Management of Prevalent Infections in Children Following a Disaster

Specimens for viral culture, immunofluorescent, or rapid diagnostic tests should be obtained if possible during the first 72 hours of illness, because the quantity of virus shed decreases rapidly as illness progresses beyond that point. Rapid enzyme immunoassay diagnostic tests for identification of influenza A and B antigens in respiratory tract specimens are available commercially, although their reported sensitivity (44%–97%) and specificity (76%–100%) compared with viral culture are variable and differ by test and specimen type. Additionally positive and negative predictive values of these influenza screening tests is influenced by the prevalence of circulating influenza viruses resulting in an increased likelihood of false-positive results during periods of low influenza activity. Direct fluorescent antibody (DFA) and indirect immunofluorescent antibody (IFA) staining for detection of influenza A and B antigens in nasopharyngeal or nasal specimens are available at most hospitalbased laboratories and can yield results in 3 to 4 hours. Reverse transcriptase-polymerase chain reaction (RT-PCR) testing of respiratory tract specimens may be available at some institutions and offers potential for high sensitivity and specificity in particular with the 2009-2010 H1N1 pandemic strain.