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Gao P, Fan Y, Kong X, Zhang R, Chen L, Jiang Y, Liu Y, Zhao M, Deng G, Cao Y, Ma L. A novel assay based on DNA melting temperature for multiplexed identification of SARS-CoV-2 and influenza A/B viruses. Front Microbiol 2023; 14:1249085. [PMID: 38173675 PMCID: PMC10762780 DOI: 10.3389/fmicb.2023.1249085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and influenza viruses can cause respiratory illnesses with similar clinical symptoms, making their differential diagnoses challenging. Additionally, in critically ill SARS-CoV-2-infected patients, co-infections with other respiratory pathogens can lead to severe cytokine storm and serious complications. Therefore, a method for simultaneous detection of SARS-CoV-2 and influenza A and B viruses will be clinically beneficial. Methods We designed an assay to detect five gene targets simultaneously via asymmetric PCR-mediated melting curve analysis in a single tube. We used specific probes that hybridize to corresponding single-stranded amplicons at low temperature and dissociate at high temperature, creating different detection peaks representing the targets. The entire reaction was conducted in a closed tube, which minimizes the risk of contamination. The limit of detection, specificity, precision, and accuracy were determined. Results The assay exhibited a limit of detection of <20 copies/μL for SARS-CoV-2 and influenza A and <30 copies/μL for influenza B, with high reliability as demonstrated by a coefficient of variation for melting temperature of <1.16% across three virus concentrations. The performance of our developed assay and the pre-determined assay showed excellent agreement for clinical samples, with kappa coefficients ranging from 0.98 (for influenza A) to 1.00 (for SARS-CoV-2 and influenza B). No false-positive, and no cross-reactivity was observed with six common non-influenza respiratory viruses. Conclusion The newly developed assay offers a straightforward, cost-effective and nucleic acid contamination-free approach for simultaneous detection of the SARS-CoV-2, influenza A, and influenza B viruses. The method offers high analytical sensitivity, reliability, specificity, and accuracy. Its use will streamline testing for co-infections, increase testing throughput, and improve laboratory efficacy.
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Affiliation(s)
- Peng Gao
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Fan
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiaomu Kong
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Rui Zhang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Lida Chen
- Department of Blood Transfusion, China-Japan Friendship Hospital, Beijing, China
| | - Yongwei Jiang
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Yi Liu
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Meimei Zhao
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Guoxiong Deng
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Yongtong Cao
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Liang Ma
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
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Temte JL, Checovich MM, Barlow S, Shult PA, Reisdorf E, Haupt TE, Hamrick I, Mundt MP. Rapid Detection of Influenza Outbreaks in Long-Term Care Facilities Reduces Emergency Room Visits and Hospitalization: A Randomized Trial. J Am Med Dir Assoc 2023; 24:1904-1909. [PMID: 37421970 DOI: 10.1016/j.jamda.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To assess whether the use of rapid influenza diagnostic tests (RIDTs) for long-term care facility (LTCF) residents with acute respiratory infection is associated with increased antiviral use and decreased health care utilization. DESIGN Nonblinded, pragmatic, randomized controlled trial evaluating a 2-part intervention with modified case identification criteria and nursing staff-initiated collection of nasal swab specimen for on-site RIDT. SETTING AND PARTICIPANTS Residents of 20 LTCFs in Wisconsin matched by bed capacity and geographic location and then randomized. METHODS Primary outcome measures, expressed as events per 1000 resident-weeks, included antiviral treatment courses, antiviral prophylaxis courses, total emergency department (ED) visits, ED visits for respiratory illness, total hospitalizations, hospitalizations for respiratory illness, hospital length of stay, total deaths, and deaths due to respiratory illness over 3 influenza seasons. RESULTS Oseltamivir use for prophylaxis was higher at intervention LTCFs [2.6 vs 1.9 courses per 1000 person-weeks; rate ratio (RR) 1.38, 95% CI 1.24-1.54; P < .001]; rates of oseltamivir use for influenza treatment were not different. Rates of total ED visits (7.6 vs 9.8/1000 person-weeks; RR 0.78, 95% CI 0.64-0.92; P = .004), total hospitalizations (8.6 vs 11.0/1000 person-weeks; RR 0.79, 95% CI 0.67-0.93; P = .004), and hospital length of stay (35.6 days vs 55.5 days/1000 person-weeks; RR 0.64, 95% CI 0.0.59-0.69; P < .001) were lower at intervention as compared to control LTCFs. No significant differences were noted for respiratory-related ED visits or hospitalizations or in rates for all-cause or respiratory-associated mortality. CONCLUSIONS AND IMPLICATIONS The use of low threshold criteria to trigger nursing staff-initiated testing for influenza with RIDT resulted in increased prophylactic use of oseltamivir. There were significant reductions in the rates of all-cause ED visits (22% decline), hospitalizations (21% decline), and hospital length of stay (36% decline) across 3 combined influenza seasons. No significant differences were noted in respiratory-associated and all-cause deaths between intervention and control sites.
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Affiliation(s)
- Jonathan L Temte
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA.
| | - Mary M Checovich
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Shari Barlow
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Peter A Shult
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Thomas E Haupt
- Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA
| | - Irene Hamrick
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
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Munguía-Ramírez B, Armenta-Leyva B, Henao-Díaz A, Cheng TY, Zhang J, Rawal G, Ye F, Giménez-Lirola L, Zimmerman JJ. Effect of extrinsic factors on the detection of PRRSV and a porcine-specific internal sample control in serum, oral fluid, and fecal specimens tested by RT-rtPCR. J Vet Diagn Invest 2023; 35:374-383. [PMID: 37166086 PMCID: PMC10331379 DOI: 10.1177/10406387231174556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
We characterized the effect of 1) temperature × time, 2) freeze-thaw cycles, and 3) high porcine reproductive and respiratory syndrome virus (PRRSV) RNA concentrations on the detection of PRRSV and a porcine-specific internal sample control (ISC) in serum, oral fluid, and fecal samples using a commercial PRRSV RT-rtPCR assay (Idexx). In study 1, the effect of temperature × time on PRRSV and ISC detection was shown to be specimen dependent. In serum stored at 4, 10, or 20°C, PRRSV detection was consistent for up to 168 h, but storage at 30°C reduced detectable PRRSV RNA. ISC RNA was stable in serum held at 4 and 10°C, but not at 20 and 30°C. In contrast, PRRSV and ISC RNAs in oral fluid and fecal samples continuously decreased at all temperature × time treatments. Based on these data, serum samples should be stored at ≤ 20°C to optimize PRRSV RNA detection. Oral fluid and fecal samples should be frozen in a non-self-defrosting freezer until tested. In study 2, freeze-thaw cycles had little impact on PRRSV and ISC detection, but more so in oral fluids than serum or fecal samples. Thus, freeze-thaw cycles in oral fluids should be minimized before RT-rtPCR testing. In study 3, the ISC was not affected by high concentrations of PRRSV RNA in serum, oral fluid, or fecal samples. It should not be assumed that data from our PRRSV study are applicable to other pathogens; additional pathogen-specific studies are required.
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Affiliation(s)
- Berenice Munguía-Ramírez
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Betsy Armenta-Leyva
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | | | - Ting-Yu Cheng
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Jianqiang Zhang
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Gaurav Rawal
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Fangshu Ye
- Department of Statistics, College of Liberal Arts and Sciences, Iowa State University, Ames, IA, USA
| | - Luis Giménez-Lirola
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Jeffrey J. Zimmerman
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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Munguía-Ramírez B, Armenta-Leyva B, Henao-Díaz A, Ye F, Baum DH, Giménez-Lirola LG, Zimmerman JJ. Evaluation of a Porcine Endogenous Reference Gene (Internal Sample Control) in a Porcine Reproductive and Respiratory Syndrome Virus RT-qPCR. Vet Sci 2023; 10:381. [PMID: 37368767 DOI: 10.3390/vetsci10060381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Endogenous reference genes are used in gene-expression studies to "normalize" the results and, increasingly, as internal sample controls (ISC) in diagnostic quantitative polymerase chain reaction (qPCR). Three studies were conducted to evaluate the performance of a porcine-specific ISC in a commercial porcine reproductive and respiratory syndrome virus (PRRSV) reverse transcription-qPCR. Study 1 evaluated the species specificity of the ISC by testing serum from seven non-porcine domestic species (n = 34). In Study 2, the constancy of ISC detection over time (≥42 days) was assessed in oral fluid (n = 130), serum (n = 215), and feces (n = 132) collected from individual pigs of known PRRSV status. In Study 3, serum (n = 150), oral fluid (n = 150), and fecal samples (n = 75 feces, 75 fecal swabs) from commercial herds were used to establish ISC reference limits. Study 1 showed that the ISC was porcine-specific, i.e., all samples from non-porcine species were ISC negative (n = 34). In Study 2, the ISC was detected in all oral fluid, serum, and fecal samples, but differed in concentration between specimens (p < 0.05; mixed-effects regression model). The results of Study 3 were used to establish ISC reference limits for the 5th, 2.5th and 1.25th percentiles. Overall, the ISC response was consistent to the point that failure in detection is sufficient justification for re-testing and/or re-sampling.
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Affiliation(s)
- Berenice Munguía-Ramírez
- Veterinary Diagnostic and Production Animal Medicine Department, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Betsy Armenta-Leyva
- Veterinary Diagnostic and Production Animal Medicine Department, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Alexandra Henao-Díaz
- Pig Improvement Company (PIC) México, Santiago de Querétaro 76040, Querétaro, Mexico
| | - Fangshu Ye
- Department of Statistics, College of Liberal Arts and Sciences, Iowa State University, Ames, IA 50011, USA
| | - David H Baum
- Veterinary Diagnostic and Production Animal Medicine Department, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Luis G Giménez-Lirola
- Veterinary Diagnostic and Production Animal Medicine Department, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Jeffrey J Zimmerman
- Veterinary Diagnostic and Production Animal Medicine Department, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
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Kinnamon DS, Heggestad JT, Liu J, Chilkoti A. Technologies for Frugal and Sensitive Point-of-Care Immunoassays. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2022; 15:123-149. [PMID: 35216530 PMCID: PMC10024863 DOI: 10.1146/annurev-anchem-061020-123817] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Immunoassays are a powerful tool for sensitive and quantitative analysis of a wide range of biomolecular analytes in the clinic and in research laboratories. However, enzyme-linked immunosorbent assay (ELISA)-the gold-standard assay-requires significant user intervention, time, and clinical resources, making its deployment at the point-of-care (POC) impractical. Researchers have made great strides toward democratizing access to clinical quality immunoassays at the POC and at an affordable price. In this review, we first summarize the commercially available options that offer high performance, albeit at high cost. Next, we describe strategies for the development of frugal POC assays that repurpose consumer electronics and smartphones for the quantitative detection of analytes. Finally, we discuss innovative assay formats that enable highly sensitive analysis in the field with simple instrumentation.
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Affiliation(s)
- David S Kinnamon
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA;
| | - Jacob T Heggestad
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA;
| | - Jason Liu
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA;
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA;
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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.
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7
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Berwa A, Gallouche M, Larrat S, Fauconnier J, Viglino D, Bosson JL, Landelle C. Effect of point-of-care influenza tests on antibiotic prescriptions by emergency physicians in a French hospital. J Hosp Infect 2022; 122:133-139. [PMID: 35122886 DOI: 10.1016/j.jhin.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Influenza is a public health issue worldwide. Although antibiotics should not be used to treat viral infections, they are often prescribed to patients with influenza-like illness (ILI). Such misuse promotes antibiotic resistance. The role of rapid point-of-care tests (POCT) in preventing antibiotic misuse in adults with ILI symptoms remains relatively unexplored. AIM To evaluate whether POCT implemented in 2018-2019 to detect influenza viruses lead to a decrease in antibiotic prescriptions compared to laboratory based influenza tests. METHODS Adult patients with ILI in one emergency department (ED) were retrospectively enrolled over three epidemic seasons (from 2016-2017 to 2018-2019). The primary outcome was the rate of antibiotic prescriptions, which was compared between the three seasons in bivariate and multivariate analyses. Prescriptions for ancillary laboratory tests, chest X-rays and oseltamivir were also compared, along with hospitalisations and length of stay (LOS) at the ED. FINDINGS Overall, 1849 patients were included. Median age was over 70 throughout all three seasons. The number of antibiotic prescriptions was significantly different between the three periods in bivariate analysis (48.3% in 2016/2017, 44% in 2017/2018 and 31.1% in 2018/2019; p<0,0001) and in multivariate analysis (adjusted Odds Ratio [aOR]=0.48, 95%CI=0.30-0.76 for 2018/2019 and aOR=0.99, 95%CI=0.67-1.46 for 2017/2018, compared to 2016/2017). There were significantly fewer prescriptions of ancillary laboratory tests, X-rays, hospitalisations and more oseltamivir prescriptions in 2018/2019, compared to the previous seasons. LOS was significantly lower in 2018/2019 only for influenza-positive patients. CONCLUSION ED influenza POCT decreased antibiotic use and lead to less ancillary testing, X-rays and hospitalisations among patients with ILI. However, medico-economic studies are necessary before formulating definite recommendations.
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Affiliation(s)
- A Berwa
- Service D'Hygiène Hospitalière, CHU Grenoble Alpes, Grenoble, France
| | - M Gallouche
- Service D'Hygiène Hospitalière, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France.
| | - S Larrat
- Laboratoire de Virologie, CHU Grenoble Alpes, Grenoble, France
| | - J Fauconnier
- Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France; Département D'Information Médicale, CHU Grenoble Alpes, Grenoble, France
| | - D Viglino
- Service des Urgences, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, HP2 Laboratory INSERM U1042, CHU Grenoble Alpes, Grenoble, France
| | - J L Bosson
- Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France; Département de Méthodologie de L'Information de Santé, CHU Grenoble Alpes, Grenoble, France
| | - C Landelle
- Service D'Hygiène Hospitalière, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France
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Turtle J, Riley P, Ben-Nun M, Riley S. Accurate influenza forecasts using type-specific incidence data for small geographic units. PLoS Comput Biol 2021; 17:e1009230. [PMID: 34324487 PMCID: PMC8354478 DOI: 10.1371/journal.pcbi.1009230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/10/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022] Open
Abstract
Influenza incidence forecasting is used to facilitate better health system planning and could potentially be used to allow at-risk individuals to modify their behavior during a severe seasonal influenza epidemic or a novel respiratory pandemic. For example, the US Centers for Disease Control and Prevention (CDC) runs an annual competition to forecast influenza-like illness (ILI) at the regional and national levels in the US, based on a standard discretized incidence scale. Here, we use a suite of forecasting models to analyze type-specific incidence at the smaller spatial scale of clusters of nearby counties. We used data from point-of-care (POC) diagnostic machines over three seasons, in 10 clusters, capturing: 57 counties; 1,061,891 total specimens; and 173,909 specimens positive for Influenza A. Total specimens were closely correlated with comparable CDC ILI data. Mechanistic models were substantially more accurate when forecasting influenza A positive POC data than total specimen POC data, especially at longer lead times. Also, models that fit subpopulations of the cluster (individual counties) separately were better able to forecast clusters than were models that directly fit to aggregated cluster data. Public health authorities may wish to consider developing forecasting pipelines for type-specific POC data in addition to ILI data. Simple mechanistic models will likely improve forecast accuracy when applied at small spatial scales to pathogen-specific data before being scaled to larger geographical units and broader syndromic data. Highly local forecasts may enable new public health messaging to encourage at-risk individuals to temporarily reduce their social mixing during seasonal peaks and guide public health intervention policy during potentially severe novel influenza pandemics.
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Affiliation(s)
- James Turtle
- Infectious Disease Group, Predictive Science Inc., San Diego, California, United States
- * E-mail:
| | - Pete Riley
- Infectious Disease Group, Predictive Science Inc., San Diego, California, United States
| | - Michal Ben-Nun
- Infectious Disease Group, Predictive Science Inc., San Diego, California, United States
| | - Steven Riley
- Infectious Disease Group, Predictive Science Inc., San Diego, California, United States
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
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Lu S, Lin S, Zhang H, Liang L, Shen S. Methods of Respiratory Virus Detection: Advances towards Point-of-Care for Early Intervention. MICROMACHINES 2021; 12:mi12060697. [PMID: 34203612 PMCID: PMC8232111 DOI: 10.3390/mi12060697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 01/23/2023]
Abstract
Respiratory viral infections threaten human life and inflict an enormous healthcare burden worldwide. Frequent monitoring of viral antibodies and viral load can effectively help to control the spread of the virus and make timely interventions. However, current methods for detecting viral load require dedicated personnel and are time-consuming. Additionally, COVID-19 detection is generally relied on an automated PCR analyzer, which is highly instrument-dependent and expensive. As such, emerging technologies in the development of respiratory viral load assays for point-of-care (POC) testing are urgently needed for viral screening. Recent advances in loop-mediated isothermal amplification (LAMP), biosensors, nanotechnology-based paper strips and microfluidics offer new strategies to develop a rapid, low-cost, and user-friendly respiratory viral monitoring platform. In this review, we summarized the traditional methods in respiratory virus detection and present the state-of-art technologies in the monitoring of respiratory virus at POC.
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Affiliation(s)
- Siming Lu
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou 310003, China; (S.L.); (H.Z.)
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China;
| | - Sha Lin
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China;
| | - Hongrui Zhang
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou 310003, China; (S.L.); (H.Z.)
| | - Liguo Liang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China;
- Centre for Clinical Laboratory, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou 310006, China
- Correspondence: (L.L.); (S.S.); Tel.: +86-15861481568 (L.L.)
| | - Shien Shen
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou 310003, China; (S.L.); (H.Z.)
- Correspondence: (L.L.); (S.S.); Tel.: +86-15861481568 (L.L.)
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Lee J, Song JU, Kim YH. Diagnostic Accuracy of the Quidel Sofia Rapid Influenza Fluorescent Immunoassay in Patients with Influenza-like Illness: A Systematic Review and Meta-analysis. Tuberc Respir Dis (Seoul) 2021; 84:226-236. [PMID: 33979987 PMCID: PMC8273023 DOI: 10.4046/trd.2021.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Although the Quidel Sofia rapid influenza fluorescent immunoassay (FIA) is widely used to identify influenza A and B, the diagnostic accuracy of this test remains unclear. Thus, the objective of this study was to determine the diagnostic performance of this test compared to reverse transcriptase-polymerase chain reaction. Methods A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary receiver-operating characteristic curve (HSROC) of this test for identifying influenza A and B were determined using meta-analysis. A sensitivity subgroup analysis was performed to identify potential sources of heterogeneity within selected studies. Results We identified 17 studies involving 8,334 patients. Pooled sensitivity, specificity, and DOR of the Quidel Sofia rapid influenza FIA for identifying influenza A were 0.78 (95% confidence interval [CI], 0.71–0.83), 0.99 (95% CI, 0.98–0.99), and 251.26 (95% CI, 139.39–452.89), respectively. Pooled sensitivity, specificity, and DOR of this test for identifying influenza B were 0.72 (95% CI, 0.60–0.82), 0.98 (95% CI, 0.96–0.99), and 140.20 (95% CI, 55.92–351.54), respectively. The area under the HSROC for this test for identifying influenza A was similar to that for identifying influenza B. Age was considered a probable source of heterogeneity. Conclusion Pooled sensitivities of the Quidel Sofia rapid influenza FIA for identifying influenza A and B did not quite meet the target level (≥80%). Thus, caution is needed when interpreting data of this study due to substantial between-study heterogeneity.
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Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Jung SW, Kim YJ, Han SB, Lee KY, Kang JH. Differences in the age distribution of influenza B virus infection according to influenza B virus lineages in the Korean population. Postgrad Med 2020; 133:82-88. [PMID: 32945235 DOI: 10.1080/00325481.2020.1825295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Since the 2000s, two lineages of the influenza B virus (influenza B/Victoria and influenza B/Yamagata) have been co-circulating. Information on the age distribution of patients infected by each influenza B virus lineage may be helpful for establishing differentiated influenza prevention and control strategies for each age group. METHODS Age distributions were compared between patients infected by influenza A and B viruses and between those infected by the influenza B virus when B/Victoria and B/Yamagata lineages circulated dominantly. RESULTS Between the 2014-2015 and 2018-2019 influenza seasons, 2,718 and 1,397 patients were diagnosed with influenza A and B virus infections, respectively. The median age of patients infected by the influenza B virus was lower than that of patients infected by the influenza A virus (8 vs 12 years, p < 0.001). In the Yamagata season, the median ages of patients infected by influenza A and B viruses were similar (12 vs 11 years, p = 0.732); however, in the Victoria season, the median age of patients infected by the influenza B virus was lower than that of patients infected by the influenza A virus (6 vs 10 years, p < 0.001). In patients infected by the influenza B virus, patients aged <6 years and those aged ≥6 years were more likely to be infected during the Victoria and Yamagata seasons, respectively (p < 0.001). CONCLUSION The age distribution of patients infected by the influenza virus was different between the Yamagata and Victoria seasons. Different influenza prevention and control strategies should be considered on the basis of the predominantly circulating virus and the affected age group.
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Affiliation(s)
- Seung Won Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Ye Jin Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
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12
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Li W, Liu L, Chen L, Shang S. Evaluation of a Commercial Colloidal Gold Assay for Detection of Influenza A and B Virus in Children's Respiratory Specimens. Fetal Pediatr Pathol 2020; 39:93-98. [PMID: 31304835 DOI: 10.1080/15513815.2019.1639088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To evaluate the clinical diagnostic value of colloidal gold assay for detection of influenza A and B virus. Methods: Results were compared for colloidal gold assay for influenza antigen detection and real-time RT-PCR for RNA detection. Results: By performing the colloidal gold assay, the positive rate was 25.67% (105/409) for influenza A virus and 8.56% (35/409) for influenza B virus. While tested by real-time RT-PCR, 107(26.2%) were positive for influenza A virus and 35(8.6%) for influenza B virus. Using real-time RT-PCR as the gold standard, the sensitivity and specificity of the colloidal gold assay were 84.1% and 95.0%, respectively, for influenza A virus and 85.7% and 98.7% for influenza B virus. Conclusion: This colloidal gold assay may be one of the viable tools for the rapid screening for influenza viruses in an outpatient clinical practice.
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Affiliation(s)
- Wei Li
- Clinical Laboratory, Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Lifang Liu
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Luyan Chen
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Shiqiang Shang
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
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13
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Le Thi N, Ikuyo T, Nguyen Gia B, Truong Thai P, Vu Thi TV, Bui Minh V, Dao Xuan C, Le Trung D, Phan Thu P, Do Duy C, Pham The T, Do VT, Pham Thi PT, Ngo Quy C, Dang Quoc T, Jin T, Shohei S, Takato O, Noriko N, Tsutomu K. A clinic-based direct real-time fluorescent reverse transcription loop-mediated isothermal amplification assay for influenza virus. J Virol Methods 2019; 277:113801. [PMID: 31838003 DOI: 10.1016/j.jviromet.2019.113801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023]
Abstract
Seasonal influenza virus causes acute respiratory tract infections, which can be severe in children and the elderly. At present, rapid influenza diagnostic tests (RIDTs) are popular at clinical sites because they enable early diagnosis and avoid unnecessary use of antibiotics; in addition, high risk patients with underlying disease can be given antiviral drugs. However, the sensitivity and specificity of some of those tests are relatively poor. To overcome these problems, nucleic acid-based molecular point-of-care tests have been developed; however, they are significantly more expensive than RIDTs. Previously, the authors developed real-time reverse transcription loop-mediated isothermal amplification (rRT-LAMP) assays using a quenching primer to detect influenza viruses. However, the assay is limited to laboratory use because it requires a nucleic acid purification step and preparation of reaction mixtures on ice. Therefore, the authors developed and validated direct rRT-LAMP assays that require no nucleic acid purification steps using commercial RNA isolation kits, and no storage and handling of reagents on ice. These assays can be performed within 10-30 min and require only mixing a clinical specimen with extraction reagent followed by addition of a lyophilized detection reagent. The established assay showed high sensitivity and specificity when validated using 310 clinical specimens. Thus, the assay is a powerful tool for molecular diagnosis of seasonal influenza virus infection in the clinic.
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Affiliation(s)
- Ngan Le Thi
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Takayama Ikuyo
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
| | - Binh Nguyen Gia
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Phuong Truong Thai
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Tuong Van Vu Thi
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Vuong Bui Minh
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Co Dao Xuan
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Dung Le Trung
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Phuong Phan Thu
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Cuong Do Duy
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Thach Pham The
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Van Thanh Do
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Phuong Thuy Pham Thi
- NCGM-Bach Mai Hospital Medical Collaboration Center, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Chau Ngo Quy
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Tuan Dang Quoc
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Takasaki Jin
- National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Semba Shohei
- Eiken Chemical Co., Ltd, 4-19-9 Taito, Taito-ku, Tokyo, 110-8408, Japan
| | - Odagiri Takato
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
| | - Nakajima Noriko
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.
| | - Kageyama Tsutomu
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
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14
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Song JY, Noh JY, Lee JS, Wie SH, Kim YK, Lee J, Jeong HW, Kim SW, Lee SH, Park KH, Choi WS, Cheong HJ, Kim WJ. Effectiveness of repeated influenza vaccination among the elderly population with high annual vaccine uptake rates during the three consecutive A/H3N2 epidemics. Vaccine 2019; 38:318-322. [PMID: 31690467 DOI: 10.1016/j.vaccine.2019.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Annually, about 80% of the Korean elderly aged ≥65 years receive influenza vaccination. Repeated annual vaccination has been suggested as an important factor of poor influenza vaccine effectiveness (VE), though reported conflicting results. METHODS During the consecutive A/H3N2-dominant influenza seasons between 2012 and 2015, we comparatively evaluated the VE (repeated vs. current season only) against laboratory-confirmed influenza, pneumonia and hospitalization in the elderly aged ≥65 years with influenza-like illness (ILI). Clinical and demographic data were collected prospectively, and vaccination status of prior and current seasons was verified using the immunization registry data of Korean Centers for Disease Control and Prevention. RESULTS During the first A/H3N2-dominant season in 2012-2013, influenza vaccine showed statistically significant effectiveness against influenza A infection only and when vaccinated in the current season only (VE 53%, 95% CI 15-77). In the latter two seasons (2013-2015 years), the adjusted VE for influenza A was indistinguishable between repeated vaccination and vaccination in the current season only. CONCLUSION During consecutive influenza A/H3N2 epidemics, poor influenza vaccine effectiveness may be more pronounced among the elderly population with a high annual vaccine uptake rate.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Jin Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, Catholic University Medical College, St. Vincent's Hospital, Suwon, South Korea
| | - Young Keun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Shin Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Sun Hee Lee
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University School of Medicine, Pusan, South Korea
| | - Kyung-Hwa Park
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea.
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15
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Vandamme S, Van Cleempoel S, Michiels M, Goossens H, Jansens H, Matheeussen V. Comparison of the Coris Influ A + B K-SeT® and BD Veritor Flu A + B® for rapid detection of influenza viruses in respiratory samples from 3 consecutive flu seasons in Belgium. Diagn Microbiol Infect Dis 2019; 94:227-230. [PMID: 30827806 DOI: 10.1016/j.diagmicrobio.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Sarah Vandamme
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Shauni Van Cleempoel
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Mindy Michiels
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Herman Goossens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Hilde Jansens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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16
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Takayama I, Nakauchi M, Takahashi H, Oba K, Semba S, Kaida A, Kubo H, Saito S, Nagata S, Odagiri T, Kageyama T. Development of real-time fluorescent reverse transcription loop-mediated isothermal amplification assay with quenching primer for influenza virus and respiratory syncytial virus. J Virol Methods 2019; 267:53-58. [PMID: 30831121 PMCID: PMC7113748 DOI: 10.1016/j.jviromet.2019.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/31/2019] [Accepted: 02/28/2019] [Indexed: 12/20/2022]
Abstract
Influenza virus and respiratory syncytial virus cause acute upper and lower respiratory tract infections, especially in children and the elderly. Early treatment for these infections is thought to be important, so simple and sensitive detection methods are needed for use at clinical sites. Therefore, in this study, real-time reverse transcription loop-mediated isothermal amplification assays with quenching primer for influenza virus and respiratory syncytial virus were developed. Evaluation of a total of 113 clinical specimens compared to real-time RT-PCR assays showed that the novel assays could distinguish between the types and subtypes of influenza virus and respiratory syncytial virus and had 100% diagnostic specificity. The diagnostic sensitivity of each assay exceeded 85.0% and the assays showed sufficient clinical accuracy. Furthermore, positive results could be obtained in around 15 min using the novel assays in cases with high concentrations of virus. The developed assays should be useful for identifying influenza virus and respiratory syncytial virus cases not only in experimental laboratories but also in hospital and quarantine laboratories.
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Affiliation(s)
- Ikuyo Takayama
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Mina Nakauchi
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Hitoshi Takahashi
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira-shi, Tokyo 187-0002, Japan
| | - Shohei Semba
- Eiken Chemical Co. Ltd., 4-19-9 Taito, Taito-ku, Tokyo 110-8408, Japan
| | - Atsushi Kaida
- Division of Microbiology, Osaka Institute of Public Health, 8-34 Tojo-cho, Tennoji-ku, Osaka 543-0026, Japan
| | - Hideyuki Kubo
- Division of Microbiology, Osaka Institute of Public Health, 8-34 Tojo-cho, Tennoji-ku, Osaka 543-0026, Japan
| | - Shinji Saito
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Shiho Nagata
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Takato Odagiri
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Tsutomu Kageyama
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
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17
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Zhu D, Lok C, Chao S, Chen L, Li R, Zhao Z, Dong J, Qin K, Zhao X. Detection and characterization of type B influenza virus from influenza-like illness cases during the 2017-2018 winter influenza season in Beijing, China. Arch Virol 2019; 164:995-1003. [PMID: 30729995 DOI: 10.1007/s00705-019-04160-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/04/2019] [Indexed: 12/15/2022]
Abstract
In the winter of 2017-2018, there was significant influenza activity in China, resulting in unprecedented usage of influenza rapid antigen tests (IRAT) and neuraminidase inhibitors (NAIs). The aim of this study was to characterize the most prevalent influenza virus type in a clinical setting with respect to diagnosis and concomitant NAI treatment. From Dec 2017 to Jan 2018, 3257 patients with influenza-like illness (ILI) were screened using IRAT. We summarized and compared the results with the last influenza season. Subtyping of influenza B viruses and identification of NAI drug resistance mutations were carried out by sequencing the HA and NA genes and aligning these with genetic isotypes. The performance of IRAT and RT-PCR was compared. Screening results indicated that influenza B virus was the leading cause of this influenza epidemic, with children being more susceptible to infection than adults. Phylogenetic analysis revealed that the prevailing influenza B virus belonged to the Yamagata lineage and were genetically similar to strains isolated from North America in the same influenza season. Cross-continental spread of influenza/B/Yamagata occurred. NAI resistance mutations were not identified in the 18 samples analyzed. The current antiviral protocol was still effective for influenza B control. RT-PCR positivity was significantly higher than that of IRAT (P = 0.004). IRAT and RT-PCR had a consistency rate of 86.9%, with the consistency rates of the positive and negative cases being 54.3% and 97.3%, respectively. Clinicians should be alert to the possibility of obtaining false negative results when using IRAT, and RT-PCR is recommended to improve the accuracy of pathogen detection.
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Affiliation(s)
- Dong Zhu
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Chonghou Lok
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Shuang Chao
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Lingling Chen
- Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, China CDC, National Health and Family Planning Commission, Beijing, People's Republic of China
| | - Runqing Li
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Zhipeng Zhao
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Jingxiao Dong
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Kun Qin
- Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, China CDC, National Health and Family Planning Commission, Beijing, People's Republic of China.
| | - Xiuying Zhao
- School of Clinical Medicine, Beijing Tsinghua Chang-gung Hospital, Tsinghua University, Beijing, People's Republic of China.
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18
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Impact of bedside diagnosis of influenza in the paediatric emergency ward. Clin Microbiol Infect 2018; 25:898-903. [PMID: 30502486 DOI: 10.1016/j.cmi.2018.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/12/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This prospective study performed in the paediatric emergency department of the University Hospital of Saint-Etienne aimed to measure the impact of the 24/7 bedside use of the Veritor™ System (Becton Dickinson) on the reduction of supplementary investigations, hospital stay and antimicrobial use. METHODS Influenza virus A and B antigens were detected with a rapid influenza digital immunoassay (DIA) on nasopharyngeal aspirates (NPAs) sampled from the children consulting at the paediatric emergency department between January and March 2016 for influenza-like illness. The same NPA was tested by immunofluorescence and/or molecular routine assays. Before performing the DIA, the clinician filled in a questionnaire listing the tests that he/she would have prescribed in the absence of the rapid testing. The prescription of complementary investigations, antimicrobial treatments and hospital stay were also compared to those of the 3 previous years. RESULTS A total of 514 children with flu-like symptoms were included. The use of the DIA at bedside decreased the prescription of blood puncture by 47.9% (21.2% to 6.6%), of chest X-rays by 69.0% (33.3% to 10.3%), of lumbar puncture by 77.8% (7.0% to 1.6%), of urine culture by 79.2% (23.3% to 4.9%), of antibiotic treatments by 70.1% (16.9% to 5.1%), and of hospital stay by 25.0% (27.2% to 20.4%), resulting in a reduction of medical costs estimated to more than €69 000 in a season. CONCLUSIONS In addition to delivering a rapid aetiological diagnosis, this strategy saves medical costs and favours an antimicrobial stewardship strategy. However, further prospective studies are needed to confirm our findings.
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19
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Tang JW, Blount J, Bradley C, Donaghy B, Shardlow C, Bandi S, Baxter C, Hunter A, Range S, Lam TT. Impact of a poorly performing point-of-care test during the 2017-2018 influenza season. J Infect 2018; 78:249-259. [PMID: 30408493 PMCID: PMC7172292 DOI: 10.1016/j.jinf.2018.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/13/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Julian W Tang
- Clinical Microbiology and Virology, University Hospitals of Leicester NHS Trust, Level 5 Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; Infection, Immunity, Inflammation, University of Leicester, Leicester, UK.
| | - Janice Blount
- Infection Prevention and Control, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Carina Bradley
- Clinical Microbiology and Virology, University Hospitals of Leicester NHS Trust, Level 5 Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK
| | - Bernadette Donaghy
- Adult Cystic Fibrosis Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Carol Shardlow
- Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Srini Bandi
- Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Caroline Baxter
- Clinical Decisions Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ann Hunter
- Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Simon Range
- Adult Cystic Fibrosis Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tommy Ty Lam
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
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20
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Detection of Influenza A and B Viruses and Respiratory Syncytial Virus by Use of Clinical Laboratory Improvement Amendments of 1988 (CLIA)-Waived Point-of-Care Assays: a Paradigm Shift to Molecular Tests. J Clin Microbiol 2018; 56:JCM.00367-18. [PMID: 29695519 DOI: 10.1128/jcm.00367-18] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
An accurate laboratory diagnosis of influenza, respiratory syncytial virus (RSV), and other respiratory viruses can help to guide patient management, antiviral therapy, infection prevention strategies, and epidemiologic monitoring. Influenza has been the primary driver of rapid laboratory testing due to its morbidity and mortality across all ages, the availability of antiviral therapy, which must be given early to have an effect, and the constant threat of new pandemic strains. Over the past 30 years, there has been an evolution in viral diagnostic testing, from viral culture to rapid antigen detection, and more recently, to highly sensitive nucleic acid amplification tests (NAAT), as well as a trend to testing at the point of care (POC). Simple rapid antigen immunoassays have long been the mainstay for POC testing for influenza A and B viruses and respiratory syncytial virus (RSV) but have been faulted for low sensitivity. In 2015, the first POC NAAT for the detection of influenza was approved by the Food and Drug Administration (FDA), ushering in a new era. In 2017, the FDA reclassified rapid influenza diagnostic tests (RIDTs) from class I to class II devices with new minimum performance standards and a requirement for annual reactivity testing. Consequently, many previously available RIDTs can no longer be purchased in the United States. In this review, recent developments in Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived testing for respiratory virus infections will be presented, with the focus on currently available FDA-cleared rapid antigen and molecular tests primarily for influenza A and B viruses and RSV.
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Affiliation(s)
- Mark D Gonzalez
- Department of Pathology, Children's Healthcare of Atlanta, 1405 Clifton Road, Northeast, Atlanta, GA 30322, USA
| | - Erin McElvania
- Department of Pathology, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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22
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Abstract
Acute upper and lower respiratory infections are a major public health problem and a leading cause of morbidity and mortality worldwide. At greatest risk are young children, the elderly, the chronically ill, and those with suppressed or compromised immune systems. Viruses are the predominant cause of respiratory tract illnesses and include RNA viruses such as respiratory syncytial virus, influenza virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. Laboratory testing is required for a reliable diagnosis of viral respiratory infections, as a clinical diagnosis can be difficult since signs and symptoms are often overlapping and not specific for any one virus. Recent advances in technology have resulted in the development of newer diagnostic assays that offer great promise for rapid and accurate detection of respiratory viral infections. This chapter emphasizes the fundamental characteristics and clinical importance of the various RNA viruses that cause upper and lower respiratory tract diseases in the immunocompromised host. It highlights the laboratory methods that can be used to make a rapid and definitive diagnosis for the greatest impact on the care and management of ill patients, and the prevention and control of hospital-acquired infections and community outbreaks.
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Shapiro D, Bodinayake CK, Nagahawatte A, Devasiri V, Kurukulasooriya R, Hsiang J, Nicholson B, De Silva AD, Østbye T, Reller ME, Woods CW, Tillekeratne LG. Burden and Seasonality of Viral Acute Respiratory Tract Infections among Outpatients in Southern Sri Lanka. Am J Trop Med Hyg 2017; 97:88-96. [PMID: 28719323 PMCID: PMC5508919 DOI: 10.4269/ajtmh.17-0032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/08/2017] [Indexed: 11/07/2022] Open
Abstract
In tropical and subtropical settings, the epidemiology of viral acute respiratory tract infections varies widely between countries. We determined the etiology, seasonality, and clinical presentation of viral acute respiratory tract infections among outpatients in southern Sri Lanka. From March 2013 to January 2015, we enrolled outpatients presenting with influenza-like illness (ILI). Nasal/nasopharyngeal samples were tested in duplicate using antigen-based rapid influenza testing and multiplex polymerase chain reaction (PCR) for respiratory viruses. Monthly proportion positive was calculated for each virus. Bivariable and multivariable logistic regression were used to identify associations between sociodemographic/clinical information and viral detection. Of 571 subjects, most (470, 82.3%) were ≥ 5 years of age and 53.1% were male. A respiratory virus was detected by PCR in 63.6% (N = 363). Common viral etiologies included influenza (223, 39%), human enterovirus/rhinovirus (HEV/HRV, 14.5%), respiratory syncytial virus (RSV, 4.2%), and human metapneumovirus (hMPV, 3.9%). Both ILI and influenza showed clear seasonal variation, with peaks from March to June each year. RSV and hMPV activity peaked from May to July, whereas HEV/HRV was seen year-round. Patients with respiratory viruses detected were more likely to report pain with breathing (odds ratio [OR] = 2.60, P = 0.003), anorexia (OR = 2.29, P < 0.001), and fatigue (OR = 2.00, P = 0.002) compared with patients with no respiratory viruses detected. ILI showed clear seasonal variation in southern Sri Lanka, with most activity during March to June; peak activity was largely due to influenza. Targeted infection prevention activities such as influenza vaccination in January-February may have a large public health impact in this region.
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Affiliation(s)
- David Shapiro
- Department of Pediatrics, Duke University, Durham, North Carolina
| | | | - Ajith Nagahawatte
- Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka
| | - Vasantha Devasiri
- Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka
| | | | - Jeremy Hsiang
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | | | - Truls Østbye
- Duke Global Health Institute, Durham, North Carolina
- Department of Community and Family Medicine, Duke University, Durham, North Carolina
| | - Megan E. Reller
- Department of Medicine, Duke University, Durham, North Carolina
| | - Christopher W. Woods
- Duke Global Health Institute, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - L. Gayani Tillekeratne
- Duke Global Health Institute, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
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Berry GJ, Oladipo O, Wittnebert D, Loeffelholz MJ, Petersen JR. Comparison of the Alere i and BD Veritor Assays for the Rapid Detection of Influenza A and B Viruses. J Appl Lab Med 2017; 1:735-739. [PMID: 33379826 DOI: 10.1373/jalm.2016.022350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/10/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The use of point-of care testing (POCT) in patient management decisions is becoming increasingly common. Our goal was to evaluate the diagnostic performance of 2 commercially available rapid POCT devices for influenza viruses A and B: the Alere™ i Instrument (Alere, Scarborough) and the BD Veritor™ System (BD Diagnostics). METHODS Paired nasopharyngeal swabs were collected from patients (18-71 years) presenting with influenza-like symptoms at 3 outpatient clinics. A total of 65 samples were obtained. The Alere i and BD Veritor were performed according to the manufacturers' instructions. Discordant results were resolved using real-time reverse transcription PCR (RT-PCR). RESULTS In a head-to-head comparison involving symptomatic adult patients visiting outpatient clinics during the 2014-2015 and 2015-2016 influenza seasons, the Alere i and BD Veritor had 90.63% agreement in the detection of influenza A virus and a statistically significant observed κ coefficient of 0.754 (P <0.0001). Discordant results between the Alere i and BD Veritor were further investigated using RT-PCR, showing that the BD Veritor missed 5 positive influenza A virus results (false negatives) and detected 1 false positive, while the Alere i results agreed with all RT-PCR results. There were no discordant results between the Alere i and BD Veritor in the detection of influenza B virus. CONCLUSIONS Our data suggest that the Alere i has higher sensitivity and specificity than the BD Veritor in the detection of influenza A virus. Both assays showed equal performance in the detection of influenza B virus.
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Affiliation(s)
- Gregory J Berry
- Department of Pathology, University of Texas Medical Branch, Galveston, TX.,Current affiliation: Northwell Health, Department of Pathology and Laboratory Medicine, Lake Success, NY
| | - Olajumoke Oladipo
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
| | | | | | - John R Petersen
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
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Comparison of influenza and RSV diagnostic from nasopharyngeal swabs by rapid fluorescent immunoassay (Sofia system) and rapid bedside testing (BinaxNOW) vs. conventional fluorescent immunoassay in a German university children's hospital. Infection 2017; 45:529-532. [PMID: 28290129 DOI: 10.1007/s15010-017-1001-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
The Sofia fluorescent immunoassay showed excellent sensitivity and specificity compared to conventional fluorescent immunoassay for Influenza A (Influenza B was not detected during the study period) and RSV in patients with suspected ILI (influenza-like illness). Thus the fast and easy-to-handle Sofia FIA leads to rapid and reliable diagnosis, which can be used by clinicians to avoid unnecessary antibiotic treatment and rapidly identify patients who need to be isolated upon hospital admission.
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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.
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Koski RR, Klepser ME. A systematic review of rapid diagnostic tests for influenza: considerations for the community pharmacist. J Am Pharm Assoc (2003) 2017; 57:13-19. [DOI: 10.1016/j.japh.2016.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
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Evaluation of the rapid influenza detection tests GOLD SIGN FLU and Quick Navi-Flu for the detection of influenza A and B virus antigens in adults during the influenza season. Int J Infect Dis 2016; 52:55-58. [DOI: 10.1016/j.ijid.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/17/2016] [Accepted: 10/02/2016] [Indexed: 11/21/2022] Open
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Mese S, Akan H, Badur S, Uyanik A. Analytical performance of the BD veritor™ system for rapid detection of influenza virus A and B in a primary healthcare setting. BMC Infect Dis 2016; 16:481. [PMID: 27612949 PMCID: PMC5016879 DOI: 10.1186/s12879-016-1811-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
Background Infections with influenza A virus cannot be clinically differentiated from infections caused by influenza B virus or other respiratory viruses. Additionally, although antiviral treatment is available for influenza A virus, it is not effective for the other viruses and must be initiated early in the course of disease for it to be effective. For these reasons, there is a need for a rapid, accurate diagnostic test for use in physicians’ offices at the time patients are seen. We report the first field performance of BD Veritor™ System for Rapid Detection of Flu A + B test compared to real time PCR. The performance of this test was compared to real time PCR performed in the Istanbul University Influenza Reference Laboratory. Method A single-blinded cross sectional study was conducted in nine different family medicine centers in Istanbul, Turkey between 01 November 2014 and 01 May 2015. For every patient, two specimens were collected, one for real time PCR and one for the Veritor test. Specimens for the Veritor test were immediately tested at the participating clinic according to the manufacturer’s instructions. The specimens for real time PCR were transferred to the reference laboratory. Results A total of 238 persons were included in the study: 72 (30 %) of the patients included in the study were below 19 years old and accepted as childhood group. Mean age of adults was 42.4 and children 10.2 years. A total of 122 patients out of 238 were positive for influenza. The clinical sensitivity and specificity of the Veritor test in all age groups was determined to be 80 and 94 %, respectively. Positive predictive value was 93 % and the negative one was 81 %. Conclusion Field performance of the rapid influenza test was high and found to be useful with respect to rational antiviral use, avoiding unnecessary antibiotic usage and the management of cases by the family physicians.
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Affiliation(s)
- Sevim Mese
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Hulya Akan
- Department of Family Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Selim Badur
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysun Uyanik
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Arbefeville SS, Fickle AR, Ferrieri P. Sensitivity of the Quidel Sofia Fluorescent Immunoassay Compared With 2 Nucleic Acid Assays and Viral Culture to Detect Pandemic Influenza A(H1N1)pdm09. Lab Med 2016. [PMID: 26199264 DOI: 10.1309/lmrxbn8p59itdhqz] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
To confirm a diagnosis of influenza at the point of care, healthcare professionals may rely on rapid influenza diagnostic tests (RIDTs). RIDTs have low to moderate sensitivity compared with viral culture or real-time reverse-transcription polymerase chain reaction (rRT-PCR). With the resurgence of the influenza A (Flu A; subtype H1N1) pandemic 2009 (pdm09) strain in the years 2013 and 2014, we evaluated the accuracy of the United State Food and Drug Administration (FDA)-approved Sofia Influenza A+B Fluorescent Immunoassay to detect epidemic Flu A(H1N1)pdm09 in specimens from the upper-respiratory tract. During a 3-month period, we collected 40 specimens that tested positive via PCR and/or culture for Flu A of the H1N1 pdm09 subtype. Of the 40 specimens, 27 tested positive (67.5%) via Sofia assay for Flu A. Of the 13 specimens with a negative result via Sofia testing, 4 had coinfection, as detected by the GenMark Diagnostics eSensor Respiratory Viral Panel. This sensitivity of the RIDT Sofia assay to detect Flu A(H1N1) pdm09 was comparable to previously reported sensitivities ranging from 10% to 75% for older RIDTs.
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Affiliation(s)
- Sophie S Arbefeville
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Ann R Fickle
- University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Patricia Ferrieri
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
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Ryu SW, Lee JH, Kim J, Jang MA, Nam JH, Byoun MS, Lim CS. Comparison of two new generation influenza rapid diagnostic tests with instrument-based digital readout systems for influenza virus detection. Br J Biomed Sci 2016; 73:115-120. [PMID: 27327199 DOI: 10.1080/09674845.2016.1189026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Influenza rapid diagnostic tests (RDTs) have been developed to supply scientists with more sensitive and specific techniques. Newly developed digital reader-based techniques require test evaluations before their clinical application. METHODS Two types of digital influenza RDTs using a digital readout system and one conventional RDT were compared using 314 nasopharyngeal swabs of influenza. The swabs originated from symptomatic individuals suspected of influenza infection, and the presence of influenza was confirmed with influenza real-time polymerase chain reaction (PCR) testing and influenza subtyping. Methods were the Sofia® Influenza A + B Fluorescence Immunoassay (FIA), which uses a portable fluorescence analyser, the BD Veritor™ System Flu A + B, which uses a colorimetric immunochromatographic method with a reflectance-based measurement digital device, and the SD Bioline assay, which is based on a traditional immunochromatographic method. RESULTS The Sofia® Influenza A + B system, the BD Veritor™ System Flu A + B and the SD Bioline assay showed sensitivities in relative real-time PCR results of 74.2, 73.0 and 53.9%, respectively, for influenza A, and 82.5, 72.8 and 71.0%, respectively, for influenza B. All three RDTs showed 100% specificities for influenza A and influenza B. The Sofia® Influenza A + B Fluorescence Immunoassay showed sensitive and specific results for the detection of influenza B in contrast to the BD Veritor™ System Flu A + B. The two digital RDTs showed higher sensitivity and specificity than the conventional RDT in the detection of the influenza H3 subtype. CONCLUSIONS Digital-based readout systems for the detection of the influenza virus can be applied for more sensitive diagnosis in clinical settings than conventional RDTs.
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Affiliation(s)
- S-W Ryu
- a Department of Laboratory Medicine, School of Medicine , Kangwon National University , Chuncheon , Korea
| | - J-H Lee
- b Department of Laboratory Medicine , Osan Hankook General Hospital , Osan , Korea
| | - J Kim
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - M-A Jang
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - J-H Nam
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - M-S Byoun
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - C S Lim
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
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Abstract
OBJECTIVES To describe the strengths and limitations of the available influenza diagnostics, with a focus on rapid antigen detection assays and nucleic acid detection assays. METHODS A case-based presentation is used to illustrate the potential limitations of rapid antigen detection assays for influenza. RESULTS Influenza is a seasonal illness; estimates attribute influenza to approximately 200,000 hospitalizations and 41,000 deaths in the United States annually. Antigen detection assays for influenza are rapid and convenient, and thus are widely used in a variety of health care settings, even though the sensitivity of these assays may be suboptimal. The United States Food and Drug Administration has recently created new guidelines intended to improve the oversight and performance characteristics of influenza antigen detection assays. Molecular assays, although more costly and complex, are more sensitive and may be designed to simultaneously detect multiple respiratory pathogens within a single assay. CONCLUSIONS Diagnostic assays for influenza can vary greatly with regards to analytical performance characteristics, complexity, turnaround time and cost. This can have important patient care and infection prevention implications.
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Affiliation(s)
- Allison R McMullen
- From the Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Neil W Anderson
- From the Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Carey-Ann D Burnham
- From the Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO.
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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.
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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
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Chiarella FC, Culebras E, Fuentes-Ferrer ME, Picazo JJ. Evaluation of the Alere i Influenza A&B assay for rapid identification of influenza A and influenza B viruses. J Med Microbiol 2016; 65:456-461. [PMID: 26967368 DOI: 10.1099/jmm.0.000249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Alere i Influenza A&B assay is a novel isothermal nucleic acid amplification assay capable of detecting and differentiating influenza A and B viruses in approximately 15 min with minimal hands-on time. This study was conducted in order to assess the performance of the Alere i Influenza A&B assay compared to molecular techniques, considered to be gold standard methods, to evaluate the results. A total of 119 nasopharyngeal swabs collected from inpatients with influenza-like illness were included in the study using both archived and prospectively collected samples from adults and children. Prospectively collected samples were also compared to the Alere BinaxNOW® Influenza A & B Card. The overall sensitivity for detection of influenza A and B viruses compared to those of molecular techniques were 65.96 % and 53.33 % respectively, while the specificity was 98.51 % and 95.96 %. Compared to the Alere BinaxNOW® Influenza A & B Card, the Alere i assay is considerably more sensitive for detection of influenza A and B viruses, although both tests demonstrated excellent specificity for diagnosis of influenza viruses.
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Affiliation(s)
| | - Esther Culebras
- Department of Microbiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | | | - Juan José Picazo
- Department of Microbiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
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Selove W, Rao LV. Performance of rapid SOFIA Influenza A+B test compared to Luminex x-TAG respiratory viral panel assay in the diagnosis of influenza A, B, and subtype H3. J Investig Med 2016; 64:905-7. [PMID: 26911275 PMCID: PMC4819670 DOI: 10.1136/jim-2016-000055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/25/2022]
Abstract
Influenza is an acute respiratory illness caused by influenza A or B viruses that occur in outbreaks, mainly during the winter season. Rapid laboratory diagnosis of influenza can help guide the clinical management of suspected patients effectively. Clinical sensitivities and specificities of the rapid influenza diagnostic tests have varied considerably in the literature. Most of these studies are evaluated using previously frozen or stored specimens that had previously tested positive. This study compares the performance of the rapid SOFIA Influenza A+B test to nucleic acid multiplex test x-TAG respiratory viral panel (RVP) assay in freshly collected nasal aspirates and measured simultaneously by both assays. Retrospective data from 1649 nasal aspirates (September 2014 to May 2015) collected from adults as well as from children tested simultaneously by both rapid SOFIA Influenza A+B FIA immunofluorescence (Quidel, San Diego, CA) and qualitative nucleic acid multiplex RVP assay X-TAG Luminex technology (Luminex, Austin, Texas, USA) were analyzed. Concordance, and analytical sensitivity and specificity were evaluated for influenza A, subtypes H1 and H3, and influenza B. Prevalence for influenza A by RVP was 15%, for subtype H3 it was 11.2%, and for influenza B, 2.9%. None of the aspirates were positive for influenza A subtype H1. SOFIA Influenza rapid test demonstrated good specificity and low sensitivity compared with a nucleic acid test for influenza A, subtype H3, and for influenza B. SOFIA Influenza A + B test performed well in providing a rapid diagnosis, however, confirmatory molecular testing is recommended for negative test results. Re-evaluation of test performance should be periodically carried out during outbreaks with the emergence and circulation of new influenza strains.
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Affiliation(s)
- W Selove
- Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - L V Rao
- Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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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: 13] [Impact Index Per Article: 1.6] [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.
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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
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Kwong JC. Editorial Commentary: Symptoms and Viral Shedding in Naturally Acquired Influenza Infections. Clin Infect Dis 2015; 62:438-9. [PMID: 26518470 PMCID: PMC4725383 DOI: 10.1093/cid/civ914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences Department of Family and Community Medicine Dalla Lana School of Public Health, University of Toronto Public Health Ontario University Health Network, Toronto, Ontario, Canada
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[Interests and limitations of rapid diagnostic tests for respiratory and gastrointestinal viral diseases]. ACTA ACUST UNITED AC 2015; 2015:45-50. [PMID: 32288822 PMCID: PMC7140266 DOI: 10.1016/s1773-035x(15)30200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Les tests de dépistage rapide (TDR) basés sur la technique d’immunochromatographie sont très répandus pour le diagnostic des maladies infectieuses. Dans le cadre des infections respiratoires virales, il s’agit essentiellement de tests pour le diagnostic de la grippe et des infections à virus respiratoire syncytial (VRS). Pour le diagnostic des gastroentérites virales, ce sont des tests de détection des rotavirus, adénovirus, norovirus et astrovirus qui peuvent être utilisés. Les TDR pour les infections à VRS et les gastroentérites sont utilisés essentiellement dans le cadre de la pathologie pédiatrique. Ces tests présentent généralement une spécificité élevée mais une sensibilité modeste par rapport aux techniques moléculaires. Ce sont donc surtout des tests de dépistages et leur négativité ne permet pas d’exclure le diagnostic.
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Dunn JJ, Ginocchio CC. Can newly developed, rapid immunochromatographic antigen detection tests be reliably used for the laboratory diagnosis of influenza virus infections? J Clin Microbiol 2015; 53:1790-6. [PMID: 25274999 PMCID: PMC4432049 DOI: 10.1128/jcm.02739-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Five years ago, the Point-Counterpoint series was launched. The initial article asked about the role of rapid immunochromatographic antigen testing in the diagnosis of influenza A virus 2009 H1N1 infection (D. F. Welch and C. C. Ginocchio, J Clin Microbiol 48:22-25, 2010, http://dx.doi.org/10.1128/JCM.02268-09). Since that article, not only have major changes been made in immunochromatographic antigen detection (IAD) testing for the influenza viruses, but there has also been rapid development of commercially available nucleic acid amplification tests (NAATs) for influenza virus detection. Further, a novel variant of influenza A, H7N9, has emerged in Asia, and H5N1 is also reemergent. In that initial article, the editor of this series, Peter Gilligan, identified two issues that required further consideration. One was how well IAD tests worked in clinical settings, especially in times of antigen drift and shift. The other was the role of future iterations of influenza NAATs and whether this testing would be available in a community hospital setting. James Dunn, who is Director of Medical Microbiology and Virology at Texas Children's Hospital, has extensive experience using IAD tests for diagnosing influenza. He will discuss the application and value of these tests in influenza diagnosis. Christine Ginocchio, who recently retired as the Senior Medical Director, Division of Infectious Disease Diagnostics, North Shore-LIJ Health System, and now is Vice President for Global Microbiology Affairs at bioMérieux, Durham, NC, wrote the initial counterpoint in this series, where she advocated the use of NAATs for influenza diagnosis. She will update us on the commercially available NAAT systems and explain what their role should be in the diagnosis of influenza infection.
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Affiliation(s)
- James J Dunn
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Christine C Ginocchio
- bioMérieux, Durham, North Carolina, USA Department of Pathology and Laboratory Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
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Hurtado JC, Mosquera MM, de Lazzari E, Martínez E, Torner N, Isanta R, de Molina P, Pumarola T, Marcos MA, Estape JV. Evaluation of a new, rapid, simple test for the detection of influenza virus. BMC Infect Dis 2015; 15:44. [PMID: 25656393 PMCID: PMC4369360 DOI: 10.1186/s12879-015-0775-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Influenza virus infections are responsible for significant morbidity and mortality in both pediatric and adult populations worldwide. Rapid and accurate diagnosis of influenza is necessary for appropriate patient management during the influenza season and for optimal utilization of anti-influenza therapy. We prospectively tested the accuracy of a simple and rapid diagnostic method. METHODS Ninety-eight samples (nasal and pharyngeal swabs) from patients with upper respiratory tract infection symptoms who presented to primary healthcare centres in Barcelona (Spain) were prospectively analyzed. The samples were collected as part of influenza surveillance program. Samples that had enough volume to make the new test after aliquoting the amount needed to perform routine tests were included. None of the samples were pre-selected as a result of their status in relation to influenza virus. Samples were analyzed by in-house real-time PCR and Alere i Influenza A & B (Alere i), which uses isothermal amplification of nucleic acids for the qualitative detection of influenza A and B in nasal swabs transported in viral transport media. The two techniques were compared by positive percent agreement (PPA) and negative percent agreement (NPA). Statistical analysis was performed with Stata. RESULTS Of the 98 samples analysed 90 were concordant; 46 (46.9%) were positive and 44 (44.9%) were negative. Five samples showed invalid results with the Alere i test and could be not re-tested due to insufficient sample volume and were not included in the final statistical analysis. In the 93 remaining samples, the Alere i test showed 97% of accuracy having correctly classified 90 samples. We obtained discordant results in 3 samples (3%). The PPA was 93.8% for influenza A and 94.1% for influenza B, and NPA was 100% for influenza A and influenza B virus. In addition, the Alere i was very rapid (15 minutes or less) and extremely easy to use. CONCLUSIONS The Alere i test provided a good correlation compared to the real-time PCR test for the diagnosis of influenza. Since this method can be performed in minutes, it allows immediate, accurate clinical decisions to prescribe appropriate antiviral treatment or isolation of patients.
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Affiliation(s)
- Juan Carlos Hurtado
- />Department of Clinical Microbiology, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Mar Mosquera
- />Department of Clinical Microbiology, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain
- />Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain
| | - Elisa de Lazzari
- />Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain
| | - Esteban Martínez
- />Infectious Diseases Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nuria Torner
- />Public Health Agency of Catalonia, Barcelona, Spain
- />CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ricard Isanta
- />Department of Clinical Microbiology, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Patricia de Molina
- />Department of Clinical Microbiology, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Tomás Pumarola
- />Department of Microbiology, Hospital Universitari Vall d’Hebron (HUVH), Universidad Autónoma de Barcelona (UAB), Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Maria Angeles Marcos
- />Department of Clinical Microbiology, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain
- />Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain
| | - Jordi Vila Estape
- />Department of Clinical Microbiology, Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain
- />Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain
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Evaluation of novel second-generation RSV and influenza rapid tests at the point of care. Diagn Microbiol Infect Dis 2014; 81:171-6. [PMID: 25583129 DOI: 10.1016/j.diagmicrobio.2014.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/27/2014] [Accepted: 11/24/2014] [Indexed: 11/23/2022]
Abstract
Acute respiratory infections represent common pediatric emergencies. Infection control warrants immediate and accurate diagnoses. In the past, first-generation respiratory syncytial virus (RSV) rapid tests (strip tests) have shown suboptimal sensitivities. In 2013, the Food and Drug Administration licensed a second-generation RSV rapid test providing user-independent readouts (SOFIA™-RSV) using automated fluorescence assay technology known to yield superior results with influenza rapid testing. We are reporting the first point-of-care evaluation of the SOFIA™-RSV rapid test. In the Charité Influenza-Like Disease Cohort, 686 nasopharyngeal samples were tested in parallel with SOFIA™-RSV and SOFIA™-Influenza A+B. Compared to real-time PCR, SOFIA™-RSV sensitivities/specificities were 78.6%/93.9%, respectively (SOFIA™-Influenza A: 80.6%/99.3%). Performance was greatest in patients below 2 years of age with a test sensitivity of 81.8%. RSV sensitivities were highest (85%) in the first 2 days of illness and with nasopharyngeal compared to nasal swabs (P=0.055, McNemar's test). Second-generation RSV and influenza rapid testing provides highly accurate results facilitating timely patient cohortation and management.
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Abstract
Rapid influenza diagnostic tests (RIDTs) may be useful during institutional respiratory disease outbreaks to identify influenza and enable antivirals to be rapidly administered to patients and for the prophylactic treatment of those exposed to the virus but not yet symptomatic. The performance of RIDTs at the outbreak level is not well documented in the literature. This study aimed to evaluate the performance of RIDTs in comparison with that of real-time reverse transcription (rRT)-PCR in the context of institutional respiratory disease outbreaks. This study included outbreak-related respiratory specimens tested for influenza virus at Public Health Ontario Laboratories by both RIDT and rRT-PCR, from 1 September 2010 to 30 April 2013. At the outbreak level, performance testing of RIDTs compared to rRT-PCR for the detection of any influenza virus type demonstrated an overall sensitivity of 76.5%, a specificity of 99.7%, a positive predictive value (PPV) of 99.5%, and a negative predictive value of 85.3%. Because of their high specificity and PPV, even outside of the influenza season, RIDTs can play a role in screening for influenza virus in outbreaks and instituting antiviral therapy in a timely manner when positive. RIDTs can also be useful in remote settings where molecular virology testing is not easily accessible. Suboptimal sensitivity of RIDTs can be addressed by the use of molecular testing.
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Bruning AHL, van Dijk K, van Eijk HWM, Koen G, van Woensel JBM, Kruisinga FH, Pajkrt D, Wolthers KC. Evaluation of a rapid antigen detection point-of-care test for respiratory syncytial virus and influenza in a pediatric hospitalized population in the Netherlands. Diagn Microbiol Infect Dis 2014; 80:292-3. [PMID: 25241640 DOI: 10.1016/j.diagmicrobio.2014.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/20/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
This pilot study evaluates the diagnostic performance of Sofia RSV Fluorescent Immunoassay Analyzer (FIA) and Sofia Influenza A + B FIA for rapid detection of respiratory syncytial virus and influenza A and B. Sofia had a lower-than-expected sensitivity for all viruses and a high rate of false-positive results for influenza B virus.
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Affiliation(s)
- Andrea H L Bruning
- Department of Pediatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Karin van Dijk
- Department of Medical Microbiology and Infection Control, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Hetty W M van Eijk
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Gerrit Koen
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Job B M van Woensel
- Department of Pediatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Frea H Kruisinga
- Department of Pediatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Pediatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Katja C Wolthers
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
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