title: Performance of rapid influenza diagnostic testing in outbreak settings.
abstract: Rapid influenza diagnostic tests (RIDTs) may be useful during institutional respiratory disease outbreaks to identify influenza and enable antivirals to be rapidly administered to patients and for the prophylactic treatment of those exposed to the virus but not yet symptomatic. The performance of RIDTs at the outbreak level is not well documented in the literature. This study aimed to evaluate the performance of RIDTs in comparison with that of real-time reverse transcription (rRT)-PCR in the context of institutional respiratory disease outbreaks. This study included outbreak-related respiratory specimens tested for influenza virus at Public Health Ontario Laboratories by both RIDT and rRT-PCR, from 1 September 2010 to 30 April 2013. At the outbreak level, performance testing of RIDTs compared to rRT-PCR for the detection of any influenza virus type demonstrated an overall sensitivity of 76.5%, a specificity of 99.7%, a positive predictive value (PPV) of 99.5%, and a negative predictive value of 85.3%. Because of their high specificity and PPV, even outside of the influenza season, RIDTs can play a role in screening for influenza virus in outbreaks and instituting antiviral therapy in a timely manner when positive. RIDTs can also be useful in remote settings where molecular virology testing is not easily accessible. Suboptimal sensitivity of RIDTs can be addressed by the use of molecular testing.
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada adriana.peci@oahpp.ca.
authors.forename: Adriana
authors.initials: A
authors.lastname: Peci
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: Anne-Luise
authors.initials: AL
authors.lastname: Winter
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: Eddie-Chong
authors.initials: EC
authors.lastname: King
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Blair
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Gubbay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004196:Disease Outbreaks; D005260:Female; D006268:Health Facilities; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D009975:Orthomyxoviridae / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult