Skip to main content Accessibility help

Point-of-Care Testing for Pandemic Influenza and Biothreats

  • Richard F. Louie, Tyler Kitano, T. Keith Brock, Robert Derlet and Gerald J. Kost...


New and reemerging infectious diseases, such as pandemic viruses and resistant bacteria, pose a serious threat in the 21st century. Some of these agents represent global security threats. This review provides an overview of diagnostic challenges presented by pandemic influenza and biothreat agents. The article summarizes recent pandemics and disease outbreaks, point-of-care influenza diagnostic tests, biothreat agents, biothreat instrument systems, and technologies in development. It highlights how medical innovation and health care initiatives can help prepare health care professionals and public health personnel to handle future crises. Based on gap analysis for current point-of-care testing deficiencies, it concludes with policy recommendations that will enhance preparedness. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S193–S202)


Corresponding author

Address correspondence and reprint requests to Richard F. Louie, PhD, Medical Pathology and Laboratory Medicine, 3448 Tupper Hall, School of Medicine, University of California, Davis, Davis, CA 95616(e-mail:


Hide All
1.Kobasa, D, Takada, A, Shinya, K, et alEnhanced virulence of influenza A viruses with the haemaglutinin of the 1918 pandemic virus. Nature. 2004;431:703707.
2.Hoft, DF, Belshe, RB.The genetic archaeology of influenza. N Engl J Med. 2004;351:25502551.
3.Tumpey, TM, Basler, CF, Aguilar, PV, et alCharacterization of the reconstructed 1918 Spanish influenza pandemic virus. Science. 2005;310:7780.
4.Monto, AS.The threat of an avian influenza pandemic. N Engl J Med. 2005;352:323325.
5.Scholtissek, C, Rohde, W, von Hoyningen, V, et alOn the origin of the human influenza subtypes H2N2 and H3N2. Virology. 1978;87:1320.
6.Kawaoka, Y, Krauss, S, Webster, RG.Avian-to-human transmission of the PB1 gene of influenza A viruses in the 1957 and 1968 pandemics. J Virol. 1989;63:46034608.
7.World Health Organization. Global Alert and Response: Pandemic (H1N1) 2009–Update 61. Accessed August 13, 2009.
8.World Health Organization. Pandemic phase descriptions. Accessed June 12, 2009.
9.Kman, NE, Nelson, RN.Infectious agents of bioterrorism: a review for emergency physicians. Emerg Med Clin North Am. 2008;26:517547.
10.World Health Organization. Crimean-Congo Haemorrhagic Fever in Turkey. Accessed June 8, 2009.
11.World Health Organization. Chikungunya in India. Accessed June 8, 2009.
12.Charrel, RN, Lamballerie, X, Raoult, D.Chikungunya outbreaks—the globalization of vectorbourne diseases. N Engl J Med. 2007;8:769771.
13.Over 22,000 Chikungunya infections. Bangkok Post. May 29, 2009.
14.World Health Organization. End of Ebola Outbreak in the Democratic Republic of the Congo. Accessed June 8, 2009.
15.World Health Organization. Dengue/Dengue Haemorrhagic Fever in Brazil. Accessed June 8, 2009.
16.World Health Organization. Yellow Fever. Accessed June 8, 2009.
17.World Health Organization. Epidemic and Pandemic Alert and Response: 2002–Tularemia in Kosovo–Update 2. Accessed June 8, 2009.
18.Avian influenza: Situtation in Indonesia. Accessed June 8, 2009.
19.World Health Organization. Lassa Fever. Accessed June 8, 2009.
20.Briese, T, Janusz, PT, McMullan, LK, et alGenetic detection and characterization of Lujo virus, a new hemorrhagic fever-associated arenavirus from southern Africa. PLoS Pathog. 2009;4:e1000455.
21.World Health Organization. Marburg Haemorrhagic Fever. Accessed June 8, 2009.
22.World Health Organization. Meningococcal Meningitis. May 2003. Accessed June 9, 2009.
23.World Health Organization. Nipah Virus. Accessed June 8, 2009.
24.World Health Organization. Outbreaks of Rift Valley fever in Kenya, Somalia and United Republic of Tanzania, December 2006–April 2007. Wkly Epidemiol Rec. 2007;82:169178.
25.World Health Organization. Epidemic and Pandemic Alert and Response: Summary of Probable SARS Cases With Onset of Illness From 1 November 2002 to 31 July 2003. Accessed June 8, 2009.
26.West Nile virus activity–United States, 2007.MMWR Morb Mortal Wkly Rep. 2008;57:720723.
27.World Health Organization. Plague. Accessed June 8, 2009.
28.Thompson, WW, Weintraub, E, Dhankhar, P, et alEstimates of US influenza-associated deaths made using four different methods. Influenza Other Respir Virus. 2009;3:3749.
29.Thompson, WW, Shay, DK, Weintraub, E, et alMortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179186.
30.Centers for Disease Control and Prevention. Influenza: The Disease. Accessed June 4, 2009.
31.Derlet RW, Sandrock CE, Nguyen HH, et al. Influenza. Emedicine, April 27, 2009. Accessed May 19, 2009.
32.Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009;360:26052615.
33.Ginocchio, CC, Lotlikar, M, Falk, L, et alClinical performance of the 3M Rapid Detection Flu A+B Test compared to R-mix culture, DFA, and BinaxNow Influenza A+B Test. J Clin Virol. 2009;45:146149.
34.Ghebremedhin, B, Engelmann, I, Konig, W, et alComparison of the performance of the rapid antigen detection actin Influenza A&B test and RT-PCR in different respiratory specimens. J Med Microbiol. 2009;58:365370.
35.Grondhal, B, Puppe, W, Weigl, J, et alComparison of the BD Directigin Flu A+B kit and the Abbott TestPack RSV with a multiplex RT-PCR ELISA for rapid detection of influenza viruses and respiratory synctial virus. Clin Microbiol Infect. 2005;11:848850.
36.Hurt, AC, Alexander, R, Hibbert, J, et alPerformance of six influenza rapid tests in detecting human influenza in clinical specimens. J Clin Virol. 2007;39:132135.
37.Cazacu, AC, Demmler, GJ, Neuman, MA, et alComparison of a new lateral-flow chromatographic membrane immunoassay to viral culture for rapid detection and differentiation of Influenza A and B viruses in respiratory specimens. J Clin Microbiol. 2004;42:36613664.
38.Pabbaraju, K, Tokaryk, KL, Wong, S, et alComparison of the Luminex xTAG respiratory viral panel with in-house nucleic acid amplification tests for diagnosis of respiratory virus infections. J Clin Microbiol. 2008;46:30563062.
39.Kowalski, RP, Karenchak, LM, Romanowski, EG, et alEvaluation of the shell vial technique for detection of ocular adenovirus. Ophthalmology. 1999;106:13241327.
40.World Health Organization. WHO Recommendations on the Use of Rapid Testing for Influenza Diagnosis. July 2005. Accessed June 4, 2009.
41.Gall, A, Hoffmann, B, Harder, T, et alRapid haemagglutinin subtyping and pathotyping of avian influenza viruses by a DNA microarray. J Virol Methods. 2009;160:200205.
42.Townsend, MB, Dawson, ED, Mehlmann, M, et alExperimental evaluation of the FluChip diagnostic microarray for influenza virus surveillance. J Clin Microbiol. 2006;44:28632871.
43.Huang, Y, Tang, H, Duffy, S, et alMultiplex assay for simultaneously typing and subtyping influenza viruses by use of an electronic microarray. J Clin Microbiol. 2009;470:390396.
44.World Health Organization. Influenza A(H1N1) virus resistant to oseltamivir–2008/2009 influenza season, northern hemisphere. December 30, 2008. Accessed June 5, 2009.
45.Gubareva, L, Okomo-Adhiambo, M, Deyde, V, et alUpdate: drug susceptibility of swine-origin influenza A (H1N1) viruses. MMWR Morb Mortal Wkly Rep. 2009;58:433435.
46.Sharfstein JM. Amendment to RT-PCR Detection Panel: Emergency Use of the Swine Influenza Virus Real-Time RT-PCR Detection Panel. May 2, 2009. Accessed June 5, 2009.
47.Centers for Disease Control and Prevention. CDC Protocol of Real-Time RT-PCR for Influenza A (H1N1). Accessed June 4, 2009.
48.Khan, AS, Sage, MJ.Biological and chemical terrorism: strategic plan for preparedness and response—recommendations of the CDC Strategic Planning Workgroup. MMWR Morb Mortal Wkly Rep. 2000;49:114.
49.McBride, MT, Masquelier, D, Hindson, BJ, et alAutonomous detection of aerosolized Bacillus anthracis and Yersinia pestis. Anal Chem. 2003;75:52935299.
50.Hindson, BJ, Makarewicz, AJ, Setlur, US, et alAPDS: the autonomous pathogen detection system. Biosens Bioelectron. 2005;20:19251931.
51.Regan, JF, Makarewicz, AJ, Hindson, BJ, et alEnvironmental monitoring for biological threat agents using the autonomous pathogen detection system with multiplexed polymerase chain reaction. Anal Chem. 2008;80:74227429.
52.Jernigan, DB, Raghunathan, PL, Bell, BP, et alInvestigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Emerg Infect Dis. 2002;8:10191028.
53.Baillie, LWJ.Past, imminent and future human medical countermeasures for anthrax. J Appl Microbiol. 2006;101:594606.
54.Shepard, CW, Soriano-Gabarro, M, Zell, ER, et alAntimicrobial post exposure prophylaxis for anthrax: adverse events and adherence. Emerg Infect Dis. 2002;8:11241132.
55.Kost, GJ.Newdemics, public health, small-world networks, and point-of-care testing. Point of Care. 2006;5:138144.
56.Jamison, DT, Breman, JG, Measham, AR, et alPriorities in Health. Washington, DC: The World Bank; 2006:216.
57.Louie, RF, Sumner, SL, Belcher, S, et alThermal stress and point-of-care testing performance: suitability of glucose test strips and blood gas cartridges for disaster response. Disaster Med Public Health Preparedness. 2009;3:1317.
58.FluView. 2008–2009 Influenza Season Week 22 ending June 6, 2009. Accessed June 12, 2009.
59.Bisoffi, M, Hjelle, B, Brown, DC, et alDetection of viral bioagents using a shear horizontal surface acoustic wave biosensor. Biosens Bioelectron. 2008;23:13971403.
60.Zhu, H, Stybayeva, G, Macal, M, et alA microdevice for multiplexed detection of T-cell-secreted cytokines. Lab Chip. 2008;8:21972205.
61.Kost, GJ, Korte, B, Beyette, F, et alThe NIBIB Point of Care Technologies Research Network center themes and opportunities for exploratory POC projects. Point of Care. 2008;7:41.
62.Lam, C, Waldhorn, R, Toner, E, et alThe prospect of using alternative medical care facilities in an influenza pandemic. Biosecur Bioterror. 2006;4:384390.


Point-of-Care Testing for Pandemic Influenza and Biothreats

  • Richard F. Louie, Tyler Kitano, T. Keith Brock, Robert Derlet and Gerald J. Kost...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed