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)