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Influenza diagnostics

By Madhukar Pai Moderator | 17 Feb, 2017

With the virulent form of bird flu being reported in China now (see http://www.cfr.org/diseases-infectious/lethal-bird-flu-returns-china/p38832?c...), it may be good to have a discussion on diagnostics options for influenza.

Here are a couple of recent, free reviews on the topic:

Current Approaches for Diagnosis of Influenza Virus Infections in Humans
http://www.mdpi.com/1999-4915/8/4/96

Point-of-Care Testing for Influenza
https://www.ncbi.nlm.nih.gov/books/NBK401783/pdf/Bookshelf_NBK401783.pdf

I know we have virologists in our community and look forward to their insights, especially with diagnosis of the latest strain of bird flu in humans.

Replies

 

Ian Mackay Replied at 4:48 PM, 20 Feb 2017

I think it's important to remember the limitation of most POCT - until recent PCR-based POC developments at least - less than ideal sensitivity. PCR -based screening at professional diagnostic laboratories is essential to keep track of different flu cases.

Madhukar Pai Moderator Replied at 7:10 PM, 20 Feb 2017

I agree with Ian that influenza RIDTs (rapid tests) have less than ideal sensitivity. Please see our meta-analysis on this, and the attached commentary. However, although RIDTs are far from perfect, they could supplement the clinician judgment and help rule in influenza, in settings where RT-PCR is not easily accessible.

Attached resources:

Lee Schroeder Replied at 7:43 PM, 20 Feb 2017

That's a great review, and a positive likelihood ratio of 35 is impressive.

By the way, I've been evaluating the waived nucleic acid tests for influenza at my institution. While the liat and xpert express have fantastic sensitivity, the alere i as it currently stands seems to have a sensitivity in the 0.7 to 0.8 range. Part of that could be the use of nasal vs nasopharyngeal samples, however. They are currently only waived for nasal, but I understand that may change.

-Lee

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