title: During the summer 2009 outbreak of "swine flu" in Scotland what respiratory pathogens were diagnosed as H1N1/2009?
abstract: BACKGROUND
  During the April-July 2009 outbreak of H1N1/2009 in scotland the West of Scotland Specialist Virology Centre (WoSSVC) in Glasgow tested > 16,000 clinical samples for H1N1/2009. Most were from patients clinically diagnosed with H1N1/2009. Out of these, 9% were positive. This study sought to determine what respiratory pathogens were misdiagnosed as cases of H1N1/2009 during this time.
  
  
  METHODS
  We examined the results from 3247 samples which were sent to the laboratory during April-July 2009. All were from patients clinically diagnosed as having H1N1/2009 (based on accepted criteria) and all were given a full respiratory screen using real time reverse transcriptase polymerase chain reaction (rtRT-PCR) assays.
  
  
  RESULTS
  In total, respiratory pathogens were detected in 27.9% (95% confidence interval, 26.3-29.5%) of the samples submitted. Numerous pathogens were detected, the most common of which were rhinovirus (8.9% (95% confidence interval, 7.9-9.9%)), parainfluenza 1 (1.9% (95% confidence interval, 1.4-2.4%)) and 3 (4.1% (95% confidence interval, 3.3-4.9%)), and adenovirus ((3.5% (95% confidence interval, 2.9-4.2%)).
  
  
  CONCLUSIONS
  This study highlights the problems of using a clinical algorithm to detect H1N1/2009. Clinicians frequently misdiagnosed common respiratory pathogens as H1N1/2009 during the spring/summer outbreak in Scotland. Many undesirable consequences would have resulted, relating to treatment, infection control, and public health surveillance.
authors.affiliation: West Of Scotland Specialist Virology Centre, A Member of the UK Clinical Virology Network, Gartnavel General Hospital, Glasgow, UK. rory.gunson@ggc.scot.nhs.uk
authors.forename: Rory N
authors.initials: RN
authors.lastname: Gunson
authors.forename: William F
authors.initials: WF
authors.lastname: Carman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004196:Disease Outbreaks; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012606:Scotland / Q000453:epidemiology