The Infectious Diseases Society of America (IDSA) recommends use of rapid influenza molecular assays over rapid influenza diagnostic tests (RIDTs) for detection of influenza viruses in respiratory specimens of outpatients.
Serological testing does not provide timely results to inform clinical management decisions. As with any diagnostic test, results should be evaluated in the context of other clinical and epidemiologic information available to health care providers. The post-test probability or predictive values (positive and negative predictive values) of an influenza virus test depend upon the prevalence of circulating seasonal influenza viruses in the patient population, and the specific test characteristics (sensitivity and specificity) compared to a “gold standard” comparison test (molecular assay or viral culture). Sensitivity and specificity of any test for influenza viruses in respiratory specimens might vary by the type of testing method and specific test used, the time from illness onset to specimen collection, the quality of the specimen collected, the respiratory source of the specimen, handling and processing of the specimen, and the time from specimen collection to testing. Viral culture is important for public health purposes, but does not provide timely results to inform clinical management. Influenza Virus Testsĭiagnostic tests available for detection of influenza viruses in respiratory specimens include molecular assays (including rapid molecular assays, reverse transcription polymerase chain reaction (RT-PCR) and other nucleic acid amplification tests) and antigen detection tests (including rapid influenza diagnostic tests and immunofluorescence assays). During a respiratory illness outbreak in a closed setting (e.g., hospitals, long-term care facility, cruise ship, boarding school, summer camp) testing for influenza virus infection can be very helpful in determining if influenza is the cause of the outbreak.
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Most importantly, clinicians should understand the limitations of influenza virus tests and how to properly interpret the results, particularly negative results. Influenza virus testing is recommended for all patients with suspected influenza who are being admitted to hospital. However, influenza virus testing can inform clinical management when the results may influence clinical decisions such as whether to initiate antiviral treatment, perform other diagnostic testing, or to implement infection prevention and control measures for influenza. Influenza virus testing is not required to make a clinical diagnosis of influenza in outpatients with suspected influenza, particularly during increased influenza activity when seasonal influenza A and B viruses are circulating in the local community.
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