Rapid Influenza Research Articles

Rapid PCR Influenza Testing Decreases Inappropriate Empiric Antibiotic Use

Background: The clinical picture of influenza-like illness can mimic bacterial pneumonia, and empiric treatment is often initiated with antibacterial agents. Molecular testing such as polymerase chain reaction (PCR) is often used to diagnose influenza. However, traditional PCR tests have a slow turnaround time and cannot deliver results soon enough to influence the clinical decision making. The Detroit Medical Center (DMC) implemented the Xpert Flu test for all patients presenting with influenza-like illness (ILI). We evaluated antibacterial use after implementation of rapid influenza PCR Xpert Flu. Methods: We conducted a retrospective study comparing all pediatric and adult patients tested using traditional RT PCR during the 2017–2018 flu season to patients tested using the rapid influenza Xpert Flu during the 2018–2019 flu season in a tertiary-care hospital in Detroit, Michigan. These patients were further divided into 3 groups: not admitted (NA), admitted to acute-care floor (ACF), or admitted to intensive care unit (ICU). The groups were then compared with respect to percentage of antibacterial use after traditional RT PCR versus rapid influenza Xpert Flu testing during their hospital visit for ILI. The χ2 test was used for statistical analyses. Results: In total, 20,923 patients presented with influenza-like illness during the study period: 26% (n = 5,569) had the rapid influenza Xpert Flu and 73.4% (n= 15,354) had traditional RT PCR. For a comparison of the number of patients in 3 groups (NA, ACF, and ICU) and type of influenza PCR performed among these patients, please refer to Table 1. When comparing antibacterial use in the NA group, the proportions of patients who received antibacterial agents in the traditional RT PCR group versus the rapid influenza Xpert Flu group were 24.4% (n = 695) versus 3.9% (n = 450), respectively (P < .0001). In the ACF group, the proportions of patients who received antibacterial agents in the traditional RT PCR group versus the rapid influenza Xpert Flu group was 62.3% (n = 1,406) versus 27.7% (n = 994), respectively (P < .001). In the ICU group, the proportions of patients who received antibacterials in the traditional RT PCR group versus the rapid influenza Xpert Flu group were 80.3% (n = 382) versus 38.3% (n = 204), respectively (P < .0001). Conclusions: With rising antimicrobial resistance and increasing influenza morbidity and mortality, rapid diagnostics not only can help diagnose influenza faster but also can reduce inappropriate antimicrobial use.Funding: NoneDisclosures: None

S2846 A Case of COVID-19-Induced Diarrhea

INTRODUCTION: In early 2020, an outbreak of COVID-19 spread exponentially throughout the world causing a pandemic, with more than 3 million cases and more than 230,000 deaths both of which continue to rise. While the primary presentation has been fevers, cough, myalgias, and possible pneumonia, there have been some reports of gastrointestinal (GI) symptoms such as diarrhea in an estimated 1 to 10% of patients. This is a case of a patient who presented with primarily GI symptoms and was discovered to be COVID-19 positive. CASE DESCRIPTION/METHODS: A 93 year old Caucasian male from Massachusetts, with no history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), immunosuppression, recent travel, or sick exposure, presented with a subacute onset of nausea, vomiting and diarrhea. He reported 4–6 episodes per day of non bilious vomiting, and 8–10 episodes of large volume, watery, non-bloody diarrhea. Labs showed WBC 6,000/mL, mild lymphopenia 300/uL, hemoglobin 9gm/dL, hypokalemia, hypomagnesemia, CRP elevated to 24, and ESR of 8. Stool studies and blood cultures were negative, and he improved with supportive measures. On the third day of admission upon discharge, he developed hypoxia without SOB, cough, or fevers. CT angiography of the chest was then performed that showed multiple ground glass opacities (Figures 1-3). Rapid respiratory panel and influenza testing were negative, but SARSCOV2 PCR testing returned positive. He was treated with azithromycin 500mg for 5 days and hydroxychloroquine 400 mg twice daily by mouth for two doses, then 400 mg daily for 3 days. He was then discharged with strict self-quarantine orders. Follow-up labs in 2 weeks showed persistent leukopenia and lymphopenia, but otherwise he was afebrile with no new symptoms. DISCUSSION: While the primary symptoms of COVID-19 are respiratory, there have been increasing reports of diarrhea with one study demonstrating the presence of the virus in stool samples of 50% of COVID-19 patients. The pathophysiology is less understood, but revolves around angiotensin cleaving enzyme-2 (ACE-2) receptors and transmembrane protease serine 2 (TMPRSS2) found in high concentrations along the tract, which may be required for COVID entry into the GI tract leading to inflammation. This case adds to the increasing evidence of COVID induced GI inflammation, and it is vitally important to institute precautions against COVID-19 infection in patients that may present with primarily GI symptoms, especially in the midst of this pandemic.Figures 1-3.: Diffuse, fine, ground glass opacities seen in hilar and mediastinal regions.

Interim 2019/2020 Influenza Vaccine Effectiveness in Japan from October 2019 to January 2020.

Herein, we report the interim vaccine effectiveness (VE) of a quadrivalent inactivated influenza vaccine, during the 2019/2020 influenza season, in Japan. We conducted a retrospective observational cohort study of 381 patients aged ≥15 years, who were enrolled with influenza like illnesses and examined via the rapid influenza diagnostic test, at the Ambulatory Care unit of the National Center for Global Health and Medicine in Tokyo, Japan, from the beginning of October 2019 to the end of January 2020. VE was estimated using a test-negative design. VE was calculated as (1 - odds ratio) × 100%, comparing influenza A test positivity between vaccinated and unvaccinated patients. Of the 381 patients initially screened for inclusion, 314 were enrolled in the study. Of these, 105 were vaccinated, 98 were diagnosed with influenza A, and 5 were diagnosed with influenza B. Overall VE against influenza A was 27.6% (95% confidence interval [CI], ‒21.1 to +57.4), and in patients aged ≥65 years, it was 47.3% (95% CI, ‒76.0 to +86.0). This indicates that the influenza vaccination offered continued protection during the 2019/2020 influenza season, but a detailed analysis of more cases with a careful consideration of methodology is necessary to estimate VE more precisely.

Incorporating Real-time Influenza Detection Into the Test-negative Design for Estimating Influenza Vaccine Effectiveness: The Real-time Test-negative Design (rtTND).

With rapid and accurate molecular influenza testing now widely available in clinical settings, influenza vaccine effectiveness (VE) studies can prospectively select participants for enrollment based on real-time results rather than enrolling all eligible patients regardless of influenza status, as in the traditional test-negative design (TND). Thus, we explore advantages and disadvantages of modifying the TND for estimating VE by using real-time, clinically available viral testing results paired with acute respiratory infection eligibility criteria for identifying influenza cases and test-negative controls prior to enrollment. This modification, which we have called the real-time test-negative design (rtTND), has the potential to improve influenza VE studies by optimizing the case-to-test-negative control ratio, more accurately classifying influenza status, improving study efficiency, reducing study cost, and increasing study power to adequately estimate VE. Important considerations for limiting biases in the rtTND include the need for comprehensive clinical influenza testing at study sites and accurate influenza tests.

Beyond clinical trials: Evolutionary and epidemiological considerations for development of a universal influenza vaccine.

The prospect of universal influenza vaccines is generating much interest and research at the intersection of immunology, epidemiology, and viral evolution. While the current focus is on developing a vaccine that elicits a broadly cross-reactive immune response in clinical trials, there are important downstream questions about global deployment of a universal influenza vaccine that should be explored to minimize unintended consequences and maximize benefits. Here, we review and synthesize the questions most relevant to predicting the population benefits of universal influenza vaccines and discuss how existing information could be mined to begin to address these questions. We review three research topics where computational modeling could bring valuable evidence: immune imprinting, viral evolution, and transmission. We address the positive and negative consequences of imprinting, in which early childhood exposure to influenza shapes and limits immune responses to future infections via memory of conserved influenza antigens. However, the mechanisms at play, their effectiveness, breadth of protection, and the ability to “reprogram” already imprinted individuals, remains heavily debated. We describe instances of rapid influenza evolution that illustrate the plasticity of the influenza virus in the face of drug pressure and discuss how novel vaccines could introduce new selective pressures on the evolution of the virus. We examine the possible unintended consequences of broadly protective (but infection-permissive) vaccines on the dynamics of epidemic and pandemic influenza, compared to conventional vaccines that have been shown to provide herd immunity benefits. In conclusion, computational modeling offers a valuable tool to anticipate the benefits of ambitious universal influenza vaccine programs, while balancing the risks from endemic influenza strains and unpredictable pandemic viruses. Moving forward, it will be important to mine the vast amount of data generated in clinical studies of universal influenza vaccines to ensure that the benefits and consequences of these vaccine programs have been carefully modeled and explored.

Socioeconomic costs of influenza complications in hospitalized children.

Influenza may be correlated with a high number of complications and generate high costs of treatment. The study aimed to estimate the socioeconomic significance of hospitalized influenza cases. In the 2015-2016 flu season 157 children (median age 17 months) were hospitalized in the Department of Pediatrics. The diagnosis was confirmed with the rapid influenza diagnostic test (RIDT), polymerase chain reaction (PCR) or both. The study assessed the direct and indirect costs of hospitalization, including the cost of treatment, work absence and the related income lost. The frequency of complications among the children hospitalized was 57.3% (90/157), mainly due to pneumonia (31%) and bronchitis (23%). Patients with complications required longer hospital treatment (8 vs. 6 days, p < 0.01) and generated a higher total cost (€ 1042 vs. € 779, p < 0.01), including the patient's and systemic costs (€123 vs. € 94, p < 0.01 and € 916 vs. € 690, p < 0.01, respectively). Patients with complications had a 3.5-fold higher risk of generating higher (i.e., above median) costs. The difference in the costs between children aged under 2 and those over 2 years old was greater than the difference between children aged under 5 and those over 5 years old (€ 358 vs. € 253). Influenza complications generate higher systemic and patient's costs, both direct and indirect. The group of children for whom the difference is especially marked is under 2 years of age.

Epidemiology of influenza: findings from surveillance system of 40 hospital in Thailand, 2010-2019

Abstract Background Although recent efforts from some Asian countries to describe burden of influenza disease and seasonality, these data are missing for the vast majority, including the private section of Thailand. A near real-time laboratory-based influenza surveillance system, in a network of 40 hospitals was implemented aiming to determine influenza strains circulating in the private hospitals of Thailand and know characteristics, trend and burden of influenza viruses. Methods We obtained the data by monitoring patients with influenza-like illness (ILI) at a network of 40 private hospitals across Thailand. Throat-swab specimens in viral transport media were collected and transported within 24 h of collection using a cold-chain system. The respiratory samples were tested by rapid influenza diagnostic tests and real-time reverse transcription polymerase chain reaction. Results From January 2010 to November 2019, a total of 1,300,594 subjects were tested and 320,499 cases of influenza were identified. Of those positive cases, 116,317(36.3%) were influenza type B, 185,512(57.9%) were influenza A unspecified subtype, 8,833(2.7%) were influenza A(H1N1)pdm2009 and 6,371(1.9%) were seasonal influenza A(H3N2). Positive rate were 50.5 and 49.5 in female and male. Positivity rate was 41.4% in persons 15-49 years followed by 29.1% in 15-14 years, 17.6% in under five children and 11.7% in &amp;gt; 49 years. In 2018-2019 season, the highest positivity rate observed in February and March (39.3%) followed by April (34.2%) and January (32.3%) while the lowest positivity rate was in May (18.1%). Conclusions In Thailand, seasonal Influenza A(H3N2), Influenza A(H1N1)pdm2009 and Influenza B viruses were circulating during 2010-2019. In last season, positivity rate and number of cases peaked in February and March. Key messages Influenza is one of public health problems in Thailand. The need to introduce influenza vaccine and antivirus is important to prevent and treat the disease in future.

Correlation between Negative Rapid Influenza Diagnostic Test and Severe Disease in Hospitalized Adults with Laboratory-Confirmed Influenza Virus Infection.

.False-negative rapid influenza diagnostic test (RIDT) results could mislead physicians to exclude an influenza diagnosis. We sought to evaluate the association between negative RIDT and intensive care unit (ICU) admission. We reviewed data from hospitalized adults with laboratory-confirmed influenza virus infections in a tertiary referral hospital in Taiwan from July 2009 to February 2011. The diagnosis was documented by real-time PCR or virus culture. Of 134 hospitalized adults infected with influenza virus, 38 (28%) were admitted to the ICU. Compared with RIDT-positive patients, the percentage of ICU admission was significantly higher among RIDT-negative patients (46% versus 13%, P < 0.001). The RIDT-negative patients had higher percentages of lower respiratory symptoms and more chest radiograph infiltrates. The time interval between the RIDT and antiviral treatment was longer in RIDT-negative than RIDT-positive patients (1.94 days versus 0.03 days, P < 0.001). Among patients presenting with mild illness, only a negative RIDT and delayed antiviral treatment were associated with ICU admission after adjusting for potential confounding factors. To conclude, patients with a negative RIDT were more likely to have severe disease and a delay in initiating antiviral treatment. Our findings should help improve treatment outcomes of hospitalized patients with influenza infection.

LAST TWO INFLUENZA SEASON: EVALUATION OF SOLID ORGAN TRANSPLANT RECIPIENTS

Introduction and Purpose: Flu can cause serious complications and death especially in young children, elderly, pregnant women, patients with chronic diseases and immunosuppressive patients. In this study, solid organ transplantation recipients which were positive for influenza in laboratory in Baskent University Ankara Hospital in 2018-2019 and 2019-2020 influenza seasons were examined. Method: Patients who were admitted to our hospital with the diagnosis of influenza-like illness last two influenza seasons (September 2018- March 2019 and September 2019- February 2020) and who had positive influenza rapid antigen test (SofiaTM) or influenza PCR (VIASURE) test were included in the study. Demographic characteristics, laboratory and radiological findings, hospitalization and need for intensive care were recorded in IBM SPSS 25 program and their statistical analyzes were performed. Results: A total of 2060 tests were studied in the winter season of 2018-2019 and winter season2019-2020 in adults (≥18).Flu rapid antigen or PCR tests positivity was found in 521 tests (25.2%). Thirty-nine attacks were recorded in 38 patients with solid organ transplants. Twenty-four (63.1%) of these patients were male. Twenty-three (58.9%) of these attacks were due to Influenza A, ten (25.6%) of them were Influenza B. During this period three patients (7.6%) had combined influenza A and influenza B infections. Four patients (10.2%) had combined influenza B and RSV infections, while three patients (7.6%) had only RSV infections. The patients applied to the emergency department in 20 (51.3%) attacks and outpatient clinic in 11 (28.2%) attacks. Eight (20.5%) attacks developed in the inpatient. Only two patients (5.1%) were known to have been vaccinated. Twenty-five patients (64.1%) underwent chest X-ray. Thoracic CT was performed in 19 (48.7%) patients. All patients were given oseltamivir treatment, 26 (66.7%) patients received antibiotic treatment. Twenty-five patients (64.1%) were hospitalized due to influenza. Five of these patients (12.8%) needed intensive care support, two of them needed mechanical ventilator. Influenza was mortal in two patient (5.2%). Laboratory values of the patients were leucosyte 9898 ± 7829 (min 2380-max 35600), CRP 60.6 ± 72.5 (min 1- max 348). Discussion and Conclusion: Timely diagnosis and early treatment with antivirals reduce the duration of symptoms and reduces the risk of complications and hospitalizations. In addition, awareness of vaccination, which is the most important prevention method of influenza in solid organ transplant recipients, should be increased at the patient and physician awareness.

Clinical impact of rapid influenza PCR in the adult emergency department on patient management, ED length of stay, and nosocomial infection rate.

BackgroundSeasonal influenza causes significant morbidity and mortality and incurs large economic costs. Influenza like illness is a common presenting concern to Emergency Departments (ED), and optimizing the diagnosis of influenza in the ED has the potential to positively affect patient management and outcomes. Therapeutic guidelines have been established to identify which patients most likely will benefit from anti‐viral therapy.ObjectivesWe assessed the impact of rapid influenza PCR testing of ED patients on laboratory result generation and patient management across two influenza seasons.MethodsA pre‐post study was performed following a multifaceted clinical redesign including the implementation of rapid influenza PCR at three diverse EDs comparing the 2016‐2017 and 2017‐2018 influenza seasons. Testing parameters including turn‐around‐time and diagnostic efficiency were measured along with rates of bed transfers, hospital‐acquired (HA) influenza, and ED length of stay (LOS).ResultsMore testing of discharged patients was performed in the post‐intervention period, but influenza rates were the same. Identification of influenza‐positive patients was significantly faster, and there was faster and more appropriate prescription of anti‐influenza medication. There were no differences in bed transfer rates or HA influenza, but ED LOS was reduced by 74 minutes following clinical redesign.ConclusionsMultifaceted clinical redesign to optimize ED workflow incorporating rapid influenza PCR testing can be successfully deployed across different ED environments. Adoption of rapid influenza PCR can streamline testing and improve antiviral stewardship and ED workflow including reducing LOS. Further study is needed to determine if other outcomes including bed transfers and rates of HA influenza can be affected by improved testing practices.

The impact of early neuraminidase inhibitor therapy on clinical outcomes in patients hospitalised with influenza A-related pneumonia: a multicenter, retrospective study

BackgroundGuidelines emphasize prompt antiviral treatment in severe influenza patients. Although nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. Furthermore, data about the administration of NAIs in the real-world management of Flu-p in China are limited.MethodsData of patients hospitalised with FluA-p from five teaching hospitals in China from 1 January 2013 to 31 December 2018 were reviewed retrospectively. The impact of early NAI therapy on the outcomes in FluA-p patients, and the indications of early NAI administration by clinicians were evaluated by logistic regression analysis.ResultsIn total, 693 FluA-p patients were included. Of these patients, 33.5% (232/693) were treated early. After adjusting for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use, a multivariate logistic regression model showed that early NAI therapy was associated with decreased risk for invasive ventilation [odds ratio (OR) 0.511, 95% confidence interval (CI) 0.312–0.835, p = 0.007) and 30-day mortality (OR 0.533, 95% CI 0.210–0.807, p < 0.001) in FluA-p patients. A multivariate logistic regression model confirmed early NAI use (OR 0.415, 95% CI 0.195–0.858, p = 0.001) was a predictor for 30-day mortality in FluA-p patients and a positive rapid influenza diagnostic test was the only indication (OR 3.586, 95% CI 1.259–10.219, p < 0.001) related to the prescription of early NAI by clinicians.ConclusionsEarly NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.

Impact of Rapid Influenza Molecular Testing on Management in Pediatric Acute Care Settings

To 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. We developed a brief, elective survey that clinicians completed when an influenza RT-PCR order was placed in the ED or urgent care clinic between February 18, 2019, and March 13, 2019. We captured the clinical suspicion for influenza, intended management plans, and actual management plans once influenza RT-PCR results were available. We evaluated 339 encounters, of which 164 (48.4%) had a positive influenza RT-PCR. Clinical suspicion for influenza was a nonsignificant predictor for influenza PT-PCR positivity (P=.126). After rapid influenza RT-PCR results were available, clinicians changed their original plans in 44.5% of influenza RT-PCR positive vs 92.6% of influenza RT-PCR negative cases (P<.0001). Change in plans for antiviral use was observed in 26% of influenza positive vs 77% of influenza negative cases (P<.0001). A total of 135 antiviral prescriptions were avoided in patients with negative influenza RT-PCR. Implementation of a rapid and accurate influenza RT-PCR in the acute care setting is important to systematically diagnose influenza in children and improve outpatient management decisions, because clinical suspicion for influenza is inaccurate. A negative influenza RT-PCR decreases unnecessary antiviral use and has the potential for significant cost savings.

Does location of rapid influenza diagnostic testing influence treatment time and ancillary testing in a paediatric emergency department?

Influenza causes a significant burden of disease. Our aim was to assess whether location of rapid influenza diagnostic testing (RIDT) for patients with influenza-like illness (ILI) has an impact on ED treatment time or ancillary testing. This was a retrospective observational study in a tertiary paediatric ED during 2017 influenza season. All patients with ILI were included. Some had RIDT performed (ED bedside or at the laboratory). Primary outcome measure was the correlation of RIDT location to treatment time compared to patients with ILI with no RIDT. Secondary outcome measures were the correlation of RIDT location to ancillary testing and treatment with antibiotics. A total of 1451 patients with ILI were included. Eighty patients for whom RIDT was performed at the laboratory had a shorter treatment time in the ED when compared to the 215 patients for whom RIDT was performed bedside (2.8 and 3.4 h, respectively; P < 0.0001). However, treatment time was not statistically different when sub-analysed for admitted and discharged patients separately. Overall, patients with ILI and no RIDT had the shortest treatment time in the ED (1.7 h). There was no difference in ancillary testing and treatment with antibiotics between ILI patients for whom RIDT was performed bedside or at the laboratory regardless of admission. Location of RIDT may not have a significant impact on treatment time, ancillary testing and treatment with antibiotics. When RIDT was not performed, patients had the shortest treatment time.

Missed opportunities to use rapid influenza testing and severity assessment to avoid hospital admission: A cohort study from an East London District General Hospital.

Annual outbreaks of seasonal influenza cause a substantial health burden. The aim of this study was to compare patient demographic/clinical data in two influenza patient groups presenting to hospital; those requiring O2 or critical care admission and those requiring less intensive treatment. The study was conducted from 1 December 2017 until 1 April 2019 at a district general hospital in East London. Patient demographic and clinical information was collected for all patients who had tested influenza positive by near-patient testing. χ2 test was used for categorical variables to see if there were significant differences for those admitted and the Wilcoxon rank-sum test to compare the length of inpatient stay. Of 127 patients, 56 (44.1%) required oxygen or critical care. There were significant increases in National Early Warning Score (NEWS) observations (P %3C .001), Charlson comorbidity index (P = .049), length of inpatient stay (P %3C .001), and a strong association with increasing age (P = .066) when the more intensive treatment group was compared with the less intensive treatment group. A total of 13 (18.3%) of 71 patients not requiring oxygen or critical care were not admitted to the hospital. Following rapid influenza testing, NEWS scores, comorbidities, and age should be incorporated into a decision tool in Accident and Emergency to aid hospital admission or discharge decisions.

Effectiveness of trivalent inactivated influenza vaccines in children during 2017–2018 season in Korea: Comparison of test-negative analysis by rapid and RT-PCR influenza tests

ObjectivesIn Korea, the National Immunization Program provided trivalent inactivated influenza vaccines (IIV3) to all children aged 6–59 months during the 2017–2018 season. In this study, we aimed to evaluate the vaccine effectiveness (VE) of IIV3 in children during the 2017–2018 season. MethodsChildren aged 6–59 months who were tested for influenza for their acute respiratory illness in four hospitals during the 2017–2018 influenza season were included. We estimated the VE of IIV3 by test-negative case-control design based on the rapid influenza diagnostic test (RIDT) or reverse transcription polymerase chain reaction (RT-PCR) test results. ResultsA total of 4738 children were included in this study. The number of laboratory-confirmed influenza cases was 845 (17.8%), and there were 478 cases of influenza A and 362 cases of influenza B. The adjusted VE based on RT-PCR was 53.4% (95% CI, 25.3–70.5) against any influenza, 68.8% (95% CI, 38.7–84.1) against influenza A, and 29.7% (95% CI, −35.1 to 61.8) for influenza B. The adjusted VE based on RIDT was 14.8% (95% CI, −4.4 to 30.0) against any influenza, 24.2% (95% CI, 3.1–40.2) against influenza A, and −5.1% (95% CI, −42.6 to 21.4) against influenza B. Age-specific VE based on RT-PCR against any influenza was 44.1% (95% CI, −0.2 to 67.8) in children aged 6 months to 2 years and 59.3% (95% CI, 8.8–81.9) in children aged 3–<5 years. ConclusionOur results suggest moderate protection (53.4%) of IIV3 against RT-PCR laboratory-confirmed influenza in children in the 2017–2018 influenza season. However, the RIDT hampered the validity to assess VE during influenza season. Caution is needed when interpreting an RIDT-based test negative design influenza VE study.

Cost evaluation of point-of-care testing for community-acquired influenza in adults presenting to the emergency department.

Rapid molecular point-of-care tests (POCTs) for influenza have potential to produce cost savings in emergency departments (EDs) and acute care settings. To date, published projected savings have been based on estimated costs. This study aimed to describe the cost implications of a rapid influenza POCT using accurate real-world patient level costing data. 204 adult patients receiving point-of-care (POC) influenza testing in the ED as part of a routine clinical service were identified retrospectively, alongside a control cohort of 104 patients from the same influenza season. Costs for all were calculated at the individual patient level. Cost comparison was performed using an instrumental variable (IV) regression to overcome potential bias within the observational dataset. Patients who had a POCT on average cost 67 % less than those who did not (average cost reduction: £2066: 95 % CI: £624 and £2665). Moderate to high NEWS score at arrival, presence of ≥1 comorbidity, and age ≥70 years increased overall costs across both groups (p < 0.05). Savings from POC testing can be attributed to more targeted treatments, fewer admissions and reduced lengths of stay. The IV regression results are supported by a second method (ordinary least square against baseline characteristics). They are also in line with existing work that use estimated costs but indicate greater savings than predicted previously. In conclusion, POC influenza testing in the emergency department produces significant cost savings, this is demonstrated here through an analysis using individual real-world patient level costing data.

Rapid influenza diagnostic test at triage can decrease emergency department length of stay.

ObjectiveEven if performing rapid influenza diagnostic tests test will not change clinical decision making, we sometimes perform at triage to reduce length of stay in Japan. Whether performing rapid influenza diagnostic tests at triage may shorten emergency department (ED) length of stay (LOS) is remains unclear. We aimed to determine the utility of rapid influenza diagnostic tests at triage in shortening ED length of stay LOS.MethodsWe retrospectively reviewed medical records of patients discharged from our ED after receiving results from rapid influenza diagnostic tests during the influenza season from December, 2013 to March, 2019. Eligibility criteria were a walk‐in visit, age ≥15 years, triage performed, rapid influenza diagnostic test administered, and no admission. The triage group received rapid influenza diagnostic tests at triage. The after‐examination group received their tests only after examination by a doctor. The primary outcome was ED LOS after propensity score matching to adjust for several covariates.ResultsOf 2,768 eligible patients, 2,554 patients were enrolled in the triage group (n = 363) or after examination group (n = 2,191). There were 329 matched pairs after propensity score matching. Median ED LOS was significantly shorter in the triage group than in the after‐examination group after propensity score matching (81 min (interquartile range [IQR] 60 to 111) vs 106 min (IQR 80–142); median difference 24 min (95% confidence interval 17–30)).ConclusionsPerforming rapid influenza diagnostic tests at triage was associated with shorter ED LOS during the influenza season.

Rates of coinfection with other respiratory pathogens in patients positive for coronavirus disease 2019 (COVID‐19)

ObjectivesThe purpose of this study was to assess coinfection rates of coronavirus disease 2019 (COVID‐19) with other respiratory infections on presentation.MethodsThis is a retrospective analysis of data from a 2 hospital academic medical centers and 2 urgent care centers during the initial 2 weeks of testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), March 10, 2020 to March 23, 2020. Testing was targeted toward high‐risk patients following US Centers for Disease Control and Prevention guidelines. Demographics include age group and sex. Laboratory test results included SARS‐CoV‐2, rapid influenza A/B, and upper respiratory pathogen nucleic acid detection. Patient demographics and coinfections are presented overall and by test results with descriptive statistics.ResultsComplete laboratory results from the first 2 weeks of testing were available for 471 emergency department patients and 117 urgent care center patients who were tested for SARS‐CoV. A total of 51 (8.7%) patients tested positive for COVID‐19 with only 1 of these patients also testing positive for another respiratory infection. One of the patients positive for COVID‐19 also tested positive for influenza A. Among the 537 patients who were screened and tested negative for COVID‐19, there were 33 (6.1%) patients who tested positive in the upper respiratory pathogen nucleic acid detection test.ConclusionIn our study investigating coinfections among 51 patients testing positive for COVID‐19, 1 patient also tested positive for influenza A. Although we found limited coinfections in our emergency department and urgent care center patient populations, further research is needed to assess potential coinfection in patients with COVID‐19.

Performance of the Influ a + B K-SeT® assay as compared to two RT-PCR assays for detection of influenza virus

ObjectivesTo evaluate the performance of Influ A + B K-SeT®, a rapid influenza antigen detection kit, in order to determine whether its implementation as a point-of-care test in the emergency room (ER) is justified. MethodsNasopharyngeal swabs (n = 170) were collected in triplicates from patients with suspected influenza infection. One sample was tested by the Influ A + B K-SeT® kit and the other two samples were analyzed with Simplexa™ Flu A/B & RSV Direct Kit and Xpert® Flu, two RT-PCR-based assays routinely used in the ER. ResultsThe sensitivity and specificity of the Influ A + B K-SeT® kit were 91.2%–94.5% and 98.2%, respectively, compared to the Xpert® Flu assay and the Simplexa™ Flu A/B & RSV Direct Kit, respectively. ConclusionsConsidering the satisfactory diagnostic performance of the Influ A + B K-SeT® test, its implementation as a point-of-care is expected to aid in decision-making, minimize time-to-result and reduce healthcare costs.

Relative vaccine efficacy of high-dose versus standard-dose influenza vaccines in preventing probable influenza in a Medicare Fee-for-Service population

BackgroundHigh-dose (HD) influenza vaccine, currently the most commonly used vaccine among US seniors (aged ≥ 65 years), has been shown to be more efficacious than standard-dose (SD) vaccine in multiple randomized trials. This study evaluated the real-world relative vaccine effectiveness (rVE) of HD vs SD over four influenza seasons. MethodsThis study included Medicare Fee-for-Service enrollees who received HD or SD at an outpatient clinic or pharmacy during influenza seasons 2011–2012 through 2014–2015. Probable influenza (an inpatient stay with an influenza diagnosis on the claim, or an outpatient visit with a rapid influenza test/culture followed by an antiviral prescription) was assessed among HD recipients matched 1:1 with SD recipients by location, vaccination date, age, and sex. Fine-Gray subdistribution hazard models with competing risk of death were used to adjust for residual confounding. Analyses were stratified by outpatient vs pharmacy vaccination. ResultsAcross the four influenza seasons, there were 535,598, 1,017,552, 1,548,164, and 2,420,450 in the pharmacy cohort; and 821,662, 1,151,080, 1,559,488, and 2,421,758 in the outpatient cohort. During peak influenza season, rVEs for 2011–12 through 2014–15 were 21.8% (95% CI: −5.9%, 42.3%), 14.8% (9.3%, 19.9%), 16.9% (9.2%, 23.9%), and 17.2% (14.5%, 19.9%), respectively, in the pharmacy cohort; and 16.5% (−5.9%, 34.2%), 15.1% (10.9%, 19.1%), 10.0% (2.9%, 16.6%), and −0.2% (−3.0%, 2.5%), respectively, in the outpatient cohort. ConclusionHD was consistently associated with better protection against probable influenza. The lower treatment effect observed in the outpatient cohort could reflect provider bias due to physicians triaging HD to frailer patients.