Use of rapid influenza diagnostic tests under field conditions as a screening tool during an outbreak of the 2009 novel influenza virus

Practical considerations

Anthony R. Sambol, Baha Abdalhamid, Elizabeth R. Lyden, Tricia A. Aden, Rhonda K. Noel, Steven Heye Hinrichs

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Rapid influenza diagnostic tests (RIDTs) are used in various settings as a first-line screen of patient specimens. During the initial outbreak of the 2009 novel influenza A/H1N1 virus, the Nebraska Public Health Laboratory (NPHL) adopted a testing algorithm, attempting to maximize the usefulness of RIDTs. However, it became apparent that a high percentage of the positive specimens received from off-site facilities were negative for influenza viruses by the confirmatory test, the Luminex xTAG Respiratory Viral Panel (RVP) molecular assay. Objectives: To explore the cause of discrepancies between RIDTs results obtained from on-site facility testing versus confirmatory testing performed at NPHL. Study design: Specimens (n = 336) tested with RIDTs at off-site facilities and screened for high-probability of containing H1N1 were sent to the NPHL for confirmatory testing by RVP. Results: Of 336 specimens analyzed, 104 were negative for influenza A or B by both RIDT and RVP; 127 were positive by both tests; 102 were positive by RIDT only; and 3 were positive by RVP only. Using the RVP assay as the gold standard, overall RIDT characteristics in this screened population were: sensitivity = 97.7% (95%CI: 92.5, 99.3); specificity = 48.1% (95%CI: 40.4, 55.8); positive predictive value = 54.3% (95%CI: 47.0, 61.4); and negative predicative value = 97.1% (95%CI: 90.6, 99.1). Conclusions: The results show that the confirmation of RIDT-positive results varied widely by testing site. Possible explanations for the discrepancies in performance characteristics include testing a narrowly defined sample population, test facility characteristics, facility work load, and seasonal timing.

Original languageEnglish (US)
Pages (from-to)229-233
Number of pages5
JournalJournal of Clinical Virology
Volume47
Issue number3
DOIs
StatePublished - Mar 1 2010

Fingerprint

Orthomyxoviridae
Routine Diagnostic Tests
Human Influenza
Disease Outbreaks
Public Health
H1N1 Subtype Influenza A Virus
Influenza A virus
Workload
Population

Keywords

  • BinaxNOW
  • Luminex RVP
  • QuickVue
  • RIDT
  • Sensitivity
  • Specificity
  • TruFlu
  • Xpect

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

Cite this

Use of rapid influenza diagnostic tests under field conditions as a screening tool during an outbreak of the 2009 novel influenza virus : Practical considerations. / Sambol, Anthony R.; Abdalhamid, Baha; Lyden, Elizabeth R.; Aden, Tricia A.; Noel, Rhonda K.; Hinrichs, Steven Heye.

In: Journal of Clinical Virology, Vol. 47, No. 3, 01.03.2010, p. 229-233.

Research output: Contribution to journalArticle

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abstract = "Background: Rapid influenza diagnostic tests (RIDTs) are used in various settings as a first-line screen of patient specimens. During the initial outbreak of the 2009 novel influenza A/H1N1 virus, the Nebraska Public Health Laboratory (NPHL) adopted a testing algorithm, attempting to maximize the usefulness of RIDTs. However, it became apparent that a high percentage of the positive specimens received from off-site facilities were negative for influenza viruses by the confirmatory test, the Luminex xTAG Respiratory Viral Panel (RVP) molecular assay. Objectives: To explore the cause of discrepancies between RIDTs results obtained from on-site facility testing versus confirmatory testing performed at NPHL. Study design: Specimens (n = 336) tested with RIDTs at off-site facilities and screened for high-probability of containing H1N1 were sent to the NPHL for confirmatory testing by RVP. Results: Of 336 specimens analyzed, 104 were negative for influenza A or B by both RIDT and RVP; 127 were positive by both tests; 102 were positive by RIDT only; and 3 were positive by RVP only. Using the RVP assay as the gold standard, overall RIDT characteristics in this screened population were: sensitivity = 97.7{\%} (95{\%}CI: 92.5, 99.3); specificity = 48.1{\%} (95{\%}CI: 40.4, 55.8); positive predictive value = 54.3{\%} (95{\%}CI: 47.0, 61.4); and negative predicative value = 97.1{\%} (95{\%}CI: 90.6, 99.1). Conclusions: The results show that the confirmation of RIDT-positive results varied widely by testing site. Possible explanations for the discrepancies in performance characteristics include testing a narrowly defined sample population, test facility characteristics, facility work load, and seasonal timing.",
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