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- Title
Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis.
- Authors
Onwuchekwa, Chukwuemeka; Moreo, Laura Mora; Menon, Sonia; Machado, Belen; Curcio, Daniel; Kalina, Warren; Atwell, Jessica E; Gessner, Bradford D; Siapka, Mariana; Agarwal, Neha; Rubbrecht, Michelle; Nair, Harish; Rozenbaum, Mark; Aponte-Torres, Zuleika; Vroling, Hilde; Begier, Elizabeth
- Abstract
Background Most observational population-based studies identify respiratory syncytial virus (RSV) by nasal/nasopharyngeal swab reverse transcriptase real-time PCR (RT-PCR) only. We conducted a systematic review and meta-analyses to quantify specimen and diagnostic testing-based underascertainment of adult RSV infection. Methods EMBASE, PubMed, and Web of Science were searched (January 2000−December 2021) for studies including adults using/comparing >1 RSV testing approach. We quantified test performance and RSV detection increase associated with using multiple specimen types. Results Among 8066 references identified, 154 met inclusion. Compared to RT-PCR, other methods were less sensitive: rapid antigen detection test (RADT; pooled sensitivity, 64%), direct fluorescent antibody (DFA; 83%), and viral culture (86%). Compared to singleplex PCR, multiplex PCR's sensitivity was lower (93%). Compared to nasal/nasopharyngeal swab RT-PCR alone, adding another specimen type increased detection: sputum RT-PCR, 52%; 4-fold rise in paired serology, 44%; and oropharyngeal swab RT-PCR, 28%. Sensitivity was lower in estimates limited to only adults (for RADT, DFA, and viral culture), and detection rate increases were largely comparable. Conclusions RT-PCR, particularly singleplex testing, is the most sensitive RSV diagnostic test in adults. Adding additional specimen types to nasopharyngeal swab RT-PCR testing increased RSV detection. Synergistic effects of using ≥3 specimen types should be assessed, as this approach may improve the accuracy of adult RSV burden estimates.
- Subjects
RESPIRATORY syncytial virus infections; HUMAN metapneumovirus infection; DIAGNOSIS methods; DIAGNOSTIC specimens; REVERSE transcriptase; RESPIRATORY syncytial virus; NASAL polyps
- Publication
Journal of Infectious Diseases, 2023, Vol 228, Issue 2, p173
- ISSN
0022-1899
- Publication type
Article
- DOI
10.1093/infdis/jiad012