Main Article Content
avian influenza, is a highly pathogenic agent that causes epidemic
in the world with high mortality. Most cases are preschool and
school children. Anti-viral drug is effective when given at early
phase. The gold standard for the diagnosis of influenza is viral
culture, which takes 2 to 10 days. A rapid and accurate diagnostic
test is needed to control further viral infection.
Objective To determine the accuracy of RT-PCR as a diagnostic
test for children with influenza compared with viral culture.
Methods A cross-sectional study was conducted in primary health
cares of Jetis I, Godean I, II and Dr Sardjito Hospital Yogyakarta
between January 2005 and May 2007. The specimens, taken by
trained health personnel, were collected from both anterior nares
and throat of children aged from birth to 14 years who met the
eligibility criteria, then were stored in a frozen extraction tube
and sent to Jakarta for RT-PCR and viral culture as the gold
Results There were 34 7 children enrolled in this study. Influenza
infection was confirmed in 63 children (18.2%). There were 24
children with H3N2 subtype of influenza virus, 13 children with
HINI subtype, and one child with H5Nl subtype. The sensitivity,
specificity, positive and negative predictive value, positive and
negative likelihood ratio of RT-PCR test were 89%, 90%, 67%,
97%, 9, 3, 0, and 12 respectively.
Conclusions RT-PCR is accurate enough as influenza diagnostic
test in children.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
disease, diagnosis and treatment. Philadelphia: W.B Sauders
company; 1993. p. 250-5.
2. Shimizu, K. History of influenza epidemics and discovery of
influenza virus. Nippon Rinsho 1997;55:2501-11.
3. The Advisory Committee on Imunization Practices (ACIP).
Clinical description and diagnosis: recommendations of
prevention and control of influenza [homepage on the
internet]. c2006 [updated 2006 June 28; cited 2007 July
13]. Available from: http: //www.cdc.gov/mmwr/preview/
4. Hay A, Gregory V, Douglas A, Lin Y. The evaluation of
18. Atmar RL, Baxter BD, Domingoez EA, Taber LH. Compari-
human influenza viruses. Phi los Trans R Soc Lond B Biol Sci
2001 ;356: 1861-70.
5. Jawetz, Melnick, Adelberg. Orthomyxoviruses. Medical
microbiology. 20th ed. New York: Lange; 2002. p. 459-69.
6. Wright P. Influenza viruses. In: Behrman RE, Kliegman RM,
Jenson HB, editors. Nelson textbook of pediatrics. Philadel-
pia: Saunders; 2007.
7. Kartasasmita C. Influenza. In: Ranuh IGN, Kartasasmita
CB. Pedoman imunisasi di Indonesia. 2nd ed. Jakarta: Satgas
imunisasi Ikatan Dokter Anak Indonesia; 2005. p. 50-158.
8. World Health Organization. Guidelines of influenza
[homepage on the internet]. c2005 [updated 2005; cited
2007 July 13]. Available from: http://www. who.int.
9. The Advisory Committee on Immunization Practices (ACIP).
Influenza symtoms and laboratory diagnostic procedures:
recommendations of prevention and control of influenza
[homepage on the internet]. c2006 [updated 2006; cited 2007
July 13]. Available from: http://www.cdc.gov.
10. Call S, Vollenweider M, Hornung C, Simel D, McKinney W.
Does the patient have influenza?. JAMA 2005;293:987-97.
11. Ikatan Dokter Anak Indonesia. Flu burung, deteksi dini dan
penanganan awal. Jakarta: IDAI; 2007.
12. The Advisory Committee on Immunization Practices (ACIP).
Rapid diagnostic testing for influenza: recommendations
of prevention and control of influenza [homepage on
the internet]. c2006 [updated 2006; cited 2007 July 13[.
Available from: http://www.cdc.gov.
13. Dominguez EA, Taber LH, Couch RB. Comparison of rapid
diagnostic techniques for respiratory syncytial and influenza
A virus respiratory infection in young children. J Clin
Microbiol 1993;31 :2286-90.
14. Grijalva CG, Poehling KA, Edward KM, Weinberg GA, Staat
MA, Iwane MK, et a/. Accuracy and interpretation of rapid
influenza test in children. Pediatric 2007;119:e6-e11.
15. The Advisory Committee on Immunization Practices (ACIP).
Role of laboratory diagnosis of influenza: recommendations
for prevention and control of influenza [homepage on the
internet]. c2006. [updated 2006; cited 2007 July 13]. Available
16. Innis MA, White TJ. PCR Protocol. 1" edition. California:
Academic Press Inc; 1990.
17. Purwanta M, Lusida M.I , Handayani R. Polymerase chain
reaction. In: Putra ST, editor. Biologi molekuler kedokteran.
1st ed. Surabaya: Airlangga University Press, 1977. p. 150-
18. Atmar RL, Baxter BD, Domingoez EA, Taber LH. Compari-
son of reverse transcription-PCR with tissue culture and other
rapid diagnostic assays for detection of type A Influenza virus.
J Clin Microbiol1996;34:2604-06.
19. Beckett CG, Kosasih H, Ma'rufC, Listiyaningsih E, Elayazar
IR, Wuryadi, Yuwono D. Influenza surveillance in Indonesia
1999-2003. Clin Infect Dis 2004;39:443-49.
20. Ruest A, Michaud S, Deslandes S, Frost EH. Comparison
of the directiogen flu A+ B test, the quick influenza test,
and clinical case definition to viral culture and reverse
transcription-PCR for rapid diagnosis of influenza virus
infection. J Clin Microbiol 2003;41;3487-92.