title: Influenza outbreak during Sydney World Youth Day 2008: the utility of laboratory testing and case definitions on mass gathering outbreak containment.
abstract: BACKGROUND
  Influenza causes annual epidemics and often results in extensive outbreaks in closed communities. To minimize transmission, a range of interventions have been suggested. For these to be effective, an accurate and timely diagnosis of influenza is required. This is confirmed by a positive laboratory test result in an individual whose symptoms are consistent with a predefined clinical case definition. However, the utility of these clinical case definitions and laboratory testing in mass gathering outbreaks remains unknown.
  
  
  RESULTS
  An influenza outbreak was identified during World Youth Day 2008 in Sydney. From the data collected on pilgrims presenting to a single clinic, a Markov model was developed and validated against the actual epidemic curve. Simulations were performed to examine the utility of different clinical case definitions and laboratory testing strategies for containment of influenza outbreaks. Clinical case definitions were found to have the greatest impact on averting further cases with no added benefit when combined with any laboratory test. Although nucleic acid testing (NAT) demonstrated higher utility than indirect immunofluorescence antigen or on-site point-of-care testing, this effect was lost when laboratory NAT turnaround times was included. The main benefit of laboratory confirmation was limited to identification of true influenza cases amenable to interventions such as antiviral therapy.
  
  
  CONCLUSIONS
  Continuous re-evaluation of case definitions and laboratory testing strategies are essential for effective management of influenza outbreaks during mass gatherings.
authors.affiliation: Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, Sydney, New South Wales, Australia. vanhal@gotalk.net.au
authors.forename: Sebastiaan J
authors.initials: SJ
authors.lastname: van Hal
authors.forename: Hong
authors.initials: H
authors.lastname: Foo
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Blyth
authors.forename: Kenneth
authors.initials: K
authors.lastname: McPhie
authors.forename: Paul
authors.initials: P
authors.lastname: Armstrong
authors.forename: Vitali
authors.initials: V
authors.lastname: Sintchenko
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Dwyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D002624:Chemistry, Clinical / Q000379:methods; D002648:Child; D003198:Computer Simulation; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology* / Q000635:transmission*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011634:Public Health