Document Detail


Variations in Positive Predictive Values for Rapid Influenza Tests for 2009 Pandemic Influenza A (pH1N1)-Arizona, April-October 2009.
MedLine Citation:
PMID:  22473120     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
CONTEXT: : Rapid influenza diagnostic tests (RIDTs) are used for influenza screening, clinical decision making, and influenza surveillance. In August 2009, a hospital reported increased false-positive RIDT results to the Arizona Department of Health Services. Because of reported RIDT low sensitivities (40%-62%) for 2009 pandemic influenza A (pH1N1), the hospital's report raised further concerns about the specificity and clinical utility of RIDTs.
OBJECTIVE: : To determine the positive predictive value (PPV) of RIDTs compared with real-time reverse transcription-polymerase chain reaction assay (rRT-PCR) using Centers for Disease Control and Prevention (CDC) protocols and primers as a standard.
DESIGN: : A standardized survey collected information including RIDT brand/lot number, training of personnel performing test, type of laboratory, swab and specimen type, time from collection to testing, sample storage, and viral transport medium.
SETTING: : Arizona.
PARTICIPANTS: : Seven Arizona laboratories submitted positive RIDT clinical samples to Arizona State Public Health Laboratory (ASPHL) for confirmatory rRT-PCR testing.
MAIN OUTCOME MEASURE: : The PPV was calculated on the basis of rRT-PCR-positive results for April through October.
RESULTS: : Results from 600 specimens using 1 of 4 RIDTs were available. Median pH1N1 PPV was 80% (range: 62%-91%) when calculated by RIDT brand. A significant difference in PPV was identified between the 2 largest facilities, which used the same RIDT brand, BinaxNOW Influenza A&B, (Laboratories A, 33% and B, 92%, [P < .01]). The facilities reported similar testing practices except lot numbers used and timing of testing. Laboratory A used lot 003684 and performed testing within 1 hour of collection; Laboratory B used multiple lots, excluding lot 003684, and performed testing within 24 hours. Laboratory A switched RIDT brands and noted a significant PPV increase from 33% to 91% (P < .01).
CONCLUSIONS: : Wide PPV variability combined with documented low sensitivity among RIDTs for pH1N1 diagnosis increases concerns about their specificity and clinical and epidemiologic utility for influenza.
Authors:
Steven A Baty; Aarikha Dʼsouza; Rebecca Sunenshine; Kris Bisgard; Laura M Erhart
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of public health management and practice : JPHMP     Volume:  18     ISSN:  1550-5022     ISO Abbreviation:  J Public Health Manag Pract     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9505213     Medline TA:  J Public Health Manag Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  268-71     Citation Subset:  T    
Affiliation:
Arizona Department of Health Services, Phoenix (Dr Baty, Mss D'Souza and Erhart); Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Baty, Sunenshine, and Bisgard); and Maricopa County Department of Public Health, Phoenix, Arizona. (Dr Sunenshine).
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