Brouqui Philippe, Vu Hai Vinh, Nougairede Antoine, Lagier Jean-Christophe, Botelho Elisabeth, Ninove Laetitia, Zandotti Christine, Charrel Remi N, De Lamballerie Xavier, Raoult Didier
Infectious Diseases and Tropical Medicine at Service des Maladies Infectieuses et Tropicales, CHU Nord AP-HN, URMITE CNRS/RD 6236, Faculté de Médecine, Université de la Méditérranée, Marseille, France.
PLoS Curr. 2009 Oct 21;1:RRN1120. doi: 10.1371/currents.rrn1120.
In late June 2009, we set up a dedicated flu-like illness outpatient consultation in the Infectious Diseases and Tropical Medicine department of Marseille university hospital to detect the new A/H1N1 pandemic influenza and to contain efficiently the A/H1N1 infected patients. For 3 months, we compiled data corresponding to a total of 307 patients who presented with a flu-like syndrome. 31 of them were positive for H1N1 pandemic flu through real-time RT-PCR (rRT-PCR); among them, 19 were positive for a rapid influenza detection test (RIDT). We report here the significant clinical characteristics of A/H1N1 pandemic flu patients compared with other flu-like illnesses, which were used to improve the predictive value of the diagnosis in the current epidemiological situation. We found that regardless of the prevalence of A/H1N1 positive cases in the suspected patients, the absence of cough rejects the diagnosis of A/H1N1 infection in 100% of cases. Among patients referred for flu-like illness, those with cough should be tested for A/H1N1 by RIDT. In the current situation, the PPV and NPV of RIDT for H1N1 reached 90.5% and 95.8 %, respectively. It is important to notice that the 2 RIDT-positive that were negative for H1N1 were seasonal H3N2 influenza indicating that specificity and PPV of RIDT for all influenza was 100%. Therefore, positive RIDT does not require rRT-PCR confirmatory test. Only negative RIDT should be tested with rRT-PCR assay. Respecting this algorithm would have saved up to 70,000 Euros ( 100.000 USD) for the 307 patients and would have resulted in a significant gain of time to transmit the laboratory results to the clinical ward.
2009年6月下旬，我们在马赛大学医院传染病与热带医学科设立了专门的流感样疾病门诊咨询，以检测新型甲型H1N1大流行性流感，并有效隔离甲型H1N1感染患者。在3个月的时间里，我们收集了总共307例出现流感样综合征患者的数据。其中31例通过实时逆转录聚合酶链反应（rRT-PCR）检测甲型H1N1大流行性流感呈阳性；其中19例快速流感检测试验（RIDT）呈阳性。我们在此报告甲型H1N1大流行性流感患者与其他流感样疾病相比的显著临床特征，这些特征用于提高当前流行状况下诊断的预测价值。我们发现，无论疑似患者中甲型H1N1阳性病例的患病率如何，无咳嗽症状可100%排除甲型H1N1感染的诊断。在因流感样疾病转诊的患者中，有咳嗽症状的患者应通过RIDT检测甲型H1N1。在当前情况下，RIDT对H1N1的阳性预测值（PPV）和阴性预测值（NPV）分别达到90.5%和95.8%。需要注意的是，2例RIDT阳性但H1N1阴性的病例为季节性H3N2流感，这表明RIDT对所有流感的特异性和PPV均为100%。因此，RIDT阳性无需进行rRT-PCR确证试验。只有RIDT阴性才应进行rRT-PCR检测。遵循该算法可为这307例患者节省高达70000欧元（100000美元），并能显著缩短将实验室结果传递至临床病房的时间。
