Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Westmead Hospital, Westmead, NSW, Australia, .
New England Journal of Medicine (Impact Factor: 55.87). 11/2009; 361(25):2493. DOI: 10.1056/NEJMc0909049
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Available from: Dominic E Dwyer, May 08, 2014
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    • "In spite of the poor sensitivity of these tests for detection of influenza virus, positive results in the emergency setting or from hospitalized patients can significantly impact patient management [27, 28]. Recent evaluations of rapid immunoassays for detection of the novel 2009 influenza A (H1N1) virus have demonstrated variable and generally poor sensitivity, in some cases 25% or lower compared to reverse transcriptase (RT)-PCR [29–31]. These data highlight the limitations of diagnostic tests that target infectious agents such as influenza A virus, that have the capability to evolve significantly and rapidly. "
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    ABSTRACT: The diagnosis of respiratory virus infections has evolved substantially in recent years, with the emergence of new pathogens and the development of novel detection methods. While recent advances have improved the sensitivity and turn-around time of diagnostic tests for respiratory viruses, they have also raised important issues such as cost, and the clinical significance of detecting multiple viruses in a single specimen by molecular methods. This article reviews recent advances in specimen collection and detection methods for diagnosis of respiratory virus infections, and discusses the performance characteristics and limitations of these methods.
    International Journal of Microbiology 10/2010; 2010(1687-918X):126049. DOI:10.1155/2010/126049
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    • "Rapid detection of pandemic (H1N1) 2009 infection is performed using rRT-PCR testing due to the unreliability of rapid antigen tests [14], [15] and our laboratory used the technique extensively throughout the pandemic [10]. We have demonstrated suboptimal sensitivity (62.9%) of nasopharyngeal sampling in establishing the diagnosis of pandemic influenza (H1N1) 2009 pneumonia (fig. "
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    ABSTRACT: Background From the first case reports of pandemic influenza (H1N1) 2009 it was clear that a significant proportion of infected individuals suffered a primary viral pneumonia. The objective of this study was twofold; to assess the utility of the CURB-65 community acquired pneumonia (CAP) severity index in predicting pneumonia severity and ICU admission, and to assess the relative sensitivity of nasopharyngeal versus lower respiratory tract sampling for the detection of pandemic influenza (H1N1) CAP.MethodsA retrospective cohort study of 70 patients hospitalised for pandemic influenza (H1N1) 2009 in an adult tertiary referral hospital. Characteristics evaluated included age, pregnancy status, sex, respiratory signs and symptoms, smoking and alcohol history, CURB-65 score, co-morbidities, disabling sequelae, length of stay and in-hospital mortality outcomes. Laboratory features evaluated included lymphocyte count, C-reactive protein (CRP), nasopharyngeal and lower respiratory tract pandemic influenza (H1N1) 2009 PCR results.ResultsPatients with pandemic (H1N1) 2009 influenza CAP differed significantly from those without pneumonia regarding length of stay, need for ICU admission, CRP and the likelihood of disabling sequelae. The CURB-65 score did not predict CAP severity or the need for ICU admission (only 2/11 patients admitted to ICU had CURB-65 scores of 2 or 3). Nasopharyngeal specimens for PCR were only 62.9% sensitive in CAP patients compared to 97.8% sensitivity for lower respiratory tract specimens.Conclusions The CURB-65 score does not predict severe pandemic influenza (H1N1) 2009 CAP or need for ICU admission. Lower respiratory tract specimens should be collected when pandemic (H1N1) 2009 influenza CAP is suspected.
    PLoS ONE 09/2010; 5(9). DOI:10.1371/journal.pone.0012849 · 3.23 Impact Factor
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    • "Commonly used conventional methods of virus culture, serological testing or antigen detection by direct immunofluorescence are reasonably sensitive, but relatively complex and labour-intensive, and are generally too slow to be clinically relevant [5]. Rapid antigen or "point-of-care" tests are widely available for influenza and RSV [6-8] and take only about 15-30 minutes to perform, but their sensitivity is lower than nucleic acid testing (NAT)[9,10]. "
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    ABSTRACT: Influenza A, including avian influenza, is a major public health threat in developed and developing countries. Rapid and accurate detection is a key component of strategies to contain spread of infection, and the efficient diagnosis of influenza-like-illness is essential to protect health infrastructure in the event of a major influenza outbreak. We developed a multiplexed PCR (MT-PCR) assay for the simultaneous diagnosis of respiratory viruses causing influenza-like illness, including the specific recognition of influenza A haemagglutinin subtypes H1, H3, and H5. We tested several hundred clinical specimens in two diagnostic reference laboratories and compared the results with standard techniques. The sensitivity and specificity of these assays was higher than individual assays based on direct antigen detection and standard PCR against a range of control templates and in several hundred clinical specimens. The MT-PCR assays provided differential diagnoses as well as potentially useful quantitation of virus in clinical samples. MT-PCR is a potentially powerful tool for the differential diagnosis of influenza-like illness in the clinical diagnostic laboratory.
    BMC Infectious Diseases 05/2010; 10(1):113. DOI:10.1186/1471-2334-10-113 · 2.61 Impact Factor
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