The time is “now” for rapid PCR testing for influenza in clinical practice

Abstract

El Feghaly et al at Children's Mercy Kansas City presented a brief survey to providers in their emergency department and urgent care centers who placed an order for influenza RT-PCR test, asking their estimation of probability of the patient having influenza and their intentions to manage, including therapy. They also captured actual management once the results were available. Overall, about one-half of tests were positive. Clinical suspicion was not a predictor of test results, the positivity rate being 40% if suspicion was low and 57% if high. Test results changed clinicians' management (eg, for further tests/imaging, antibiotic/antiviral therapy) in 44% of influenza PCR-positive cases and in 93% of PCR-negative cases. The net cost savings in avoiding antiviral therapy alone offset the cost of PCR testing compared with rapid antigen testing for influenza. It's a new world. With PCR testing for influenza being the first highly sensitive and specific test, we can accurately discern the etiology of the patient's illness. As the flu season looms, not only are there ramifications of testing for optimizing treatment for influenza and saving resources, but because of pandemic SARS-CoV-2 there is an urgent need to know who has what. With clinical ability to diagnose influenza as shown in this study to be no better than a coin toss, and with most SARS-CoV-2 infections in children not discernible by clinical manifestations, we face a nightmare that includes managing families and teachers and school children, if there is concurrent community activity of both viruses. Can we tamp down the nightmare? Absolutely. 1) Promote, insist, and ensure influenza vaccination (unless a valid contraindication exists) of every person 6 months of age or older – both to reduce illness as well as the seasonal burden of influenza. In another study published in this volume and conducted across 6 countries, Goldman et al showed that there may be increased opportunity. Questioning ∼2400 parents bringing a child to an emergency department earlier in the COVID-19 pandemic about their plan to have their child immunized against influenza in the Fall, almost 30% who had not done so last year planned to do so in 2020. We must capitalize on the moment, offer, and facilitate vaccinations. 2) Continue optimal behaviors to reduce SARS-CoC-2 transmission and acquisition. 3) Sort out the logistics to be able to use the powerful technology of PCR testing in everyday clinical practice in order to accurately determine etiology of respiratory illness at least for these 2 viruses. Articles pages 87 and 271 ▸ Impact of Rapid Influenza Molecular Testing on Management in Pediatric Acute Care SettingsThe Journal of PediatricsVol. 228PreviewTo measure the impact of rapid influenza real-time qualitative reverse transcriptase polymerase chain reaction (RT-PCR) on patient management in busy pediatric emergency department (ED) and urgent care clinic settings. Full-Text PDF Willingness to Vaccinate Children against Influenza after the Coronavirus Disease 2019 PandemicThe Journal of PediatricsVol. 228PreviewTo determine factors associated with parents who plan to vaccinate their children against influenza next year, especially those who did not vaccinate against influenza last year using a global survey. Full-Text PDF