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In flu season management, POC molecular to the fore

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Anne Paxton

May 2017— Stacked against some of the nation’s previous bouts with influenza—such as the 2014–15 season—the 2016–17 flu season didn’t break records for drama.

To be sure, every flu season is different, and regional variation was prominent. In Central Texas, some outbreaks appeared to start later than usual, but the dominant viruses were the same as last year’s—H1N1, H3N2, and influenza B—says Bob Fader, PhD, chief of the virology and microbiology laboratory at Baylor Scott & White Health, Temple, Tex. The strains identified were a good match with this year’s trivalent and quadrivalent vaccine. Testing volume was up, as were positive PCRs.

From her vantage point in the northeast, “I’d say this season was about average,” says Donna M. Wolk, MHA, PhD, D(ABMM), system director of clinical and molecular microbiology for Geisinger Health System, Danville, Pa. “We had a diverse mixture of viruses throughout the entire respiratory season—nothing like two years ago when influenza predominated and the vaccine mismatch for flu strains was partly responsible for testing volumes five times that of our usual respiratory virus season.”

In Southern California, the outbreak was more substantial. “We had a heavy flu season,” says Omai Garner, PhD, D(ABMM), associate director of clinical microbiology and director of point-of-care testing for the UCLA Health System. “We counted a lot of positive PCRs this year, and our urgent cares and ERs were full. There were a lot of patients.”

But there was something more dramatic to note about this flu season, Dr. Garner says: Influenza testing technology has taken a big step forward.

For most clinicians, “Before this year, if you weren’t doing antigen testing for influenza, you were either using clinical discretion to diagnose, or you were sending the specimen to the lab and getting the result outside of the time frame that was clinically useful,” he says. But the recent approval of new CLIA-waived molecular influenza tests has triggered a whole new ball game. “You can now have a very sensitive test at the point of care. Before this flu season, that didn’t exist.”

In his dual role, helping to lead microbiology and point-of-care testing at UCLA, Dr. Garner says, “We’ve been thinking about how to improve our infectious disease testing for a long time. We completed an in-house evaluation, and we think that waived molecular influenza testing is going to represent a great solution for us.” The UCLA system plans to go live this fall with waived molecular testing in both of its emergency departments and most of its outpatient areas and study how it affects turnaround time and patient and physician satisfaction.

UCLA, which serves two 400–500-bed hospitals and 200 outpatient clinics, currently uses the Simplexa A/B & RSV PCR test in-house. “But in our very extended outreach network, we can’t turn around same-day results, so in a lot of our outpatient areas, we’re still using the poor antigen tests that are available.” The clinicians don’t trust them, and for inpatients they’ve been eliminated across the board.

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