Outcomes of a Negative Rapid Influenza Diagnostic Test in Pregnant Women

Abstract

Objective The objective of this study was to evaluate the negative predictive value (NPV) of a rapid influenza diagnostic test (RIDT) compared with polymerase chain reaction (PCR) in pregnant women.

Study Design Retrospective cohort study of pregnant women with a negative RIDT followed by confirmatory PCR for influenza A, H1N1, and B during the influenza seasons from 2012 to 2015.

Results The NPV of the RIDT was 85.4% (211 of 247), 93.5% (231 of 247), and 97.9% (242 of 247) for influenza A, H1N1, and B, respectively. Antiviral treatment was administered to 47.2% (17 of 36) of women with a false-negative RIDT for influenza A compared with 9.0% (19 of 211) of women with a true-negative RIDT (p< 0.001). Patients were more likely to receive antiviral treatment if they were feverish (adjusted odds ratio [aOR]: 6.05, 95% confidence interval [CI]: 1.83–20.03), had cough (aOR: 6.43, 95% CI: 1.06–39.26), dyspnea (aOR: 6.41, 95% CI: 1.63–25.29), or had a subsequently positive PCR (aOR: 9.41, 95% CI: 3.13–28.31).

Conclusion Up to 14.5% of women with a negative RIDT in pregnancy had positive influenza A by PCR of whom more than half did not receive antiviral treatment.

Keywords

influenza - pregnancy - diagnostic test - rapid - treatment

Note

Oral presentation at the Infectious Disease Society of Obstetrics and Gynecology Annual Meeting in Annapolis, Maryland, August 11–13, 2016.

• References

• 1 Louie JK, Salibay CJ, Kang M, Glenn-Finer RE, Murray EL, Jamieson DJ. Pregnancy and severe influenza infection in the 2013-2014 influenza season. Obstet Gynecol 2015; 125 (01) 184-192
• 2 Rasmussen SA, Jamieson DJ. 2009 H1N1 influenza and pregnancy--5 years later. N Engl J Med 2014; 371 (15) 1373-1375
• 3 Center for Disease Control and Prevention. Guidance for clinicians on the use of rapid influenza diagnostic tests. Atlanta, GA: US Department of Health and Human Services; 2017. Available at: http://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm . Accessed October 13, 2017
• 4 Chartrand C, Leeflang MM, Minion J, Brewer T, Pai M. Accuracy of rapid influenza diagnostic tests: a meta-analysis. Ann Intern Med 2012; 156 (07) 500-511
• 5 Dale SE. The role of rapid antigen testing for influenza in the era of molecular diagnostics. Mol Diagn Ther 2010; 14 (04) 205-214
• 6 Peci A, Winter AL, King EC, Blair J, Gubbay JB. Performance of rapid influenza diagnostic testing in outbreak settings. J Clin Microbiol 2014; 52 (12) 4309-4317
• 7 Fielding JE, Kelly HA, Mercer GN, Glass K. Systematic review of influenza A(H1N1)pdm09 virus shedding: duration is affected by severity, but not age. Influenza Other Respir Viruses 2014; 8 (02) 142-150
• 8 Kim JC, Kim HM, Kang YM. , et al. Severe pathogenesis of influenza B virus in pregnant mice. Virology 2014; 448: 74-81
• 9 Gao F, Loring C, Laviolette M, Bolton D, Daly ER, Bean C. Detection of 2009 pandemic influenza A(H1N1) virus Infection in different age groups by using rapid influenza diagnostic tests. Influenza Other Respir Viruses 2012; 6 (03) e30-e34
• 10 Meschi S, Selleri M, Lalle E. , et al. Duration of viral shedding in hospitalized patients infected with pandemic H1N1. BMC Infect Dis 2011; 11: 140
• 11 Center for Disease Control and Prevention. Recommendations for obstetric health care providers related to use of antiviral medications in the treatment and prevention of influenza. Atlanta, GA: US Department of Health and Human Services; 2017. Available at: https://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm . Accessed October 13, 2017
• 12 Williams LO, Kupka NJ, Schmaltz SP, Barrett S, Uyeki TM, Jernigan DB. Rapid influenza diagnostic test use and antiviral prescriptions in outpatient settings pre- and post-2009 H1N1 pandemic. J Clin Virol 2014; 60 (01) 27-33
• 13 Chu H, Lofgren ET, Halloran ME, Kuan PF, Hudgens M, Cole SR. Performance of rapid influenza H1N1 diagnostic tests: a meta-analysis. Influenza Other Respir Viruses 2012; 6 (02) 80-86
• 14 Lynd LD, Goeree R, O'Brien BJ. Antiviral agents for influenza: a comparison of cost-effectiveness data. Pharmacoeconomics 2005; 23 (11) 1083-1106