Can Your Physician Definitively Diagnose You with Swine Flu (Type A Novel H1N1) ? The Answer Might Surprise You.
After a wonderful 6 day vacation in California my wife and I headed back to Tennessee but my wife didn’t come home alone, she came home with a rapidly changing fever, body aches, headaches, and nausea. In all honesty “Swine Flu (Type A Novel H1N1)” didn’t even cross my mind. Considering we traveled back to Tennessee from California on two different flights it would be easy to understand contracting some kind of illness from being around so many people but no one thinks it can happen to them.
[singlepic id=51 w=240 h=200 float=left]About two days into a rising fever that floated from 99.6 to 101.4 degrees my wife decided to head to the doctor. Once she made it into the clinic she registered a heart wrenching 103.5 degrees. After some back and forth and somewhere around fourteen phone calls including the Centers for Disease Control and Prevention (CDC) the doctor came back and was candidly honest with my wife and mother. Much to his dismay he informed them that there was no sub-type specific test available to detect the swine flu (Novel Influenza Type A (H1N1)) without lengthy laboratory analysis. (My wife was told results would take between 7 – 14 days to get back)
You might be asking so what does this mean? There is no way for physicians to test specifically for the swine flu (Novel Influenza Type A (H1N1)) without a positive culture or RT-PCR performed by an approved laboratory. This means that you’ll be completely better or dead before you can find out whether or not you actually had the swine flu and not some other sub-type of the Type A virus. (Which includes the seasonal flu)
According to the CDC, “At this time, there are only two FDA cleared assays for confirmation of novel influenza A(H1N1) virus infection, including the CDC rRT-PCR Swine Flu Panel assay; however, experimental rRT-PCR assays, not approved or authorized by FDA, may be able to detect novel influenza A (H1N1) virus infection.”(source)
The two CDC approved tests are “real-time reverse transcriptase-polymerase chain reaction (rRT-PCR)” and “laboratory analyzed viral cultures” but the only test physicians can use is the “Rapid influenza diagnostic tests (RIDTs)”. I’m not a physician so if you’d like to know the details of each test you’ll need to do some research (See the Links at the bottom of the page) or ask your physician. What is important is what the CDC has to say about each test.
RIDT’s: According to the CDC website, “None of the currently FDA approved RIDTs can distinguish between influenza A virus subtypes (e.g. seasonal influenza A (H3N2) versus seasonal influenza A (H1N1) viruses), and RIDTs cannot provide any information about antiviral drug susceptibility.” (Source)
rRT-PCR Swine Flu Panel: “The rRt-PCR Swine Flu Panel test should be ordered to presumptively diagnose novel influenza A (H1N1) infection only.” (Source)
Further, “A positive test result from the rRt-PCR Swine Flu Panel indicates that the patient is presumptively infected with novel influenza A (H1N1).” (Source)
According to Merriam-Webster’s Medical Dictionary, Presumptive is “expected to develop in a particular direction under normal conditions” (Source)
CDC had the following to say when comparing the RIDT’s (Only test physician can perform) and The rRt-PCR Swine Flu Panel test ,
“These tests differ in their sensitivity and specificity in detecting influenza viruses as well as in their commercial availability, the amount of time needed from specimen collection until results are available, and the tests’ ability to distinguish between different influenza virus types (A versus B) and influenza A subtypes (e.g. novel H1N1 versus seasonal H1N1 versus seasonal H3N2 viruses).” (Source)
I’m left with one VERY important question, What does the CDC consider a confirmed case of Swine Flu?
The CDC uses the following guidelines: 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:
The CDC has this to say about the real-time RT-PCR test, “If reactivity of real-time RT-PCR for influenza A is strong (e.g. Ct <30) it is more suggestive of a novel influenza A (H1N1) virus. Confirmation as novel influenza A (H1N1) virus by real-time RT-PCR was originally performed only at CDC, but at this time may be available in your state public health laboratory.” (Source) What I’m left wandering is how something based on suggestion turns conclusive. I couldn’t find any information where the CDC elaborates.
The CDC has this to say about Viral Cultures: “Isolation of novel influenza A (H1N1) virus is diagnostic of infection, but may not yield timely results for clinical management. A negative viral culture does not exclude infection with novel influenza A (H1N1) virus.” Seeing the word “Diagnostic” is a move in the right direction but I am a bit discouraged when they say a negative culture does not exclude an infection. My hopes are this leaves room for human error when collecting the cultures and isn’t proclaiming the culture test itself is flawed.
So what exactly am I getting at? There is no way for a physician or health organization to definitively tell a patient whether they have H1N1, H3N2, or any other Influenza A sub-type (Which includes seasonal flu) when using readily available RIDT’s. The only diagnostic results come from the lengthy process of laboratory analyzed cultures and rRt-PCR swine flu panels.
If you have any information you think I should add or anything you’d like to say feel free to leave a comment.
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Merriam-Webster Medical Source: