Gooskens J, Swaan C M, Claas E C J, Kroes A C M
Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
J Clin Virol. 2008 Jan;41(1):7-12. doi: 10.1016/j.jcv.2007.10.023. Epub 2007 Dec 11.
Nursing home influenza outbreaks occur in spite of established vaccination programs, and require rapid and sensitive laboratory confirmation for timely intervention.
To evaluate diagnostic approaches for rapid confirmation of nursing home influenza outbreaks.
Influenza virus real-time PCR and Directigen Flu A+B enzyme immunoassay were performed on nasopharyngeal swabs, nasopharyngeal washes and throat swabs collected from residents with clinical suspicion of influenza during seven probable nursing home outbreaks in 2004-2005 and 2005-2006. The efficacy of specimen sampling and transport management by Public Health Service outbreak team was evaluated.
PCR detected influenza RNA in 80% (68/85) of specimens from 81% (38/47) residents, confirming six suspected outbreaks. Immunoassay sensitivity was highest on nasopharyngeal swabs (38%; 11/29) with a positive predictive value of 100% compared to PCR. Nasopharyngeal swabs were equally sensitive to nasopharyngeal washes by PCR. Nasopharyngeal wash sampling appeared unpractical due to common underlying disability of residents. Outbreak team support was associated with a shorter time to PCR diagnosis compared to outbreaks with no logistical support (mean, 28.2h vs. 84h; P=0.05).
Influenza real-time PCR on nasopharyngeal swabs, obtained by Public Health Service outbreak teams, enabled rapid and sensitive confirmation of nursing home influenza outbreaks.
尽管有既定的疫苗接种计划，养老院仍会发生流感暴发，需要快速且灵敏的实验室确诊以便及时干预。
评估快速确诊养老院流感暴发的诊断方法。
对2004 - 2005年和2005 - 2006年七次可能的养老院流感暴发期间，从临床怀疑感染流感的居民采集的鼻咽拭子、鼻咽冲洗液和咽拭子进行流感病毒实时聚合酶链反应（PCR）和甲型/乙型流感病毒直接免疫测定。评估了公共卫生服务暴发应对小组的标本采样和运输管理的效果。
PCR在来自81%（38/47）居民的80%（68/85）标本中检测到流感RNA，确诊了六起疑似暴发。免疫测定在鼻咽拭子上的灵敏度最高（38%；11/29），与PCR相比，阳性预测值为100%。通过PCR检测，鼻咽拭子与鼻咽冲洗液的灵敏度相同。由于居民普遍存在潜在残疾，鼻咽冲洗采样似乎不实用。与没有后勤支持的暴发相比，暴发应对小组的支持与PCR诊断时间缩短相关（平均，28.2小时对84小时；P = 0.05）。
由公共卫生服务暴发应对小组采集的鼻咽拭子进行流感实时PCR，能够快速且灵敏地确诊养老院流感暴发。
