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Preparing for Flu Testing Season? Consider Lessons Learned from Last Year

September 14th, 2018 / Christine Valle

Lab directors describe use of VERIGENE® RP Flex, plus practical tips for meeting demand

Preparing for Flu Testing Season? Consider Lessons Learned from Last Year

The 2017-2018 flu season was one for the record books, and it served to impart several key lessons for clinical labs offering respiratory testing. That was the theme of a recent CAP Today webinar featuring speakers from leading laboratories at Cedars-Sinai Medical Center and Northwell Health. Both lab directors offered important lessons and practical tips to help other facilities plan for the upcoming flu season.

Influenza Rates Reaching Triple the Average Peak Levels

To illustrate the severity of the last flu season, the webinar included some significant trends and statistics. Margie Morgan, PhD, D(ABMM), director of microbiology at Cedars-Sinai in Los Angeles, noted that the demand began surging in late December; some nights her team ran as many as 100 rapid antigen point-of-care tests. At Northwell Health in New York City, molecular diagnostics director Gregory Berry, PhD, D(ABMM), reported that the “incredible spike” of flu cases had his team running as many as 600 tests per day, with the weekly reported influenza rates reaching triple the average peak levels.

That spike had serious consequences for both clinical labs, including shortages of tests and reagents. Morgan, who had ordered an unusually large number of rapid antigen tests and VERIGENE® Respiratory Pathogens Flex Tests (RP Flex) for the season, still found herself scrambling to fulfill her hospital’s needs. The situation was made worse because some physicians did not understand the lab’s flu algorithm and inadvertently ordered duplicate tests. Berry also encountered issues due to nationwide supply bottlenecks, but said his team got by thanks to bringing in additional instruments. “We were able to work with Luminex and get two units dropped in as an emergency measure,” he said, referring to the VERIGENE system.

Lessons for Surviving Drastic Demand Spikes

Despite the array of problems their labs faced, both directors focused on lessons learned, offering webinar attendees tips for how to survive drastic spikes in demand. Redundancy is one key ingredient; having multiple testing platforms, particularly those with complementary functions, is essential for overcoming supply shortages. Morgan and Berry mentioned the unusually high rates of influenza B and RSV seen during the 2017-18 season, underscoring the importance of having a test that covers both flu A/B as well as RSV. The lab teams will also work to improve education about specimen collection protocols, when to order a test, and more.

The low sensitivity of the rapid antigen assay used for point-of-care testing — the speakers cited rates ranging from 30% to 60% — led to decisions to reduce its use at Cedars-Sinai, where it will still be used for outpatients due to cost. At Northwell, the plan is to phase out rapid antigen testing for all hospital-based laboratory tests.

Preparing for the Upcoming Season

For the coming flu season, Morgan’s lab will once again use the RP Flex test in a targeted manner for primary flu A/B and RSV testing and the entire panel for more complex cases, such as with immunocompromised patients. The RP Flex’s targeted flexible testing allows her team to manage costs carefully, while generating a great deal of information for optimal patient care.

The speakers also agreed that it’s not too early to start planning for the upcoming flu season. Morgan, for instance, has already met with her emergency department and begun monitoring influenza results reported from Australia and Asia to get a sense of what to expect.

While last flu season hit clinical labs hard, it was a chance to really explore what it takes to establish a robust workflow. “It was a year that taught us a lot of valuable lessons,” Berry said.

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CAP Today - Aftermath of an Overwhelming Flu Season: A Discussion on Lessons Learned