Respiratory virus surveillance and outbreak investigation

Abstract

Sensitive, rapid detection of respiratory viruses is needed for surveillance and for investigation of epidemiologically linked cases. The utility of rapid antigen-based methods for detection of common respiratory viruses and to confirm the cause of outbreaks is well established. However, nucleic acid amplification tests (NATs) offer some benefits above antigen or culture-based procedures, with the main advantages being sensitivity and range of pathogens detectable. It is important to understand how changes in our testing methodology alter respiratory virus detection and information for epidemiological studies. For viruses such as influenza A, influenza B and respiratory syncytial virus, NATs offer enhanced sensitivity above antigen assays but still identify the seasonal peaks important for predicting disease and managing time-sensitive prophylaxis. For other viruses, such as rhinoviruses, coronaviruses, human bocavirus and parainfluenza virus type 4, culture and antigen-based procedures are not available and/or lack sensitivity. Thus such targets would be missed if NATs were not included in testing for surveillance and outbreak investigation. As more respiratory viruses are identified there is a need to expand surveillance and further evaluate new technologies and automation beyond currently-available diagnostics to address detection of a broad range of potential pathogens.

Human metapneumovirus small hydrophobic (SH) protein downregulates type I IFN pathway signaling by affecting STAT1 expression and phosphorylation

“…Clinical disease is similar between HMPV and other related viruses such as RSV and PIV (Fox, 2007; Freymuth et al, 1995; Freymuth et al, 2006; Garcia-Garcia et al, 2006), despite the absence of sequence homology in the HMPV genome for previously known innate immune antagonists (Piyaratna et al, 2011; van den Hoogen et al, 2002). Both type I and II IFN signaling rely on STAT1 phosphorylation as a crucial component in both pathways.…”

Clinical and economical impact of multiplex respiratory virus assays

“…The economic impact of respiratory virus outbreaks has been modeled, highlighting another role of respiratory virus surveillance (Achonu et al, 2005;Halasa et al, 2005). The extended use of multiplex respiratory assays in clinical laboratories will improve surveillance efficacy and will procure benefits to the general community (Fox, 2007;Wong et al, 2009).…”

Respiratory Viral Infections in Transplant and Oncology Patients

“…DFA is not as sensitive a test for AdV as NAT. 95 In situ hybridization, immunohistochemistry, or PCR of fixed tissue can also identify adenovirus. Monitoring for AdV, similar to cytomegalovirus, may permit early detection in certain high-risk settings.…”