miércoles, 19 de agosto de 2015

Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

FULL-TEXT ►

Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC





Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program

Emerging Infections Program

Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates

Alexander J. MillmanComments to Author , Carrie Reed, Pam Daily Kirley, Deborah Aragon, James I. Meek, Monica M. Farley, Patricia Ryan, Jim Collins, Ruth Lynfield, Joan Baumbach, Shelley Zansky, Nancy M. Bennett, Brian Fowler, Ann Thomas, Mary L. Lindegren, Annette Atkinson, Lyn Finelli, and Sandra Chaves
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A.J. Millman, C. Reed, L. Finelli, S.S. Chaves)California Emerging Infections Program, Oakland, California, USA (P. Daily Kirley)Colorado Department of Public Health and Environment, Denver, Colorado, USA (D. Aragon)Connecticut Emerging Infections Program, New Haven, Connecticut, USA (J. Meek)Emory University School of Medicine, Atlanta (M.M. Farley)Atlanta Veterans Administration Medical Center, Atlanta (M.M. Farley)Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA (P. Ryan)Michigan Department of Health and Human Services, Lansing, Michigan, USA (J. Collins)Minnesota Department of Health, St. Paul, Minnesota, USA (R. Lynfield)New Mexico Department of Health, Santa Fe, New Mexico, USA (J. Baumbach)New York State Department of Health, Albany, New York, USA (S. Zansky)University of Rochester School of Medicine and Dentistry, Rochester, New York, USA (N.M. Bennett)Monroe County Department of Public Health, Rochester (N.M. Bennett)Ohio Department of Health, Columbus, Ohio, USA (B. Fowler)Oregon Public Health Division, Portland, Oregon, USA (A. Thomas)Vanderbilt University School of Medicine, Nashville, Tennessee, USA (M.L. Lindegren)Utah Department of Health, Salt Lake City, Utah, USA (A. Atkinson)

Abstract

Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from <10% during 2003–2008 to ≈70% during 2009–2013. Observed hospitalization rates per 100,000 persons varied by season: 7.3–50.5 for children <18 years of age, 3.0–30.3 for adults 18–64 years, and 13.6–181.8 for adults >65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children <18 years, ≈20% higher for adults 18–64 years, and ≈55% for adults >65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates.
In the United States, surveillance for influenza-associated hospitalizations relies on laboratory-confirmed diagnostic testing (13). Influenza testing modalities have expanded from traditional viral culture to include rapid influenza diagnostic tests (RIDTs) and molecular assays, such as reverse transcription PCR (RT-PCR) (4,5). RIDTs are point-of-care tests that provide results within 30 minutes; however, with reported sensitivities of 10%–80%, negative test results can be unreliable (69). RT-PCR exceeds viral culture in sensitivity for detecting influenza, but its widespread use is limited by cost and complexity of the assay (10,11).
Researchers have examined rates of influenza-associated hospitalization during different influenza seasons (1,2,12,13). However, comparing rates between seasons can be inaccurate without accounting for changes in the sensitivity of diagnostic testing used. In particular, after the 2009 influenza A(H1N1) pandemic, hospitals and state public health laboratories expanded diagnostic capabilities with high-sensitivity molecular assays to better detect influenza viruses and other respiratory pathogens (5). Particularly for nationally based surveillance, the use of different testing platforms by health care facilities and the variability in sensitivity of these diagnostic tests could lead to underestimation of rates of influenza-associated hospitalization and limit comparisons of severity across influenza seasons (3,4,6,7).

Dr. Millman is a physician and an Epidemic Intelligence Service Officer assigned to the Influenza Division, CDC. His research interests include influenza, emerging infections surveillance, and advanced molecular diagnostics.

Acknowledgments


We thank the following persons for their contributions at CDC and the FluSurv-NET sites: Alejandro Perez, Michelle Leon, Hallie Randel, Maria Rosales, Darcy Fazio, John Palumbo, Kimberly Yousey-Hindes, Olivia Almendares, Delmar Little, Kyle Openo, May Monroe; Dave Boxurd, Craig Morin, Sara Vetter, Minnesota Team Flu, Meghan Fuschino, Nancy Spina, Kirsten St. George, Gary Hollick, Maria Gaitan; Matthew Laidler, Patricia Newman, Katie Dyer, and Karen Leib.
FluSurv-NET is a collaboration of state health departments, academic institutions, and local partners and is funded by CDC. This publication was supported in part by cooperative agreement nos. CDC-RFA-CK12-1202 and 5U38HM000414.

References

  1. Dao CNKamimoto LNowell MReingold AGershman KMeek JAdult hospitalizations for laboratory-positive influenza during the 2005–2006 through 2007–2008 seasons in the United States. J Infect Dis2010;202:8818DOIPubMed
  2. Dawood FSFiore AKamimoto LBramley AReingold AGershman KBurden of seasonal influenza hospitalization in children, United States, 2003 to 2008. J Pediatr2010;157:80814DOIPubMed
  3. Chaves SSAragon DBennett NCooper TD'Mello TFarley MPatients hospitalized with laboratory-confirmed influenza during the 2010–2011 influenza season: exploring disease severity by virus type and subtype. J Infect Dis2013;208:130514DOIPubMed
  4. Takahashi HOtsuka YPatterson BKDiagnostic tests for influenza and other respiratory viruses: determining performance specifications based on clinical setting. J Infect Chemother2010;16:15561DOIPubMed
  5. Jernigan DBLindstrom SLJohnson JRMiller JDHoelscher MHumes RDetecting 2009 pandemic influenza A (H1N1) virus infection: availability of diagnostic testing led to rapid pandemic response. Clin Infect Dis2011;52(Suppl 1):S3643DOIPubMed
  6. Uyeki TMPrasad RVukotich CStebbins SRinaldo CRFerng YHLow sensitivity of rapid diagnostic test for influenza. Clin Infect Dis.2009;48:e8992DOIPubMed
  7. Chartrand CLeeflang MMMinion JBrewer TPai MAccuracy of rapid influenza diagnostic tests: a meta-analysis. Ann Intern Med.2012;156:50011DOIPubMed
  8. Talbot HKWilliams JVZhu YPoehling KAGriffin MREdwards KMFailure of routine diagnostic methods to detect influenza in hospitalized older adults. Infect Control Hosp Epidemiol2010;31:6838DOIPubMed
  9. Peterson SDugas AFRothman REEvaluation of 11 commercially available rapid influenza diagnostic tests-United States, 2011–2012. Ann Emerg Med2013;61:5737DOIPubMed
  10. Mahony JBNucleic acid amplification-based diagnosis of respiratory virus infections. Expert Rev Anti Infect Ther2010;8:127392DOIPubMed
  11. Kumar SHenrickson KJUpdate on influenza diagnostics: lessons from the novel H1N1 influenza A pandemic. Clin Microbiol Rev2012;25:34461.DOIPubMed
  12. Cox CMD'Mello TPerez AReingold AGershman KYousey-Hindes KIncrease in rates of hospitalization due to laboratory-confirmed influenza among children and adults during the 2009–10 influenza pandemic. J Infect Dis2012;206:13508DOIPubMed
  13. Zhou HThompson WWViboud CGRingholz CMCheng PYSteiner CHospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993–2008. Clin Infect Dis2012;54:142736DOIPubMed
  14. Pinner RWRebmann CASchuchat AHughes JMDisease surveillance and the academic, clinical, and public health communities. Emerg Infect Dis.2003;9:7817DOIPubMed
  15. Dawood FSFiore AKamimoto LNowell MReingold AGershman KInfluenza-associated pneumonia in children hospitalized with laboratory-confirmed influenza, 2003–2008. Pediatr Infect Dis J2010;29:58590DOIPubMed
  16. Barker WHMenegus MAHall CBBetts RFFreundlich CBLong CECommunitywide laboratory-based influenza surveillance focused on older persons, 1989–1992. Am J Prev Med1995;11:14955 .PubMed
  17. Steininger CRedlberger MGraninger WKundi MPopow-Kraupp TNear-patient assays for diagnosis of influenza virus infection in adult patients.Clin Microbiol Infect2009;15:26773DOIPubMed
  18. Long CEHall CBCunningham CKWeiner LBAlger KPGouveia MInfluenza surveillance in community-dwelling elderly compared with children.Arch Fam Med1997;6:45965DOIPubMed
  19. Steininger CKundi MAberle SWAberle JHPopow-Kraupp TEffectiveness of reverse transcription–PCR, virus isolation, and enzyme-linked immunosorbent assay for diagnosis of influenza A virus infection in different age groups. J Clin Microbiol2002;40:20516DOIPubMed
  20. Bradley Efron RJT. An introduction to the bootstrap. London: Chapman and Hall; 1993.
  21. Novak-Weekley SMMarlowe EMPoulter MDwyer DSpeers DRawlinson WEvaluation of the Cepheid Xpert Flu Assay for rapid identification and differentiation of influenza A, influenza A 2009 H1N1, and influenza B viruses. J Clin Microbiol2012;50:170410DOIPubMed
  22. Van Wesenbeeck LMeeuws HVan Immerseel AIspas GSchmidt KHouspie LComparison of the FilmArray RP, Verigene RV+, and Prodesse ProFLU+/FAST+ multiplex platforms for detection of influenza viruses in clinical samples from the 2011–2012 influenza season in Belgium. J Clin Microbiol2013;51:297785DOIPubMed
  23. Templeton KEScheltinga SABeersma MFKroes ACClaas ECRapid and sensitive method using multiplex real-time PCR for diagnosis of infections by influenza A and influenza B viruses, respiratory syncytial virus, and parainfluenza viruses 1, 2, 3, and 4. J Clin Microbiol2004;42:15649.DOIPubMed
  24. Gharabaghi FTellier RCheung RCollins CBroukhanski GDrews SJComparison of a commercial qualitative real-time RT-PCR kit with direct immunofluorescence assay (DFA) and cell culture for detection of influenza A and B in children. J Clin Virol2008;42:1903DOIPubMed
  25. Walsh EECox CFalsey ARClinical features of influenza A virus infection in older hospitalized persons. J Am Geriatr Soc2002;50:1498503.DOIPubMed
  26. LaSala PRBufton KKIsmail NSmith MBProspective comparison of R-mix™ shell vial system with direct antigen tests and conventional cell culture for respiratory virus detection. J Clin Virol2007;38:2106DOIPubMed
  27. Irmen KEKelleher JJUse of monoclonal antibodies for rapid diagnosis of respiratory viruses in a community hospital. Clin Diagn Lab Immunol.2000;7:396403 .PubMed
  28. Rahman MKieke BAVandermause MFMitchell PDGreenlee RTBelongia EAPerformance of Directigen flu A+B enzyme immunoassay and direct fluorescent assay for detection of influenza infection during the 2004–2005 season. Diagn Microbiol Infect Dis2007;58:4138DOIPubMed
  29. Uyeki TMInfluenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza. Pediatr Infect Dis J2003;22:16477DOIPubMed
  30. Stout CMurphy MDLawrence SJulian SEvaluation of a monoclonal antibody pool for rapid diagnosis of respiratory viral infections. J Clin Microbiol1989;27:44852 .PubMed
  31. Fader RCComparison of the Binax NOW Flu A enzyme immunochromatographic assay and R-Mix shell vial culture for the 2003–2004 influenza seasons. J Clin Microbiol2005;43:61335DOIPubMed
  32. Nelson EAIp MTam JSMounts AWChau SLLaw SKBurden of influenza infection in hospitalised children below 6 months of age and above in Hong Kong from 2005 to 2011. Vaccine2014;32:66928DOIPubMed
  33. Ortiz JRNeuzil KMShay DKRue TCNeradilek MBZhou HThe burden of influenza-associated critical illness hospitalizations. Crit Care Med.2014;42:232532DOIPubMed
  34. Poehling KAEdwards KMGriffin MRSzilagyi PGStaat MAIwane MKThe burden of influenza in young children, 2004–2009. Pediatrics.2013;131:20716DOIPubMed
  35. Williamson DAHuang QSRoberts SAGrant CCMcArthur CBaker MGSurveillance for influenza using hospital discharge data may underestimate the burden of influenza-related hospitalization. Infect Control Hosp Epidemiol2012;33:10646DOIPubMed
  36. Widmer KZhu YWilliams JVGriffin MREdwards KMTalbot HKRates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis2012;206:5662DOIPubMed
  37. Burton CVaudry WMoore DBettinger JATran DHalperin SABurden of seasonal influenza in children with neurodevelopmental conditions.Pediatr Infect Dis J2014;33:7104DOIPubMed
  38. Emukule GOKhagayi SMcMorrow MLOchola ROtieno NWiddowson MAThe burden of influenza and RSV among inpatients and outpatients in rural western Kenya, 2009–2012. PLoS ONE2014;9:e105543DOIPubMed
  39. Reed CChaves SSDaily Kirley PEmerson RAragon DHancock EBEstimating influenza disease burden from population-based surveillance data in the United States. PLoS ONE2015;10:e0118369DOIPubMed

Figures

Table

Technical Appendix

Suggested citation for this article: Millman AJ, Reed C, Daily Kirley P, Aragon D, Meek J, Farley MM, et al. Improving accuracy of influenza-associated hospitalization rate estimates. Emerg Infect Dis. 2015 Aug [date cited]. http://dx.doi.org/10.3201/eid2109.141665
DOI: 10.3201/eid2109.141665

No hay comentarios:

Publicar un comentario