title: Laboratory test performance in young adults during influenza outbreaks at World Youth Day 2008.
abstract: BACKGROUND
  The performance of influenza laboratory diagnostics in young adults and in the setting of outbreaks during mass gatherings has not been well studied.
  
  
  OBJECTIVE
  We compare the performance of point-of-care tests (POCTs) and immunofluorescence assays (IFAs) with nucleic acid tests (NATs) and viral culture in pilgrims attending influenza clinics established during a large influenza outbreak (World Youth Day, Sydney, Australia, 2008) to assess their performance under the real-life pressures of a mass influenza outbreak.
  
  
  METHODS
  Patients with an influenza-like illness (ILI) underwent respiratory specimen sampling. Combined deep nares and throat swabs were collected for POCT by trained or untrained clinic staff; type-specific IFA; NAT and viral culture. Laboratory-confirmed influenza occurred if viral culture and/or NAT were positive; the performance of laboratory tests was calculated against this 'gold standard'.
  
  
  RESULTS
  A total of 230 samples were collected from 227 patients (median age, 20 years; interquartile range, 18-28 years), with 95 samples (41.3%) having laboratory-confirmed influenza infection (influenza A, 57; influenza B, 38). IFA and POCT sensitivities were 74.5% and 55%, respectively. Four of 51 (8%) culture-positive specimens were negative by NAT, and several errors in influenza virus typing occurred with IFA, POCT and NAT. A non-significant trend towards better POCT performance with increased operator training was demonstrated.
  
  
  CONCLUSIONS
  Different environments, patient populations, operator experience, laboratory access and practicalities associated with performing tests during mass influenza outbreaks may affect performance of influenza-specific laboratory tests.
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Microbiology Research, Westmead Hospital, Sydney, Australia. hongfoo@ymail.com
authors.forename: H
authors.initials: H
authors.lastname: Foo
authors.forename: C C
authors.initials: CC
authors.lastname: Blyth
authors.forename: S
authors.initials: S
authors.lastname: van Hal
authors.forename: K
authors.initials: K
authors.lastname: McPhie
authors.forename: M
authors.initials: M
authors.lastname: Ratnamohan
authors.forename: M
authors.initials: M
authors.lastname: Fennell
authors.forename: F
authors.initials: F
authors.lastname: Ba Alawi
authors.forename: W
authors.initials: W
authors.lastname: Rawlinson
authors.forename: S
authors.initials: S
authors.lastname: Adamson
authors.forename: P
authors.initials: P
authors.lastname: Armstrong
authors.forename: D E
authors.initials: DE
authors.lastname: Dwyer
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D019411:Clinical Laboratory Techniques; D004196:Disease Outbreaks; D005455:Fluorescent Antibody Technique; D006801:Humans; D009980:Influenza A virus / Q000302:isolation & purification*; D009981:Influenza B virus / Q000302:isolation & purification*; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D055815:Young Adult