Abstract
As the world prepares for the next influenza pandemic, governments have made significant funding commitments to vaccine development and antiviral stockpiling. While these are essential components to pandemic response, rapid and accurate diagnostic testing remains an often neglected cornerstone of pandemic influenza preparedness. Clinicians and Public Health Practitioners need to understand the benefits and drawbacks of different influenza tests in both seasonal and pandemic settings. Culture has been the traditional gold standard for influenza diagnosis but requires from 1–10 days to generate a positive result, compared to nucleic acid detection methods such as real time reverse transcriptase polymerase chain reaction (RT-PCR). Although the currently available rapid antigen detection kits can generate results in less than 30 minutes, their sensitivity is suboptimal and they are not recommended for the detection of novel influenza viruses. Until point-of-care (POC) tests are improved, PILPN recommends that the best option for pandemic influenza preparation is the enhancement of nucleic acid-based testing capabilities across Canada.
Key words: Pandemic influenza, seasonal influenza, point of care testing, nucleic acid amplification testing
Résumé
Tandis que le monde se prépare à la prochaine pandémie de grippe, les gouvernements se sont engagés à financer substantiellement la mise au point de vaccins et la constitution de réserves d’antiviraux. Même s’il s’agit là de volets essentiels à une intervention en cas de pandémie, le diagnostic rapide et exact demeure une pierre angulaire, souvent négligée, de la préparation à la pandémie de grippe. Les cliniciens et les praticiens en santé publique doivent comprendre les avantages et les inconvénients des différents tests de dépistage tant en saison de grippe qu’en situation de pandémie. La mise en culture est depuis longtemps le test de référence servant au diagnostic de la grippe, mais il faut de 1 à 10 jours pour obtenir un résultat positif, comparativement aux méthodes de détection des acides nucléiques telles que l’amplification par la polymérase après transcription inverse (RT-PCR) en temps réel. Bien que les trousses courantes de détection des antigènes puissent donner un résultat en moins de 30 minutes, leur sensibilité est sous-optimale, et elles ne sont pas conseillées pour déceler les nouveaux virus de la grippe. Tant que les tests au point de service ne se seront pas améliorés au Canada, le RPLPI recommande un renforcement dans tout le pays, de la capacité de dépistage du virus à l’aide d’un test d’amplification des acides nucléiques comme étant le meilleur moyen de se préparer à une pandémie de grippe.
Mots clés: grippe saisonnière, dépistage au point de service, test d’amplification des acides nucléiques
Footnotes
Members of PILPN: Nathalie Bastien, Jody Berry, Tim F. Booth, Max Chernesky, Michel Couillard, Steven Drews, Anthony Ebsworth, Margaret Fearon, Kevin Fonseca, Julie Fox, Jean-Nicolas Gagnon, Steven Guercio, Greg Horsman, Cathy Jorowski, Theodore Kuschak, Yan Li, Anna Majury, Martin Petric, Sam Ratnam, Marek Smieja, Paul Van Caeseele.
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