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In the last 20 years much progress has been made in the development of techniques for the isolation of a wide range of viruses from patients with respiratory disease (Rowe et al. 1953; Chanock, 1956; C:hanock & Finberg, 1957; Beem et al. 1960; Tyrrell et al. 1960; Tyrrell & Bynoe, 1965). By 1965 techniques had become sufficiently advanced for a viral cause to be established in 62 °/O of children with bronchiolitis and 42 °/O with pneumonia (Elderkin, Gardner, Turk & White, 1965). The routine method for the investigation of children with respiratory disea.se has been the collection of material from the upper respiratory tract by cough and nasal (CN) swabs (Andrew & Gardner, 1963; Holzel et al. 1963). In 1939, Auger devised a method for aspirating secretion from the naso-pharynx using a catheter attached to a syringe. He considered that this was an improved method for the isolation of pneumococci from children with pneumonia, although he made no direct comparison with other isolation procedures. Similar methods for obtaining secretions were later used by virologists for the isolation of parainfluenza viruses from children with croup (Morgan et al. 1956; Beale, McLeod, Stackiw & Rhodes, 1958; McLean et al. 1961); secretions are abundant and easily obtainable in this condition. Recently, a number of workers have used nasopharyngeal secretions for rapid diagnosis. Doane et al. (1967) examined preparations of nasopharyngeal secretions from patients with tracheitis by electron microscopy and observed large numbers of parainfluenza virions. McQuillin & Gardner (1968) and Gardner & McQuillin (1968) examined cellular deposits from nasopharyngeal secretions by an indirect immunofluorescent technique for the rapid diagnosis of respiratory syncytial virus (RSV) infections in infants, and found many infected cells present. The large numbers of parainfluenza viruses visible by electron microscopy in nasopharyngeal secretion and of exfoliated cells exhibiting specific fluorescence for RSV suggest that this material is heavily infected. Therefore, nasopharyngeal secretions should prove to be an equal or more fruitful source of virus than swabs from the upper respiratory tract. Such aspirates may reflect more closely the pathogens present in the lower respiratory tract in bronchitis, bronchiolitis and pneumonia. In this laboratory, nasopharyngeal (NP) secretions were taken from children mainly of 1 year of age or less who were suffering from acute lower respiratory disease. This material, examined by the fluorescent antibody technique to demon-

A comparative study of methods for the diagnosis of respiratory virus infections in childhood