The multicentre, open-label, randomised controlled trial evaluating the molecular point-of-care test-and-treat strategy for influenza (FluPOC) has shown that the routine use of this strategy improves influenza detection and other clinical outcomes in hospitalised patients.¹  

Influenza remains a major public health challenge across the world, causing an estimated 3–5 million cases of acute respiratory illness and 650,000 deaths a year.² Given its significant burden on healthcare, there is considerable interest in understanding effective influenza management.³ Early detection and administration of antiviral drugs have been identified as an important intervention to shorten symptom duration, prevent hospitalisation and/or complications, and reduce mortality in patients with influenza.^4-6 However, long turnaround times of centralised laboratory polymerase chain reaction testing often delay the rate of diagnosis within hospitals, which contributes to the inappropriate and late use of antiviral drugs and isolation facilities.⁷ Hence, researchers of the FluPOC trial investigated the possibility of a more efficient and accurate diagnostic tool to improve influenza management within hospitals via the use of molecular point-of-care tests (mPOCTs).¹

Over two influenza seasons from Dec 2017 to May 2019, the FluPOC trial included 613 patients with acute respiratory illness who were within 16 hours of admission to two hospitals in Hampshire, United Kingdom.¹ All patients were 18 years and older, with acute respiratory illness of 10 days or fewer duration before admission to hospital. Participants were randomly assigned to undergo mPOCT (n=307, of which 100 patients had influenza), or routine clinical care (n=306, of which 102 patients had influenza). The primary outcome was the proportion of patients with influenza who were treated appropriately with antivirals within 5 days of admission, whereas the secondary outcomes include time to antiviral treatment, isolation facility use, and clinical outcomes.

The findings revealed that all patients with influenza in the mPOCT group were diagnosed, as compared with 59% of patients with influenza in the control group (relative risk [RR]=1.7; 95% confidence interval [CI] 1.7–1.7; p<0.0001).¹ Antiviral treatment was administered within 5 days of admission in 99% of patients with influenza in the mPOCT group, versus 62% of the control group (RR=1.6; 95% CI 1.4–1.9; p<0.0001), with the median time to antiviral treatment being 6 times longer in the control group (95% CI 0.0–6.0; p=0.0039). Isolation to single-room accommodation occurred in 70% of patients with influenza in the mPOCT group, versus 38% in the control group (RR=1.8; 95% CI 1.4–2.4; p<0.0001). There were 19 adverse events in the mPOCT group compared with 34 adverse events in the control group.

This study highlights the role of routine mPOCT as a promising new standard of care in hospitals during the influenza season.¹ Given the broad inclusion criteria and multicentre design of this study, the results suggest a possible application of mPOCT across similar institutions. Further research on the application of mPOCT should be promoted for better patient care and to replace laboratory-based diagnostics for acute admissions to hospital.

References:

1. Clark TW, et al. Lancet Respir Med doi: 10.1016/S2213-2600(20)30469-0. Online ahead of print.
2. World Health Organization. Influenza (Seasonal). Available at: https://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal). Accessed 4 Jan 2021.
3. Szucs TD. Virus Res 2004;103:25–30.
4. Dobson J, et al. Lancet 2015;385:1729–1737.
5. Muthuri SG, et al. Lancet Respir Med 2014;2:395–404.
6. Muthuri SG, et al. J Infect Dis 2013;207:553–563.
7. Brendish NJ, et al. J Infect 2015;71:501–510.