title: Evaluation of the point-of-care Becton Dickinson Veritor™ Rapid influenza diagnostic test in Kenya, 2013-2014.
abstract: We evaluated the performance of the Becton Dickinson Veritor™ System Flu A + B rapid influenza diagnostic test (RIDT) to detect influenza viruses in respiratory specimens from patients enrolled at five surveillance sites in Kenya, a tropical country where influenza seasonality is variable.
  
  
  
  Nasal swab (NS) and nasopharyngeal (NP)/oropharyngeal (OP) swabs were collected from patients with influenza like illness and/or severe acute respiratory infection. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the RIDT using NS specimens were evaluated against nasal swabs tested by real time reverse transcription polymerase chain reaction (rRT-PCR). The performance parameter results were expressed as 95% confidence intervals (CI) calculated using binomial exact methods, with P < 0.05 considered significant. Two-sample Z tests were used to test for differences in sample proportions. Analysis was performed using SAS software version 9.3.
  
  
  
  From July 2013 to July 2014, 3,569 patients were recruited, of which 78.7% were aged <5 years. Overall, 14.4% of NS specimens were influenza-positive by RIDT. RIDT overall sensitivity was 77.1% (95% CI 72.8-81.0%) and specificity was 94.9% (95% CI 94.0-95.7%) compared to rRT-PCR using NS specimens. RIDT sensitivity for influenza A virus compared to rRT-PCR using NS specimens was 71.8% (95% CI 66.7-76.4%) and was significantly higher than for influenza B which was 43.8% (95% CI 33.8-54.2%). PPV ranged from 30%-80% depending on background prevalence of influenza.
  
  
  
  Although the variable seasonality of influenza in tropical Africa presents unique challenges, RIDTs may have a role in making influenza surveillance sustainable in more remote areas of Africa, where laboratory capacity is limited.
authors.affiliation: DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya. ikf7@cdc.gov.|Infection Control African Network (ICAN), Infection prevention network-Kenya (IPNET-K), Mbagathi Road off Mbagathi way, Village Market, PO Box 606, 00621, Nairobi, Kenya. ikf7@cdc.gov.
authors.forename: Linus K
authors.initials: LK
authors.lastname: Ndegwa
authors.affiliation: DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Gideon
authors.initials: G
authors.lastname: Emukule
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention-Atlanta, Georgia, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Uyeki
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya.
authors.forename: Eunice
authors.initials: E
authors.lastname: Mailu
authors.affiliation: DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Chaves
authors.affiliation: DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.affiliation: Coast County Referral Hospital, Nairobi, Kenya.
authors.forename: Bandika V
authors.initials: BV
authors.lastname: Lewa
authors.affiliation: Nyeri County Referral Hospital, Nairobi, Kenya.
authors.forename: Francis K
authors.initials: FK
authors.lastname: Muiruri
authors.affiliation: Ministry of Health, Nairobi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Omoth
authors.affiliation: DGHP, Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Barry
authors.initials: B
authors.lastname: Fields
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention-Atlanta, Georgia, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000956:Antigens, Viral / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007118:Immunoassay; D007223:Infant; D009980:Influenza A virus / Q000235:genetics*; D007251:Influenza, Human / Q000175:diagnosis* / Q000821:virology; D029524:Betainfluenzavirus / Q000235:genetics*; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000821:virology; D009305:Nasopharynx / Q000821:virology; D009960:Oropharynx / Q000821:virology; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000956:Antigens, Viral
keywords: Influenza; Kenya; Rapid influenza test; Sensitivity and specificity