Department of Pathology, Box 47, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
J Clin Microbiol. 2010 Apr;48(4):1189-94. doi: 10.1128/JCM.01657-09. Epub 2010 Feb 10.
The experience of a public hospital virology laboratory during a springtime 2009 outbreak of a novel influenza A (H1N1) virus in New York State is described. Influenza virus was isolated from 145 of 613 respiratory swab specimens. Symptoms of fever (temperature, 102.7 +/- 0.32 degrees F), cough, upper respiratory infection, myalgia, and headache were reported. Atypical symptoms of nausea/vomiting and diarrhea were also observed. Illness occurred mainly in patients <or=21 years of age (85/145 patients). Only two patients were >or=65 years old. Compared to the results of traditional culture methods, the sensitivities of a rapid chromatographic influenza A and B virus immunoassay and rapid shell vial culture were 70.3% and 98.6%, respectively. A sensitivity of 80% was obtained by testing 50 specimens by a direct fluorescent-antibody (DFA) assay. The observation of adequate numbers of cells on the DFA assay slides suggests that the low sensitivity of the chromatographic immunoassay may result from its intrinsic nature and not from improper specimen collection. A reverse transcription-PCR (RT-PCR) assay of 45 specimens performed off-site yielded 21 novel (H1N1) viruses and 2 seasonal (H3N2) influenza viruses. The mean time interval of 5.69 +/- 0.37 days from specimen collection to the availability of RT-PCR results limited the value of this assay for patient care. In laboratories lacking on-site molecular capabilities, shell vial techniques can rapidly (about 1 day) confirm negative results and/or identify false-negative chromatographic immunoassay results. Laboratories lacking culture capabilities may also use the DFA assay to confirm or replace the results obtained by these immunoassays. Increasing testing demands caused shortages in commodities and personnel. Alternative testing strategies and planning are necessary in order to optimize virus detection and ensure appropriate resource allocation.
描述了纽约州一家公立医院病毒实验室在 2009 年春季新型甲型 H1N1 流感爆发期间的经历。从 613 份呼吸道拭子标本中分离出流感病毒 145 份。报告的症状有发热（体温 102.7 +/- 0.32 华氏度）、咳嗽、上呼吸道感染、肌痛和头痛。还观察到恶心/呕吐和腹泻等非典型症状。发病主要发生在年龄<or=21 岁的患者（145 例患者中的 85 例）。只有 2 例患者年龄>or=65 岁。与传统培养方法的结果相比，快速色谱流感 A 和 B 病毒免疫检测和快速壳瓶培养的敏感性分别为 70.3%和 98.6%。通过直接荧光抗体（DFA）检测 50 份标本，获得了 80%的敏感性。DFA 检测载玻片上有足够数量的细胞，表明色谱免疫检测的低敏感性可能是由于其固有特性，而不是由于标本采集不当。对 45 份标本进行的场外逆转录-PCR（RT-PCR）检测发现 21 种新型（H1N1）病毒和 2 种季节性（H3N2）流感病毒。从标本采集到 RT-PCR 结果可用的平均时间间隔为 5.69 +/- 0.37 天，限制了该检测方法在患者护理中的价值。在缺乏现场分子能力的实验室中，壳瓶技术可以快速（约 1 天）确认阴性结果和/或识别假阴性色谱免疫检测结果。缺乏培养能力的实验室也可以使用 DFA 检测来确认或替代这些免疫检测的结果。检测需求的增加导致商品和人员短缺。为了优化病毒检测并确保适当的资源分配，需要制定替代检测策略和计划。
