Tillekeratne L Gayani, Bodinayake Champica K, Nagahawatte Ajith, Vidanagama Dhammika, Devasiri Vasantha, Arachchi Wasantha Kodikara, Kurukulasooriya Ruvini, De Silva Aruna Dharshan, Østybe Truls, Reller Megan E, Woods Christopher W
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Am J Trop Med Hyg. 2015 May;92(5):1023-9. doi: 10.4269/ajtmh.14-0708. Epub 2015 Mar 2.
Influenza accounts for a large burden of acute respiratory tract infections in high-income countries; data from lower-income settings are limited due to lack of confirmatory testing. Consecutive outpatients presenting to the largest tertiary care hospital in southern Sri Lanka were surveyed for influenza-like illness (ILI), defined as acute onset of fever ≥ 38.0°C and cough. Patients were administered a questionnaire and nasal/nasopharyngeal sampling for rapid influenza A/B testing. We enrolled 311 patients with ILI from March to November 2013: 170 (54.7%) children and 172 (55.3%) males. Approximately half (147, 47.3%) tested positive for influenza, but 253 (81.4%) were prescribed antibiotics. On bivariable analysis, symptoms associated with influenza included pain with breathing (P < 0.001), headache (P = 0.005), fatigue (P = 0.003), arthralgias (P = 0.003), and myalgias (P = 0.006) in children and pain with breathing (P = 0.01), vomiting (P = 0.03), and arthralgias (P = 0.03) in adults. Our final clinical predictive models had low sensitivity and fair specificity-50.0% (95% CI: 38.6-61.4%) and 83.2% (95% CI: 73.4-90.0%), respectively, in children and 52.2% (95% CI: 39.9-64.2%) and 81.4% (95% CI: 70.0-89.4%), respectively, in adults. Our study confirms the ability of rapid influenza testing to identify an influenza epidemic in a setting in which testing is not routinely available.
在高收入国家，流感是急性呼吸道感染的一个主要负担；由于缺乏确诊检测，来自低收入地区的数据有限。对连续前往斯里兰卡南部最大的三级护理医院就诊的门诊患者进行了流感样疾病（ILI）调查，ILI定义为急性起病，发热≥38.0°C且伴有咳嗽。对患者进行问卷调查，并采集鼻/鼻咽样本进行甲型/乙型流感快速检测。我们在2013年3月至11月招募了311例ILI患者：170例（54.7%）为儿童，172例（55.3%）为男性。约一半（147例，47.3%）流感检测呈阳性，但253例（81.4%）被开具了抗生素。在双变量分析中，与流感相关的症状在儿童中包括呼吸时疼痛（P<0.001）、头痛（P = 0.005）、疲劳（P = 0.003）、关节痛（P = 0.003）和肌痛（P = 0.006），在成人中包括呼吸时疼痛（P = 0.01）、呕吐（P = 0.03）和关节痛（P = 0.03）。我们最终的临床预测模型敏感性低但特异性尚可——在儿童中分别为50.0%（95%CI：38.6 - 61.4%）和83.2%（95%CI：73.4 - 90.0%），在成人中分别为52.2%（95%CI：39.9 - 64.2%）和81.4%（95%CI：70.0 - 89.4%）。我们的研究证实了在一个并非常规开展检测的环境中，快速流感检测识别流感流行情况的能力。
