Guidelines for selecting respiratory virus testing

Several options are available for respiratory virus testing. Test selection should be guided by the clinical setting and facility. Many options detect combinations of respiratory viruses, particularly influenza A and B, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). For additional information, refer to the individual test descriptions linked below.

Additional clinical recommendations are also available for University of Washington providers on OCCAM.

Additional information on viruses circulating in the Seattle area can be found on the Pacific Northwest Respiratory Virus Dashboard.

Ambulatory Settings

• For routine testing, order Influenza A/B, RSV & SARS CoV2 (COVID 19) PCR Panel [FLRSNC]. This panel detects and differentiates influenza A, influenza B, RSV, and SARS-CoV-2.
• For symptomatic outpatients at FHCC South Lake Union, use COVID/FLU/RSV Respiratory Panel, Rapid PCR [FABRCV] or Rapid Flu, RSV, SARS-CoV-2 PCR w/ Extended PCR Reflex [FABRCX].
  
  • COVID/FLU/RSV Respiratory Panel, Rapid PCR [FABRCV] may also be used for symptomatic outpatients at clinics located on the HMC, UWMC-Montlake, or UWMC-NW hospital footprints only if test results would change immediate patient disposition.
  • Rapid Flu, RSV, SARS-CoV-2 PCR w/ Extended PCR Reflex [FABRCX] may also be used for symptomatic outpatients at clinics located on the HMC, UWMC-Montlake, or UWMC-NW hospital footprints only if test results would change immediate patient disposition. If all four viral targets—influenza A, influenza B, RSV, and SARS-CoV-2—are negative (not detected), testing will reflex to the extended viral targets Adeno/Metapneumo/Rhino Virus PCR Panel [FUSAMR], Parainfluenza PCR Panel [FUSPIV], and Coronavirus (Non SARS CoV2) PCR Panel [FUSCOV].

Emergency Department and Inpatient Areas

• COVID/FLU/RSV Respiratory Panel, Rapid PCR [FABRCV] is intended for symptomatic ED and inpatients at UWMC-NW, UWMC-Montlake, and HMC. Testing is performed onsite at all main hospital sites (HMC, UW-NW, and UW-MT) and FHCC South Lake Union with an expected turnaround time of ~2 hours.
• For rapid onsite testing of SARS-CoV-2 alone, use SARS CoV 2 (COVID 19) Qualitative Rapid PCR (ED & Inpatients only) [NCVRPD].

Other Testing

Influenza A H5 Subtyping

• UW now offers Influenza A H5 subtyping Influenza A H5 Subtyping by PCR [FLUH5]. This test should only be performed on patients with a known influenza A infection and is primarily intended for hospitalized patients. Outpatients with an influenza A infection should only have H5 subtyping performed if there is an appropriate exposure history.
• The ordering process for H5 subtyping Influenza A H5 Subtyping by PCR [FLUH5] depends on where a patient's original influenza A test was performed:
  • For patients whose initial influenza A test was performed at a UW Medicine Laboratory (not on a point-of-care platform) - this applies to ED patients, inpatients, and any outpatients whose samples were sent to the lab for testing:
    • Influenza A H5 subtyping Influenza A H5 Subtyping by PCR [FLUH5] should be ordered as a LADDON test with "Influenza A H5 Subtyping, FLUH5" listed as the lab test requested.
  • For patients whose initial influenza A test was performed at an outpatient clinic on a point-of-care platform - this applies to our UWPC locations that are running the Abbott ID Now platform:
    • Influenza A H5 subtyping Influenza A H5 Subtyping by PCR [FLUH5] will require collection of a new sample and should be ordered as a LABUND test with "Influenza A H5 Subtyping, FLUH5" listed as the lab test requested.
• Clients outside of UW Medicine can order H5 subtyping for Influenza A positive patients using standard ordering processes. Please contact the Clinical Virology Laboratory (206-685-6656) with any questions.

Additional Respiratory Virus Test Options

• The Extended Respiratory Virus PCR Panel [REVSQF] extended respiratory virus panel detects a broader range of respiratory viruses, including SARS-CoV-2. It is recommended for symptomatic patients with when identifying a viral cause is clinically important (e.g., determining chemotherapy timing or evaluating severe illness), or for symptomatic, severely immunocompromised patients (e.g., BMT recipients or patients receiving high-dose chemotherapy). This panel is performed daily, but is not available STAT.
• For testing subsets of the viruses included in the extended panel, the RSV, influenza and SARS-CoV-2 panels described above are available, along with individual panels for Adeno/Metapneumo/Rhino Virus PCR Panel [FUSAMR], Parainfluenza PCR Panel [FUSPIV], and Coronavirus (Non SARS CoV2) PCR Panel [FUSCOV].