Relative Contribution of Diagnostic Testing to the Diagnosis of Respiratory Syncytial Virus in Hospitalized Adults in the United States

Author:

Anderson Evan J123ORCID,Tippett Ashley12,Begier Elizabeth4ORCID,Gibson Theda12,Ess Gabby12,Patel Vikash12,Taylor Meg12,Reese Olivia12,Salazar Luis12,Jadhao Samadhan12,Sun He-Ying12,Hsiao Hui-Mien12,Gupta Shadwal12,Li Wensheng12,Stephens Kathleen12,Keane Amy12,Ciric Caroline12,Hellmeister Kieffer3,Cheng Andrew3,Al-Husein Zayna3,Bristow Laurel3,Hubler Robin4,Liu Qing4,Gessner Bradford D4,Jodar Luis4ORCID,Swerdlow David4,Kalina Warren4,Uppal Sonal4,Kamidani Satoshi12ORCID,Rouphael Nadine3ORCID,Anderson Larry J12,Rostad Christina A12ORCID

Affiliation:

1. Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia , USA

2. Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta , Atlanta, Georgia , USA

3. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA

4. Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer, Inc , Collegeville, Pennsylvania , USA

Abstract

Abstract Background Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illness (ARI) in older adults. Optimizing diagnosis could improve understanding of RSV burden. Methods We enrolled adults ≥50 years of age hospitalized with ARI and adults of any age hospitalized with congestive heart failure or chronic obstructive pulmonary disease exacerbations at 2 hospitals during 2 respiratory seasons (2018–2020). We collected nasopharyngeal (NP) and oropharyngeal (OP) swabs (n = 1558), acute and convalescent sera (n = 568), and expectorated sputum (n = 153) from participants, and recorded standard-of-care (SOC) NP results (n = 805). We measured RSV antibodies by 2 immunoassays and performed BioFire testing on respiratory specimens. Results Of 1558 eligible participants, 92 (5.9%) tested positive for RSV by any diagnostic method. Combined NP/OP polymerase chain reaction (PCR) testing yielded 58 positives, while separate NP and OP testing identified 11 additional positives (18.9% increase). Compared to study NP/OP PCR alone, the addition of paired serology increased RSV detection by 42.9% (28 vs 40) among those with both specimen types, while the addition of SOC swab PCR increased RSV detection by 25.9% (47 vs 59). Conclusions The addition of paired serology testing, SOC swab results, and separate testing of NP and OP swabs improved RSV diagnostic yield in hospitalized adults.

Funder

Pfizer

Publisher

Oxford University Press (OUP)

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