Influenza virological surveillance in children: The use of the Quickvue rapid diagnostic test

Abstract

New rapid diagnostic methods are needed to identify influenza infections to improve virological surveillance usually undertaken with conventional time-consuming, complex, and even expensive laboratory methods. Another reason for using a rapid test is to avoid inappropriate therapy, particularly in children, where use of antibiotics inappropriately and high influenza-related rates of hospitalisation are described. During two winter seasons, the performance of the QuickVue Influenza test (QV) was evaluated in children under 14 presenting with influenza like illness, and compared the results with those obtained from sentinel network surveillance using standard protocols for the sample collection and the laboratory analysis by virus culture and reverse transcription-polymerase chain reaction (RT-PCR). During the first influenza season (2000/2001), 22 paediatricians collected one nose- and one throat-swab from each of the 586 children 0-6 years old recruited in the study. The QV test was carried out in the physician's office by primary care staff on the nose swab material. When compared with virus culture of the throat swab, the QV test had a sensitivity of 36.5%. In the following 2001/2002-influenza season, the performance of the QV test as a rapid laboratory screening assay was assessed. 342 children aged 0-14 years were enrolled with only one throat swab collected from each patient and sent to the laboratory where the QV, virus culture, and RT-PCR tests were performed. The results showed a better sensitivity (54.5%) of the test in comparison with virus culture and RT-PCR assays. The data indicate that rapid QV testing in the physician office setting, using these easily obtained samples, may be too insensitive to be useful for surveillance and for immediate clinical management of children presenting with influenza-like illness. Nevertheless, the QV test may be a valuable diagnostic tool if used in laboratory, as a rapid screening test.

Influenza-associated mortality among children - United States: 2007-2008

“…Testing for influenza is at the discretion of the physician, and some children were likely never tested for influenza. Additionally, the influenza rapid antigen test, a common diagnostic method for influenza has a relatively low sensitivity 20 , 21 , 22 , 23 , 24 that could lead to undiagnosed cases. Second, the children were not systematically tested for bacterial, viral, or fungal pathogens, or radiologically confirmed pneumonia, and thus our results are limited by the testing that was performed as part of routine clinical care and postmortem analysis.…”

Comparison of Polyurethane Foam to Nylon Flocked Swabs for Collection of Secretions from the Anterior Nares in Performance of a Rapid Influenza Virus Antigen Test in a Pediatric Emergency Department

“…Because of previously reported data indicating that such rapid tests are significantly less sensitive than viral culture and other methods for laboratory diagnosis, such rapid tests are best used as stand-alone tests when applied to the diagnosis of influenza in mildly ill outpatients without underlying disease (23)(24)(25)(26). Posterior nasopharyngeal (NP) swab collections have been shown to be superior to swabs of the anterior nares (AN) for sample collection in such antigen tests (3); however, NP swab samples are uncomfortable and more difficult to collect.…”

Clinical Evaluation of the SD Bioline Influenza Virus Antigen Test for Rapid Detection of Influenza Viruses A and B in Children and Adults during the Influenza Season

“…Furthermore, they have increasingly become a useful tool for the surveillance of influenza activity (7,13,16).…”