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

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.
Competing Interests: Potential conflicts of interest. E. J. A. has consulted for Pfizer, Sanofi Pasteur, GSK, Janssen, Moderna, and Medscape; served on a safety monitoring board for Kentucky BioProcessing, Inc and Sanofi Pasteur; served on a data adjudication board for WCG and ACI Clinical; is currently employed by Moderna; and his institution had received funds to conduct clinical research unrelated to this study from MedImmune, Regeneron, PaxVax, Pfizer, GSK, Merck, Sanofi-Pasteur, Janssen, and Micron, and from the National Institutes of Health to conduct clinical trials of COVID-19 vaccines. C. A. R. has received institutional support from ModernaTX, Inc, Pfizer, Inc, BioFire, Inc, GSK, plc, MedImmune, Micron Technology, Inc, Janssen Pharmaceuticals, Merck & Co, Inc, Novavax, PaxVax, Regeneron, Sanofi Pasteur, the Centers for Disease Control and Prevention, and the National Institutes of Health; and is coinventor of patented RSV vaccine technology licensed to Meissa Vaccines, Inc. L. J. A. has done paid consultancies on RSV vaccines for Bavarian Nordic, ClearPath Vaccines Company, Janssen, Pfizer, and ADVI; is a coinventor on several CDC patents on the RSV G protein and its CX3C chemokine motif relative to immune therapy and vaccine development; is coinventor on a patent filing for use of RSV platform VLPs with the F and G proteins for vaccines; and his laboratory is currently receiving funding through Emory University from Pfizer for laboratory studies for RSV surveillance studies in adults, Sciogen for animal studies of RSV vaccines, and Advaccine Pharmaceuticals, Ltd for RSV neutralizing antibody studies. N. R. serves as safety consultant for ICON, CyanVac, and EMMES; serves or has served on the advisory boards for Sanofi, Seqirus, Pfizer, and Moderna; and her institution receives funds to conduct research from Sanofi, Lilly, Merck, Quidel, Immorna, Vaccine Company, and Pfizer. E. B., R. H., Q. L., B. D. G., L. J., D. S., W. K., and S. U. are employees of Pfizer, Inc with stock/stock options or were employees during the conduct of this study. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)