RSV Infection Underascertainment in Adults Due to Diagnostic Testing Limitations

The following is a summary of “Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis,” published in the July 2023 issue of Infectious Diseases by Onwuchekwa, et al.

For a systematic review and meta-analyses, researchers sought to quantify the underascertainment of adult respiratory syncytial virus (RSV) infection using different diagnostic testing approaches and specimen types compared to nasal/nasopharyngeal swab reverse transcriptase real-time PCR (RT-PCR).

A comprehensive search was conducted in EMBASE, PubMed, and Web of Science for relevant studies published from January 2000 to December 2021. The studies included adults and compared more than one RSV testing approach. Test performance and the increase in RSV detection associated with using multiple specimen types were quantified.

Among 8,066 references identified, 154 studies met the inclusion criteria. Compared to RT-PCR, other testing methods, such as rapid antigen detection test (RADT), direct fluorescent antibody (DFA), and viral culture, were less sensitive, with pooled sensitivities of 64%, 83%, and 86%, respectively. Multiplex PCR also showed lower sensitivity (93%) than singleplex PCR. When adding other specimen types to nasopharyngeal swab RT-PCR testing, RSV detection increased: sputum RT-PCR by 52%, 4-fold rise in paired serology by 44%, and oropharyngeal swab RT-PCR by 28%. Sensitivity estimates limited to only adults showed lower values for RADT, DFA, and viral culture, and the increases in detection rates were comparable.

RT-PCR, particularly singleplex testing, demonstrated the highest sensitivity for diagnosing adult RSV infection. Additional≥3 specimen types alongside nasopharyngeal swab RT-PCR testing resulted in increased RSV detection. The potential synergistic effects of using three or more specimen types should be further assessed, as the approach may enhance the accuracy of estimating the burden of RSV infection in adults.

Source: academic.oup.com/jid/article/228/2/173/6994132

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