The Use of Multiple Specimen Types in RSV Testing May Improve Detection Rates

The most sensitive diagnostic testing method for the detection of RSV in adults was RT-PCR via nasopharyngeal swab, with improved detection observed with additional specimen types.

Results of a systematic review and meta-analysis published in The Journal of Infectious Diseases suggests that respiratory syncytial virus (RSV) detection rates associated with singleplex real-time polymerase chain reaction (RT-PCR) testing may improve with the use of multiple specimen types.

Researchers searched publication databases through December 2021 for studies that assessed diagnostic testing methods for the detection of RSV infection. A total of 154 studies were included in the analysis. The researchers aimed to evaluate the performance of diagnostic testing methods for RSV infection and the effects of using multiple specimen types on RSV detection rates.

The majority of included studies were conducted in the Americas (37%) and Europe (32%), and most had cross-sectional designs (n=137). Enrolled patients included those with lower or upper respiratory tract infections and those with pulmonary or cardiac disease exacerbations. Overall, the majority of studies (66%) enrolled hospitalized patients. Among all studies included in the analysis, most evaluated specimens collected via nasopharyngeal swab (NPS; n=102), followed by nasopharyngeal aspirate (NPA; n=48) and oropharyngeal swab (OPS; n=36). In addition, 68.5% and 15.8% of the studies evaluated specimens that were tested using RT-PCR multiplex and singleplex platforms, respectively.

In regard to NPS RT-PCR, the researchers found that the addition of sputum RT-PCR increased the rate of RSV detection by 52% (detection rate ratio [DRR], 1.52; 95% CI, 1.15-2.01), whereas the addition of OPS RT-PCR increased the rate by 28% (DRR, 1.28; 95% CI, 1.11-1.49). The addition of paired serology testing increased the rate of detection by 42% (DRR, 1.42; 95% CI, 1.19-1.70) when compared with rates observed with NPS RT-PCR alone.

This quantification could allow adjustment of clinical burden estimates for diagnostic testing-related underascertainment and thus better estimate the true burden of disease.

Compared with singleplex RT-PCR platforms, the multiplex approach had a pooled sensitivity of 92% and specificity of 99%. Among studies restricted to only adults, the sensitivity of the multiplex approach decreased to 81%.

For non-RT-PCR approaches vs multiplex RT-PCR, direct fluorescent antibody testing had a sensitivity of 83% and specificity of 96.6% and rapid antibody detection testing (RADT) had a sensitivity of 64% and specificity of 77%. Further analysis among only studied with adult populations showed decreased sensitivity for both direct fluorescent antibody (56%) and rapid antibody detection testing (BinaxNOW, 14%; RSV ImmuView, 23%).

Limitations of this analysis were the inclusion of studies with small sample sizes, potential bias, and insufficient demographic data.

According to the researchers, “This quantification could allow adjustment of clinical burden estimates for diagnostic testing-related underascertainment and thus better estimate the true burden of [RSV] disease.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Infectious Disease Advisor


Onwuchekwa C, Moreo LM, Menon S, et al. Underascertainment of respiratory syncytial virus infection in adults due to diagnostic testing limitations: a systematic literature review and meta-analysis. J Infect Dis. Published online January 20, 2023. doi:10.1093/infdis/jiad012