Role of private labs in diagnosis of Swine Flu

1. Pandemic Influenza Role of Private Laboratories Dr Ashok Rattan, Chief Executive, Fortis Clinical Research Ltd., Adviser, Religare SRL Diagnostics, Fortis/ Escorts Hospitals, Delhi & NCR

5. Case Definitions for Infection with Novel Influenza A (H1N1) Virus A confirmed case of novel influenza A (H1N1) virus infection is defined as a person with an influenza-like illness with laboratory confirmed novel influenza A (H1N1) virus infection by one or more of the following tests: real-time RT-PCR viral culture A probable case of novel influenza A (H1N1) virus infection is defined as a person with an influenza-like-illness who is positive for influenza A, but negative for human H1 and H3 by influenza RT_PCR Optional A suspected case of novel influenza A (H1N1) virus infection is defined as a person who does not meet the confirmed or probable case definition, and is not novel H1N1 test negative, and is/has: a previously healthy person < 65 years hospitalized for ILI OR ILI and resides in a state without confirmed cases, but has traveled to a state or country where there are one or more confirmed or probable cases OR ILI and has an epidemiologic link in the past 7 days to a confirmed case or probable case

6. RNAse P for adequacy of sample Human Influenza A SRL uses ABI kit with four sets of primers, this kit is recommended by CDC / WHO

7. Swine Flu Swine Flu H1 (N1 is associated)

9. Interpretation of Real Time RT-PCR Swine Flu test Inconclusive results due to specimen quality -- -- -- -- Seasonal Flu & Swine Flu NOT detected + -- -- -- Swine Flu (10% of samples) + 2 out of 3 positive Seasonal Influenza A detected + -- -- + Swine Influenza H1N1 detected + + + + Reportable results Rnase P Swine H1 Swine Flu A Seasonal Flu A

10. Only Lab to obtain 100% concordance In PT samples supplied by NCDC

11. Day Wise Testing & Reporting (H1N1) From Gurgaon Reference Lab 12 42 117 11.09.09 32 89 62 10.09.09 31 71 99 09.09.09 29 76 68 08.09.09 16 40 71 07.09.09 29 68 46 06.09.09 21 49 62 05.09.09 19 58 50 04.09.09 23 68 84 03.09.09 18 56 62 02.09.09 14 55 46 01.09.09 11 37 62 31.08.09 06 35 32 30.08.09 03 14 30 29.08.09 Positive for swine flu Reports released Total Accessioned Date 28 th Aug Written permission from Govt of Delhi obtained Samples From Private patients collected from 29 th Aug onwards 46 342 (37 samples not in appropriate conditions, so not tested ) 379 Between 20 th & 24 th August from NICD Positive for swine flu Reports released Total Accessioned Date