Rapid molecular detection of influenza outbreaks in nursing homes
Rapid molecular detection of influenza outbreaks in nursing homes
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DOI：
10.1016/j.jcv.2007.10.023
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发表时间：
2008-01-01
影响因子：
8.8
通讯作者：
Kroes, A. C. M.
中科院分区：
文献类型：
--
作者：
Gooskens, J.;Swaan, C. M.;Kroes, A. C. M.
背景资料：尽管有既定的疫苗接种计划，但养老院流感爆发仍会发生，需要快速和敏感的实验室确认以及时干预。目的：评估快速确认养老院流感爆发的诊断方法。对鼻咽拭子进行流感病毒实时PCR和Directigen Flu A+B酶免疫测定，在2004-2005年及2005-2006年，在七间可能爆发流感的护养院，从怀疑感染流感的住客身上收集鼻咽洗液及咽拭子样本。结果：PCR检测流感病毒RNA阳性率为80%（68/85），阳性率为81%（38/47），确诊6起疑似疫情。鼻咽拭子的免疫测定灵敏度最高（38%; 11/29），与PCR相比，阳性预测值为100%。鼻咽拭子通过PCR对鼻咽洗液同样敏感。鼻咽冲洗取样似乎是不切实际的，由于共同的潜在残疾的居民。爆发团队的支持与较短的时间PCR诊断相比，爆发没有后勤支持（平均值，28.2小时与84小时; P=0.05）。结论：流感实时PCR鼻咽拭子，获得公共卫生服务爆发团队，使快速和敏感的确认疗养院流感爆发。(C)2007 Elsevier B. V.保留所有权利。
Background: Nursing home influenza outbreaks occur in spite of established vaccination programs, and require rapid and sensitive laboratory confirmation for timely intervention.Objectives: To evaluate diagnostic approaches for rapid confirmation of nursing home influenza outbreaks.Study design: 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.Results: 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, 28.2 h vs. 84 h; P=0.05).Conclusions: Influenza real-time PCR on nasopharyngeal swabs, obtained by Public Health Service outbreak teams, enabled rapid and sensitive confirmation of nursing home influenza outbreaks. (C) 2007 Elsevier B.V. All rights reserved.