Evaluation of influenza virus antiviral susceptibility testing in Europe: Results from the first external quality assessment exercise

C. I. Thompson, A. Lackenby, R. S. Daniels, J. W. McCauley, D. Pereyaslov, E. K. Broberg, A. Meijer*, M. C. Zambon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background: The first antiviral susceptibility testing external quality assessment (EQA) was held for European influenza reference laboratories during winter 2010/11. Objectives: To assess European network influenza antiviral susceptibility testing capability and provide participants with an independent performance evaluation. Study design: The EQA panel contained ten coded specimens of inactivated human influenza A and B viruses with reduced susceptibility to neuraminidase inhibitors (NAI), or adamantanes. Twenty-four laboratories from 19 member states of the WHO European region analysed the panel using phenotypic (determination of 50% inhibitory concentration (IC50) values by neuraminidase (NA) enzyme inhibition assay) and/or genotypic methods. Results: All 24 laboratories returned genotypic data for A(H1N1)pdm09 influenza virus, 18 (75%) for former seasonal A(H1N1), 16 (67%) for A(H3N2) and 15 (63%) for influenza B virus, correctly identifying NAI or adamantane reduced susceptibility-associated substitutions in the NA (mean 84%; range 52-100%) or M2 (mean 85%; range 73-94%), respectively. Thirteen laboratories (54%) returned phenotypic NAI susceptibility data. Despite inter-laboratory and inter-assay IC50 value variation, all 13 laboratories correctly identified oseltamivir reduced susceptibility/resistance in pure preparations of A(H1N1) oseltamivir-resistant viruses. However, only 11 (85%) identified oseltamivir reduced susceptibility/resistance in a mixture of A(H1N1)pdm09 oseltamivir-sensitive/-resistant viruses. Furthermore, 3 laboratories (23%) considered oseltamivir-sensitive influenza B virus reduced susceptible/resistant. Conclusions: Detection of NA-H275Y in A(H1N1) viruses was achieved by most laboratories. IC50 values and interpretation thereof varied for a sensitive/resistant virus mixture and for influenza B virus. The results of this exercise will assist harmonisation of antiviral susceptibility testing, interpretation and reporting within the European network through targeted training.

Original languageEnglish
Pages (from-to)296-302
Number of pages7
JournalJournal of Clinical Virology
Issue number3
Publication statusPublished - Mar 2013

Bibliographical note

Funding Information:
This study was part of ECDC outsourced activities under framework contract ECDC/08/013, with additional funding by the Health Protection Agency (HPA), London, UK. Non-EU laboratories were supported by WHO Regional Office for Europe.


  • Antiviral
  • External quality assessment
  • Influenza
  • Neuraminidase inhibitors
  • Proficiency testing


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