pdm09, 7 A/H3 and 89 influenza B), whereas only 43 tested positive for influenza (influenza A=22 and influenza B=21) by QuickVue. Thus, the sensitivity of the QuickVue was only 23% (95% confidence interval, CI: 17.3-29.8) and specificity was 100% (95% CI: 99.1-100) with a positive predictive value (PPV) of 100% (95% CI 91.8-100) and a negative predictive value (NPV) of 74.3% (95% CI: 70.5-77.9) as compared to RT-PCR. CONCLUSIONS The high specificity of QuickVue suggest that this POC test can be a useful tool for patient management or triaging during a public health crisis but a low sensitivity suggests that a negative test result need to be further tested using RT-PCR.
Collapse
Affiliation(s)
- P A Koul
- Department of Internal and Pulmonary Medicine and MSM Project for Influenza, Sher I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | | | | | | | | | | | | |
Collapse
|
48
|
Priest PC, Jennings LC, Duncan AR, Brunton CR, Baker MG. Eficacia de la detección sistemática de la gripe en las fronteras en los viajeros que llegan por vía aérea. Am J Public Health 2015. [DOI: 10.2105/ajph.2012.300761s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objetivos. Se midieron los síntomas y la prevalencia de la gripe (también llamada influenza), así como la eficacia del mecanismo de detección sistemática basado en los síntomas y la temperatura para diagnosticar la gripe en viajeros internacionales que llegaban por vía aérea. Métodos. El presente estudio transversal recopiló datos de viajeros que llegaron al aeropuerto internacional de Christchurch (Nueva Zelandia) en el invierno del 2008 mediante un cuestionario de salud, medición de la temperatura y toma de muestras de las vías respiratorias. Resultados. De los viajeros, 15 976 (68%) entregaron los formularios completos. De ellos, 17% notificaron al menos un síntoma de gripe; los síntomas más comunes fueron rinorrea o congestión nasal (10%) y tos (8%). Se tomaron muestras de las vías respiratorias de 3 769 viajeros. La prevalencia estimada de la gripe fue de 1,1% (4% en las personas sintomáticas, 0,2% en las asintomáticas). La sensibilidad de los criterios de detección varió de 84% para “cualquier síntoma” a 3% para la fiebre de 37,8 °C o mayor. El valor predictivo positivo fue bajo para todos los criterios. Conclusiones. El método de detección sistemática en las fronteras mediante la autonotificación de síntomas y la toma de la temperatura presenta limitaciones para impedir que una gripe pandémica entre en un país. Basarse en criterios como “cualquier síntoma” o la tos haría que se investigara a varias personas no infectadas, mientras que algunas personas infectadas pasarían inadvertidas. Si se usaran criterios más específicos como la fiebre, la mayoría de las personas infectadas entrarían en el país a pesar del mecanismo de detección.
Collapse
Affiliation(s)
- Patricia C. Priest
- Patricia C. Priest, DPhil, MPH, MBChB, Departamento de Medicina Preventiva y Social, Universidad de Otago, Dunedin, Nueva Zelandia. La correspondencia se debe dirigir a Patricia Priest,
- Lance C. Jennings, PhD, MSc, BSc, Departamento de Anatomía Patológica, Laboratorios de Salud de la Universidad de Otago en Christchurch y Canterbury, Christchurch, Nueva Zelandia
- Alasdair R. Duncan, MPH, BSc, y Cheryl R. Brunton, MBChB, DipComH, Departamento de Salud Pública y Práctica General, Universidad de Otago en Christchurch, Nueva Zelandia
- Michael G. Baker, MBChB, DPH, Departamento de Salud Pública, Universidad de Otago en Wellington, Wellington, Nueva Zelandia
| | - Lance C. Jennings
- Patricia C. Priest, DPhil, MPH, MBChB, Departamento de Medicina Preventiva y Social, Universidad de Otago, Dunedin, Nueva Zelandia. La correspondencia se debe dirigir a Patricia Priest,
- Lance C. Jennings, PhD, MSc, BSc, Departamento de Anatomía Patológica, Laboratorios de Salud de la Universidad de Otago en Christchurch y Canterbury, Christchurch, Nueva Zelandia
- Alasdair R. Duncan, MPH, BSc, y Cheryl R. Brunton, MBChB, DipComH, Departamento de Salud Pública y Práctica General, Universidad de Otago en Christchurch, Nueva Zelandia
- Michael G. Baker, MBChB, DPH, Departamento de Salud Pública, Universidad de Otago en Wellington, Wellington, Nueva Zelandia
| | - Alasdair R. Duncan
- Patricia C. Priest, DPhil, MPH, MBChB, Departamento de Medicina Preventiva y Social, Universidad de Otago, Dunedin, Nueva Zelandia. La correspondencia se debe dirigir a Patricia Priest,
- Lance C. Jennings, PhD, MSc, BSc, Departamento de Anatomía Patológica, Laboratorios de Salud de la Universidad de Otago en Christchurch y Canterbury, Christchurch, Nueva Zelandia
- Alasdair R. Duncan, MPH, BSc, y Cheryl R. Brunton, MBChB, DipComH, Departamento de Salud Pública y Práctica General, Universidad de Otago en Christchurch, Nueva Zelandia
- Michael G. Baker, MBChB, DPH, Departamento de Salud Pública, Universidad de Otago en Wellington, Wellington, Nueva Zelandia
| | - Cheryl R. Brunton
- Patricia C. Priest, DPhil, MPH, MBChB, Departamento de Medicina Preventiva y Social, Universidad de Otago, Dunedin, Nueva Zelandia. La correspondencia se debe dirigir a Patricia Priest,
- Lance C. Jennings, PhD, MSc, BSc, Departamento de Anatomía Patológica, Laboratorios de Salud de la Universidad de Otago en Christchurch y Canterbury, Christchurch, Nueva Zelandia
- Alasdair R. Duncan, MPH, BSc, y Cheryl R. Brunton, MBChB, DipComH, Departamento de Salud Pública y Práctica General, Universidad de Otago en Christchurch, Nueva Zelandia
- Michael G. Baker, MBChB, DPH, Departamento de Salud Pública, Universidad de Otago en Wellington, Wellington, Nueva Zelandia
| | - Michael G. Baker
- Patricia C. Priest, DPhil, MPH, MBChB, Departamento de Medicina Preventiva y Social, Universidad de Otago, Dunedin, Nueva Zelandia. La correspondencia se debe dirigir a Patricia Priest,
- Lance C. Jennings, PhD, MSc, BSc, Departamento de Anatomía Patológica, Laboratorios de Salud de la Universidad de Otago en Christchurch y Canterbury, Christchurch, Nueva Zelandia
- Alasdair R. Duncan, MPH, BSc, y Cheryl R. Brunton, MBChB, DipComH, Departamento de Salud Pública y Práctica General, Universidad de Otago en Christchurch, Nueva Zelandia
- Michael G. Baker, MBChB, DPH, Departamento de Salud Pública, Universidad de Otago en Wellington, Wellington, Nueva Zelandia
| |
Collapse
|
49
|
Performance of the Alere i influenza A&B assay and mariPOC test for the rapid detection of influenza A and B viruses. J Clin Virol 2015; 70:72-76. [DOI: 10.1016/j.jcv.2015.07.294] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/17/2015] [Accepted: 07/14/2015] [Indexed: 11/20/2022]
|
50
|
Incidence of medically attended influenza during pandemic and post-pandemic seasons through the Influenza Incidence Surveillance Project, 2009-13. THE LANCET RESPIRATORY MEDICINE 2015; 3:709-718. [PMID: 26300111 DOI: 10.1016/s2213-2600(15)00278-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Since the introduction of pandemic influenza A (H1N1) to the USA in 2009, the Influenza Incidence Surveillance Project has monitored the burden of influenza in the outpatient setting through population-based surveillance. METHODS From Oct 1, 2009, to July 31, 2013, outpatient clinics representing 13 health jurisdictions in the USA reported counts of influenza-like illness (fever including cough or sore throat) and all patient visits by age. During four years, staff at 104 unique clinics (range 35-64 per year) with a combined median population of 368,559 (IQR 352,595-428,286) attended 35,663 patients with influenza-like illness and collected 13,925 respiratory specimens. Clinical data and a respiratory specimen for influenza testing by RT-PCR were collected from the first ten patients presenting with influenza-like illness each week. We calculated the incidence of visits for influenza-like illness using the size of the patient population, and the incidence attributable to influenza was extrapolated from the proportion of patients with positive tests each week. FINDINGS The site-median peak percentage of specimens positive for influenza ranged from 58.3% to 77.8%. Children aged 2 to 17 years had the highest incidence of influenza-associated visits (range 4.2-28.0 per 1000 people by year), and adults older than 65 years had the lowest (range 0.5-3.5 per 1000 population). Influenza A H3N2, pandemic H1N1, and influenza B equally co-circulated in the first post-pandemic season, whereas H3N2 predominated for the next two seasons. Of patients for whom data was available, influenza vaccination was reported in 3289 (28.7%) of 11,459 patients with influenza-like illness, and antivirals were prescribed to 1644 (13.8%) of 11,953 patients. INTERPRETATION Influenza incidence varied with age groups and by season after the pandemic of 2009 influenza A H1N1. High levels of influenza virus circulation, especially in young children, emphasise the need for additional efforts to increase the uptake of influenza vaccines and antivirals. FUNDING US Centers for Disease Control and Prevention.
Collapse
|