title: Comparison of diagnostic test performance in a population of high risk young adults versus a general population presenting with influenza.
abstract: BACKGROUND
  Upper respiratory tract infection (URI) is a well-documented cause of morbidity, extra expense and lost training time among basic military trainees (BMTs).
  
  
  OBJECTIVE
  The goal of this study is to better understand how influenza diagnostic tests perform in the BMT population, and how this performance differs from the general population.
  
  
  METHODS
  Laboratory test data was collected in a prospective study that enrolled Department of Defense beneficiaries presenting to medical facilities in San Antonio, TX with URI symptoms between January 2005 and March 2011. Three laboratory tests for influenza were performed during the study period: polymerase chain reaction (PCR), enzyme immunoassay (EIA), and viral culture. Patients were grouped into BMT and non-BMT populations and the tests from each of these populations were compared for statistical differences. Similar comparisons were made with various sub-groups to include: influenza A versus influenza B, and influenza A subtypes: (H1N1) versus (H3N2) versus (H1N1)pdm09.
  
  
  RESULTS
  Among 4448 participants enrolled, 466 (10.5%) tested positive for influenza. Sensitivity of viral culture differed between BMTs and non-BMTs: 63% versus 41% (p<0.01). There was no difference in the sensitivity of PCR or EIA between the two populations. The sensitivities of viral culture, EIA and PCR were higher in those infected with influenza A than in those infected with influenza B. The sensitivity of viral culture was significantly higher in (H1N1)pdm09 subtype cases.
  
  
  CONCLUSIONS
  Viral culture performed better in BMTs than in non-BMTs. These differences are likely attributable to the younger age of the BMTs.
authors.affiliation: Pulmonary Service, Department of Medicine, San Antonio Military Medical Center, Joint Base San Antonio Fort Sam Houston, TX 78234, USA. Electronic address: henry.scheuller@us.af.mil.
authors.forename: H Samuel
authors.initials: HS
authors.lastname: Scheuller
authors.affiliation: Center for Advanced Molecular Detection, 59th Medical Wing/Science and Technology Branch, Joint Base San Antonio-Lackland, TX 78236, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lott
authors.affiliation: Center for Advanced Molecular Detection, 59th Medical Wing/Science and Technology Branch, Joint Base San Antonio-Lackland, TX 78236, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Haas
authors.affiliation: Center for Advanced Molecular Detection, 59th Medical Wing/Science and Technology Branch, Joint Base San Antonio-Lackland, TX 78236, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Tavish
authors.affiliation: Infectious Diseases Service, Department of Medicine, San Antonio Military Medical Center, Joint Base San Antonio Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. Electronic address: patrick.danaher@us.af.mil.
authors.forename: Patrick
authors.initials: P
authors.lastname: Danaher
mesh_terms: D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D007251:Influenza, Human / Q000175:diagnosis*; D008297:Male; D008889:Military Personnel; D009975:Orthomyxoviridae / Q000235:genetics / Q000254:growth & development / Q000276:immunology / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014776:Virus Cultivation / Q000379:methods*; D055815:Young Adult
keywords: Basic military trainee; Enzyme immunoassay (EIA); Influenza; Polymerase chain reaction (PCR); Viral culture