An under-recognized influenza epidemic identified by rapid influenza testing, Southern Sri Lanka, 2013

L. Gayani Tillekeratne, Champica K. Bodinayake, Ajith Nagahawatte, Dhammika Vidanagama, Vasantha Devasiri, Wasantha Kodikara Arachchi, Ruvini Kurukulasooriya, Aruna Dharshan De Silva, Truls Østybe, Megan E. Reller, Christopher W. Woods

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Influenza accounts for a large burden of acute respiratory tract infections in high-income countries; data from lower-income settings are limited due to lack of confirmatory testing. Consecutive outpatients presenting to the largest tertiary care hospital in southern Sri Lanka were surveyed for influenza-like illness (ILI), defined as acute onset of fever ≥ 38.0°C and cough. Patients were administered a questionnaire and nasal/nasopharyngeal sampling for rapid influenza A/B testing. We enrolled 311 patients with ILI from March to November 2013: 170 (54.7%) children and 172 (55.3%) males. Approximately half (147, 47.3%) tested positive for influenza, but 253 (81.4%) were prescribed antibiotics. On bivariable analysis, symptoms associated with influenza included pain with breathing (P < 0.001), headache (P = 0.005), fatigue (P = 0.003), arthralgias (P = 0.003), and myalgias (P = 0.006) in children and pain with breathing (P = 0.01), vomiting (P = 0.03), and arthralgias (P = 0.03) in adults. Our final clinical predictive models had low sensitivity and fair specificity-50.0% (95% CI: 38.6-61.4%) and 83.2% (95% CI: 73.4-90.0%), respectively, in children and 52.2% (95% CI: 39.9-64.2%) and 81.4% (95% CI: 70.0-89.4%), respectively, in adults. Our study confirms the ability of rapid influenza testing to identify an influenza epidemic in a setting in which testing is not routinely available.

Original languageEnglish (US)
Pages (from-to)1023-1029
Number of pages7
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number5
StatePublished - May 1 2015

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases


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