Selected laboratory aspects of influenza surveillance

The importance of virologically documented infections in influenza surveillance is well recognized and has been reaffirmed in recent reviews. The large number of specimens tested in surveillance make efficiency and low cost of virologic methods important. Based on observations made by others and our work with reisolation of stored specimens we have used the continuous line tissue cultures MDCK and LLC-MK2 for virus isolation in large-scale influenza surveillance studies for three years. Both cell lines were equally successful in detecting influenza A viruses in 77 fresh, virus-positive specimens. However, during the influenza B outbreak of 1979--80, of 473 specimens positive in either or both tissue cultures, 54 were positive only in MDCK and just six in LLC-MK2 only. For parainfluenza viruses, LLC-MK2 was much superior to MDCK. The most promising alternative to tissue culture at this time, based on a review of the literature, appears to be enzyme immunoassay. Sensitivity sufficient for direct detection of viral antigen in routine specimens currently requires fluorescent or radioactive substrates. Identification of early virus growth in continuous cell line cultures by enzyme immunoassay is practical now and can be considered.