Table 1 Benefits of using each influenza A testing scenario during the pandemic
Scenario | Description | Pros | Cons | Other comments |
|---|---|---|---|---|
A | RVP first with typing &Flu A-neg* samples by CDC-M and Typing * Flu A positive samples not typed by RVP were also tested by CDC-M for confirmation | • Provide data on the performance characteristics of different diagnostic assays • Identifies mixed influenza and other respiratory infections • Surveillance for other respiratory viruses | • Argument about relevance of diagnosing other viruses apart from RSV A/B during a public health emergency • Resource intense • Labor intensive • May be difficult to stock for pandemic • Poor turn-around time for influenza A | • After obtaining data for validation purposes and total virus surveillance, this approach was replaced by a more cost-effective and time sensitive diagnostic approach (Scenario B) which does not provide the prevalence of mixed infection with influenza A |
B | CDC-M first with H-typing & FluA-neg samples by RVP | • Quicker Turn-around-time to influenza diagnosis compared to RVP-based assays • Scenario drops out more labor intensive test as % influenza increases • Influenza-negative specimens still being tested for other respiratory viruses | • Will not identify influenza co-infections with other viruses • May still be considered as resources intense • Argument about relevance of diagnosing other viruses apart from influenza A during a public health emergency | • Some laboratories may find this approach too resource intense. • Relative cost decrease as % specimen positive for influenza increases |
C | RVP only with H-typing | • Diagnosis of mixed infections | • Questionable use for influenza surveillance • Labor intensive • May be difficult to stock for pandemic • Poor turn-around time for influenza A | • Possible use when no influenza circulating or influenza prevalence <5% or acceptance of having missed influenza cases because of lower sensitivity of RVP |
D | influenza A by CDC-M only with H-typing | • Less labor-intensive, • Lower cost than RVP • Quicker Turn-around-time compared to RVP-based assays • Excellent tool for testing during peak pandemic period | • Does not allow for identification of other circulating viruses or co-infections | • Depends on high prevalence of influenza A and lower prevalence of other viruses or mixed infections • Role when maximum peaks are seen (>60% specimen influenza A) |