Pediatr Allergy Respir Dis.  2012 Mar;22(1):71-77.

Usefulness of Influenza Rapid Antigen Test in Influenza A (H1N1)

• Lee BK
• Ju JK
• Choi BS
• Jung SG
• Jung JA
• Yun HJ

Abstract

PURPOSE
The aim of this study was to examine the sensitivity and specificity of the influenza rapid antigen test, in comparison with reverse transcription polymerase chain reaction (RT-PCR), according to the time of the test from symptom onset and the clinical manifestations in the patients tested for suspected infection of the influenza A (H1N1) at a second hospital.
METHODS
A total of 529 pediatric patients, aged between 6 and 12 years old, who visited the emergency department from October 1, 2009 to December 31, 2009, received the influenza rapid antigen test and RT-PCR. We examined the sensitivity and specificity of the influenza rapid antigen test in comparison with RT-PCR according to the time of the test from symptom onset (<24 hours, 24 to 48 hours, 48 to 72 hours, >72 hours) and clinical manifestations (fever, cough, rhinorrhea.nasal obstruction, sore throat, gastrointestinal symptoms, and general symptoms) in a retrospective study based on hospital charts.
RESULTS
The sensitivity of the influenza rapid antigen test at elapsed times of less than 24 hours, 24 to 48 hours, and 48 to 72 hours after the onset of the symptoms was 53.9%, 61.4%, and 62.1% respectively. When the elapse time was greater than 72 hours, the sensitivity was 31.6%; thus, the sensitivity of the influenza rapid antigen test tended to decrease with elapsed time. The sensitivity of the test was 79% in patients presenting with gastrointestinal symptoms, which was the highest, but there was no statistical difference according to the clinical manifestations of the patients.
CONCLUSION
Our study suggests that more accurate results might be gained when the influenza rapid antigen test is performed within 72 hours after symptom onset.

Keyword

Influenza A (H1N1); Influenza rapid antigen test; RT-PCR; Children

MeSH Terms

Aged
Child
Cough
Emergencies
Humans
Influenza, Human
Pharyngitis
Polymerase Chain Reaction
Retrospective Studies
Reverse Transcription
Sensitivity and Specificity

Figure

• 

  Fig. 1 The decrease in the sensitivity of the influenza rapid antigen test after 72 hours of symptom onset.

Reference

1. Lee KH, Kim WK, Kim MR, Kim DH, Lee HR, Park CY, et al. A clinical analysis on acute lower respiratory tract infections in children caused by influenza virus in children. J Korean Pediatr Soc. 1998. 41:1623–1631.

2. Betts R. Mandell GL, Bennett J, Dolin R, editors. Orthomyxovirus, influenza virus. Principles and practice of infectious diseases. 1995. 4th ed. New York: Churchill Livingstone Inc.;1546–1567.

3. Neumann G, Noda T, Kawaoka Y. Emergence and pandemic potential of swine-origin H1N1 influenza virus. Nature. 2009. 459:931–939.

4. Lee DH, Shin SS, Jun BY, Lee JK. National level response to pandemic (H1N1) 2009. J Prev Med Public Health. 2010. 43:99–104.

5. Eskin B, Levy R. Evidence-based emergency medicine/rational clinical examination abstract. Does this patient have influenza? Ann Emerg Med. 2007. 49:103–105.

6. Falsey AR. Community-acquired viral pneumonia. Clin Geriatr Med. 2007. 23:535–552. vi

7. Grijalva CG, Poehling KA, Edwards KM, Weinberg GA, Staat MA, Iwane MK, et al. Accuracy and interpretation of rapid influenza tests in children. Pediatrics. 2007. 119:e6–e11.

8. Kwon A, Kim JS, Kim HS, Song W, Park JY, Cho HC, et al. Comparison of rapid antigen test and real-time reverse transcriptase PCR for diagnosing novel swine influenza A (H1N1). Korean J Clin Microbiol. 2010. 13:109–113.

9. Kim WJ. Epidemiology, clinical manifestations, and management of pandemic novel Influenza A (H1N1). Korean J Med. 2009. 77:157–164.

10. Ohmit SE, Monto AS. Symptomatic predictors of influenza virus positivity in children during the influenza season. Clin Infect Dis. 2006. 43:564–568.

11. Beigel JH. Influenza. Crit Care Med. 2008. 36:2660–2666.

12. Lee DH, Kim JS, Kim CW, Kim SE, Lee SJ, Park YS. Characteristics of diagnosed novel influenza A (H1N1) cases in the community sentinel hospital and usefulness of clinical diagnosis. Korean J Fam Med. 2010. 31:115–123.

13. Kim JS, Choi HJ, Ahn YM, Hwang YO. Clinical usefulness of rapid antigen test on the diagnosis of influenza. Korean J Pediatr. 2005. 48:1348–1353.

14. Uyeki TM. Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza. Pediatr Infect Dis J. 2003. 22:164–177.

15. van Elden LJ, van Essen GA, Boucher CA, van Loon AM, Nijhuis M, Schipper P, et al. Clinical diagnosis of influenza virus infection: evaluation of diagnostic tools in general practice. Br J Gen Pract. 2001. 51:630–634.

16. Rodriguez WJ, Schwartz RH, Thorne MM. Evaluation of diagnostic tests for influenza in a pediatric practice. Pediatr Infect Dis J. 2002. 21:193–196.

17. Poehling KA, Griffin MR, Dittus RS, Tang YW, Holland K, Li H, et al. Bedside diagnosis of influenzavirus infections in hospitalized children. Pediatrics. 2002. 110(1 Pt 1):83–88.

18. McNicholl IR, McNicholl JJ. Neuraminidase inhibitors: zanamivir and oseltamivir. Ann Pharmacother. 2001. 35:57–70.

19. Park YH, Woo YD, Kim SK, Bae HJ, Park SW. Simultaneous detection and identification of human respiratory syncytial virus, influenza virus A (H3N2, H1N1) and B by one-tube multiplex reverse transcription polymerase chain reaction. J Bacteriol Virol. 2001. 31:269–274.

20. Kim YK, Kim HY, Uh Y, Chun JK. Detection rate of rapid antigen test for pandemic influenza A (H1N1 2009). Infect Chemother. 2010. 42:95–98.

21. Hwang Y, Kim K, Lee M. Evaluation of the efficacies of rapid antigen test, multiplex PCR, and real-time PCR for the detection of a novel influenza A (H1N1) virus. Korean J Lab Med. 2010. 30:147–152.

22. Stripeli F, Sakkou Z, Papadopoulos N, Georgiou V, Gratsia P, Christodoulou I, et al. Performance of rapid influenza testing in hospitalized children. Eur J Clin Microbiol Infect Dis. 2010. 29:683–688.

23. Lee CS, Lee JH, Kim CH. Time-dependent sensitivity of a rapid antigen test in patients with 2009 H1N1 influenza. J Clin Microbiol. 2011. 49:1702.

24. Choi WS, Noh JY, Huh JY, Kee SY, Jeong HW, Lee J, et al. The clinical usefulness of the SD Bioline Influenza Antigen Test® for detecting the 2009 influenza A (H1N1) virus. Yonsei Med J. 2011. 52:683–685.