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Rapid Testing For InfluenzaInfluenza kills approximately 36,000 people in the United States each year. In addition to the annual toll of seasonal influenza, human fatalities caused by Influenza A virus
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Good Laboratory Practices for Waived TestingCategory: Peer-reviewed Study Posted by ShevrinI on 11/28/2007 Surveys conducted during 1999--2004 by the Centers for Medicare & Medicaid Services and studies funded by CDC during 1999--2003 evaluated testing practices in sites holding a CLIA Certificate of Waiver (CW). Although study findings indicate CW sites generally take measures to perform testing correctly, they raise quality concerns about practices that could lead to errors in testing and poor patient outcomes.
Impact of the Rapid Diagnosis of Influenza on Physician Decision-Making and Patient Management in the Pediatric Emergency Department: Results of a Randomized, Prospective, Controlled TrialCategory: Peer-reviewed Study Posted by ShevrinI on 11/28/2007 Physician awareness of a rapid diagnosis of influenza in the pediatric emergency department significantly reduced the number of laboratory tests and radiographs ordered and their associated charges, decreased antibiotic use, increased antiviral use, and decreased length of time to discharge.
Enhancing public health surveillance for influenza virus by incorporating newly available rapid diagnostic testsCategory: Peer-reviewed Study Posted by EricaGalvez on 12/20/2007 This is the first evaluation of integrating influenza rapid testing into public health surveillance (Hawaii). Coupling rapid tests with cultures appears to be an effective means of improving influenza surveillance.
Impact of rapid diagnosis on management of adults hospitalized with influenzaCategory: Original Research Posted by EricaGalvez on 12/20/2007 Study concludes that rapid influenza testing leads to reductions in antibiotic use in hospitalized adults. Better tools
to rule out concomitant bacterial infection are needed to optimize the impact of viral testing.
A cost-benefit analysis of testing for influenza A in high-risk adultsCategory: Peer-reviewed Study Posted by EricaGalvez on 12/20/2007 When clinicians are planning to use the nonneuraminidase inhibitors
to treat influenza, rapid testing is not the most cost-beneficial approach. Even
when the more expensive neuraminidase inhibitors will be used, testing has a
limited role in managing influenza in high-risk patients.
Management of influenza symptoms in healthy adults: Cost-effectiveness of rapid testing and antiviral therapyCategory: Peer-reviewed Study Posted by EricaGalvez on 12/20/2007 Examination of cost-effectiveness of rapid testing and antiviral therapy.
Rapid antigen testing for the surveillance of influenza epidemicsCategory: Peer-reviewed Study Posted by EricaGalvez on 12/20/2007 Rapid influenza testing is a reliable tool for influenza surveillance and, compared with traditional methods, provides faster results.
Influenza-Testing and Antiviral-Agent Prescribing Practices --- Connecticut, Minnesota, New Mexico, and New York, 2006--07 Influenza SeasonCategory: Resource Material Posted by EricaGalvez on 01/25/2008 Survey conducted with Primary Care Physicians (PCPs) identified that 69% of participating PCPs administered influenza tests to patients who had influenza-like illnesses during the influenza season and 53.8% prescribed antiviral agents, including two no longer recommended by CDC (i.e., amantadine & rimantadine).
Rapid Diagnostic Testing for Influenza:When does it make sense?Category: Resource Material Posted by NattawanL on 12/19/2008 Because the clinical diagnosis of influenza can be difficult, pediatricians often turn to rapid antigen tests to confirm a clinical suspicion of influenza. However, keep in mind that the predictive values of such tests vary with disease prevalence; despite the favorable sensitivity and specificity of most such tests, their positive predictive value is relatively low early and late in the influenza season. In addition, to gauge the predictive accuracy of a test in a particular setting, consider the degree of clinical suspicion as well as the frequency of influenza in the community at that time. Rapid influenza tests are most often helpful when the likelihood of influenza is intermediate (ie, in the early phase of influenza season when there is very strong clinical suspicion or during the peak of the season when there is moderate clinical suspicion).
 NattawanL said (on 19 Dec 08): Useful information to help with the use of rapid flu testing in your practice.... See all comments on this report...Accuracy and Interpretation of Rapid Influenza Tests in ChildrenCategory: Resource Material Posted by NattawanL on 12/19/2008 BACKGROUND. Influenza rapid antigen detection (rapid tests) can provide timely identification of infection and aid in clinical decision-making. Although the interpretation of test results depends on test characteristics and influenza prevalence, this information is limited in routine clinical practice.
OBJECTIVE. We sought to assess the times at which rapid tests are most predictive of influenza infection.
METHODS. The New Vaccine Surveillance Network enrolled children aged < 5 years who were hospitalized with respiratory symptoms or fever from October 2000 through September 2004. Nasal and throat swabs were obtained, and influenza virus was detected by culture and reverse-transcription polymerase chain reaction. Provider-ordered rapid influenza tests were compared with the criterion standard (culture and reverse-transcription polymerase chain reaction) to determine their sensitivity and specificity. The New Vaccine Surveillance Network also enrolled children in outpatient settings during the 2002–2003 and 2003–2004 influenza seasons and determined the weekly influenza prevalence among symptomatic children. Trends in weekly predictive values of the rapid tests were estimated over the influenza seasons.
RESULTS. Rapid influenza tests had an overall sensitivity of 63% and specificity of 97%. In 2002–2003, the prevalence of influenza in symptomatic outpatient children peaked at 21% and stayed above 10% for 4 weeks. In contrast, in 2003–2004, influenza prevalence peaked at 60% and remained above 20% for 6 weeks. The positive predictive value of the rapid tests approached 80% when influenza prevalence was 15% but decreased to < 70% when influenza prevalence was < 10%.
CONCLUSIONS. Influenza prevalence varies between and within seasons. On the basis of our estimates, rapid tests are of limited use when prevalence is < 10%. The appropriate interpretation of rapid influenza tests requires local influenza surveillance and timely communication of this information to the practitioners.
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LinksLink to CDC Clinical Description and Lab Diagnosis of Influenza
http://www.cdc.gov/flu/professionals/diagnosis/
Link to WHO Recommendations on the Use of Rapid Influenza Testing
http://www.who.int/csr/disease/avian_influenza/guidelines/RapidTestInfluenza_web.pdf
Link to U.S.Government avian and pandemic flu information
http://www.pandemicflu.gov/index.html
Link to FDA Flu information
http://www.fda.gov/oc/opacom/hottopics/flu.html
Link to FDA site "Cautions in Using Rapid Test for Detecting Influenzae A Viruses"
http://www.fda.gov/cdrh/oivd/tips/rapidflu.html
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