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Abstract
Purpose
Rapid antigen test (RAT) is used to screen influenza rapidly. The clinical sensitivity of RAT was poor for 2009 H1N1 influenza. The aim of this study was to identify the correlation of time gap (TG) between fever onset and the sensitivity of RAT for 2009 H1N1 influenza.
Methods
Data were collected retrospectively during the pandemic H1N1 2009 influenza season between October 2009 and February 2010. The RAT was done by using SD Bioline influenza antigen (Standard Diagnostics Inc.) in nasopharyngeal swab. The 2009 H1N1 influenza was confirmed by real- time reverse transcriptase polymerase chain reaction (rRT-PCR). Specimens were categorized according to the TG between fever onset and performance of RAT. They were classified into <24 hours (TG1), 24 to 48 hours (TG2), 48 to 72 hours (TG3), 72 to 96 hours (TG4), 96 to 120 hours (TG5), ˃120 hours (TG6).
Results
The overall sensitivity of RAT was 69.9%. The TG dependent sensitivity of RAT at TG1, TG2, TG3, TG4, TG5, and TG6 was 64.3%, 73.3%, 61.1%, 88.9%, 83.3%, and 61.1% respectively. The sensitivity of RAT was the highest when the TG was 72 to 96 hours. But this result was not statistically significant.
Conclusion
Correlation of TG between fever onset and the sensitivity of RAT for 2009 H1N1 influenza was not statistically significant. But our study suggested that 72 to 96 hours after fever onset is the most sensitive time of RAT. Timely optimal performance of the RAT could have a significant impact on improving results. Further evaluation for better sensitivity would be needed.
References
1. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009; 360:2605–15.
2. World Health Organization [Internet]. Geneva: World Health Organization;c2012. [cited 2010 May 18]. First confirmed case of influenza A (H1N1) in Republic of Korea. Available from:. http://www.wpro.who.int/internet/templates/M. ED_News_or_Press_Release.aspx?NRMODE=P ublished&NRNODEGUID=%7B25EF48D3-DD8 F-4AE4-B247–11D7EFA2EB0E%7D&NRORIG INALURL=%2Fmedia_centre%2Fnews%2Fne ws_20090503.htm&NRCACHEHINT=Guest.
3. World Health Organization [Internet]. Geneva: World Health Organization;c2012. [cited 2010 May 18]. Republic of Korea raises alert level as Pandemic (H1N1) 2009 spreads. Available from:. http://www.wpro.who.int/media_centre/news/news_20090723.htm.
4. World Health Organization [Internet]. Geneva: World Health Organization;c2012. [cited 2010 May 18]. World now at the start of 2009 influenza pandemic. Available from:. http://www.who.int/mediacentre/news/statements/2009/h1. n1_pandemic_phase6_20090611/en/.
5. Korean Centers for Disease Control and Prevention [Internet]. Cheongwon: Korean Centers for Disease Control and Prevention;c2012. [cited 2010 Apr 7]. Influenza weekly report. Available from:. http://www.cdc.go.kr/kcdchome/jsp/observation/influenza/out/INFLOUT1200. Detail.jsp?menuid=110253&contentid=6286& boardid=null&appid=kcdcinfl&pageNum=1&su b=4&tabinx=1&q_had01=A&q_had02=2009& q_gunCode_tmp=null&q_disCode_tmp=null&q_popupOn=null&q_disguntexts_tmp=&q_discod etexts_tmp=&q_discodetexts_tmp=','HTML','r esizable=no scrollbars=yes.
6. World Health Organization [Internet]. Geneva: World Health Organization;c2012. [cited 2010 Apr 7]. WHO information for laboratory diagnosis of pandemic (H1N1) 2009 virus in humans-revised. Available from:. http://www.who.int/csr/resources/publications/swineflu/WHO_Diagnostic_RecommendationsH1N1_20090521.pdf.
7. Pabbaraju K, Wong S, Wong AA, Appleyard GD, Chui L, Pang XL, et al. Design and validation of real-time reverse transcription-PCR assays for detection of pandemic (H1N1) 2009 virus. J Clin Microbiol. 2009; 47:3454–60.
8. Mai LQ, Hien PT, Hang NL, Oh JS, Ha GW, Kwon JA, et al. Evaluation of two lateral-flow chromatographic membrane immunoassays for rapid detection of influenza virus in limited respiratory specimens. J Lab Med Qual Assur. 2005; 27:243–9.
9. Bang HI, Shin JW, Choi TY, Park R, Shin YJ. Comparison of SD BIOLINE rapid influenza antigen test using two different specimens, Nasopharyngeal swabs and nasopharyngeal aspirates. Korean J Clin Microbiol. 2010; 13:147–50.
10. Hurt AC, Alexander R, Hibbert J, Deed N, Barr IG. Performance of six influenza rapid tests in detecting human influenza in clinical specimens. J Clin Virol. 2007; 39:132–5.
11. van Elden LJ, van Essen GA, Boucher CA, van Loon AM, Nijhuis M, Schipper P, et al. Clinical diagnosis of influenza virus infection: evaluation of diagnostic tools in general practice. Br J Gen Pract. 2001; 51:630–4.
12. Kok J, Blyth CC, Foo H, Patterson J, Taylor J, McPhie K, et al. Comparison of a rapid antigen test with nucleic acid testing during cocirculation of pandemic influenza A/H1N1 2009 and seasonal influenza A/H3N2. J Clin Microbiol. 2010; 48:290–1.
13. Druce J, Tran T, Kelly H, Kaye M, Chibo D, Kostecki R, et al. Laboratory diagnosis and surveillance of human respiratory viruses by PCR in Victoria, Australia, 2002–2003. J Med Virol. 2005; 75:122–9.
14. Blyth CC, Iredell JR, Dwyer DE. Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009; 361:2493.
15. Cheng CK, Cowling BJ, Chan KH, Fang VJ, Seto WH, Yung R, et al. Factors affecting QuickVue Influenza A+B rapid test performance in the community setting. Diagn Microbiol Infect Dis. 2009; 65:35–41.
16. Drexler JF, Helmer A, Kirberg H, Reber U, Panning M, Müller M, et al. Poor clinical sensitivity of rapid antigen test for influenza A pandemic (H1N1) 2009 virus. Emerg Infect Dis. 2009; 15:1662–4.
17. Louie JK, Guevara H, Boston E, Dahlke M, Nevarez M, Kong T, et al. Rapid influenza antigen test for diagnosis of pandemic (H1N1) 2009. Emerg Infect Dis. 2010; 16:824–6.
18. Sambol AR, Abdalhamid B, Lyden ER, Aden TA, Noel RK, Hinrichs SH. Use of rapid influenza diagnostic tests under field conditions as a screening tool during an outbreak of the 2009 novel influenza virus: practical considerations. J Clin Virol. 2010; 47:229–33.
19. Vasoo S, Stevens J, Singh K. Rapid antigen tests for diagnosis of pandemic (Swine) influenza A/H1N1. Clin Infect Dis. 2009; 49:1090–3.
20. Velasco JM, Montesa-Develos ML, Jarman RG, Lopez MN, Gibbons RV, Valderama MT, et al. Evaluation of QuickVue influenza A+B rapid test for detection of pandemic influenza A/H1N1 2009. J Clin Virol. 2010; 48:120–2.
21. Watcharananan S, Kiertiburanakul S, Chantra-tita W. Rapid influenza diagnostic test during the outbreak of the novel influenza A/H1N1 2009 in Thailand: an experience with better test performance in resource limited setting. J Infect. 2010; 60:86–7.
22. Centers for Disease Control and Prevention (CDC). Evaluation of rapid influenza diagnostic tests for detection of novel influenza A (H1N1) virus-United States, 2009. MMWR Morb Mortal Wkly Rep. 2009; 58:826–9.
23. Ginocchio CC, Zhang F, Manji R, Arora S, Born-freund M, Falk L, et al. Evaluation of multiple test methods for the detection of the novel 2009 influenza A (H1N1) during the New York City outbreak. J Clin Virol. 2009; 45:191–5.
24. Rodriguez WJ, Schwartz RH, Thorne MM. Evaluation of diagnostic tests for influenza in a pediatric practice. Pediatr Infect Dis J. 2002; 21:193–6.
25. Agoritsas K, Mack K, Bonsu BK, Goodman D, Salamon D, Marcon MJ. Evaluation of the Quidel QuickVue test for detection of influenza A and B viruses in the pediatric emergency medicine setting by use of three specimen collection methods. J Clin Microbiol. 2006; 44:2638–41.
26. Biggs C, Walsh P, Overmyer CL, Gonzalez D, Feola M, Mordechai E, et al. Performance of influenza rapid antigen testing in influenza in emergency department patients. Emerg Med J. 2010; 27:5–7.
27. Chan KH, Peiris JS, Lim W, Nicholls JM, Chiu SS. Comparison of nasopharyngeal flocked swabs and aspirates for rapid diagnosis of respiratory viruses in children. J Clin Virol. 2008; 42:65–9.
28. Stevenson HL, Loeffelholz MJ. Poor positive accuracy of QuickVue rapid antigen tests during the influenza A (H1N1) 2009 pandemic. J Clin Microbiol. 2010; 48:3729–31.
29. Choi YJ, Kim HJ, Park JS, Oh MH, Nam HS, Kim YB, et al. Evaluation of new rapid antigen test for detection of pandemic influenza A/H1N1 2009 virus. J Clin Microbiol. 2010; 48:2260–2.
30. Cheng PK, Wong KK, Mak GC, Wong AH, Ng AY, Chow SY, et al. Performance of laboratory diagnostics for the detection of influenza A (H1N1) virus as correlated with the time after symptom onset and viral load. J Clin Virol. 2010; 47:182–5.
31. Lee CS, Lee JH, Kim CH. Time-dependent sensitivity of a rapid antigen test in patients with 2009 H1N1 influenza. J Clin Microbiol. 2011; 49:1702.
Fig. 1.
The time dependent sensitivity of rapid antigen test (RAT). Our result showed that 72 to 96 hours after fever onset was the most sensitive time for RAT, but there was no statistical significance.
Table 1.
The Age Dependent Sensitivity of Rapid Antigen Test (RAT)
| Age (yr) | RAT | Total, n (%) | Sensitivity (%) | |
|---|---|---|---|---|
| Negative | Positive | |||
| ≤1 | 3 | 21 | 24 (11.2) | 87.5 |
| 2–5 | 28 | 66 | 94 (45.6) | 70.2 |
| 6–10 | 25 | 44 | 69 (33.5) | 63.8 |
| ≥11 | 6 | 13 | 19 (9.2) | 68.4 |
| Total | 62 | 144 | 206 (100) | 69.9 |
Table 2.
The Sex Dependent Sensitivity of Rapid Antigen Test (RAT)
| Sex | RAT | Total S | Sensitivity (%) | |
|---|---|---|---|---|
| Negative | Positive | |||
| Male | 43 | 90 | 133 | 67.7 |
| Female | 19 | 54 | 73 | 74.0 |
| Total | 62 | 144 | 206 | 69.9 |
Table 3.
Characteristics according to the Time Gap Between Fever Onset and Performance of Rapid Antigen Test (RAT)
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