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Background <p>The burden of Respiratory Syncytial Virus (RSV) infection in adults is of interest in the context of recently-licensed vaccines. However, burden estimates are affected by test error associated with the testing platform, and number and type of samples tested.</p> Methods <p>We conducted a prospective cohort study of adults with acute lower respiratory tract disease (aLRTD) hospitalised in Bristol, UK, from April 2022–March 2023. RSV was detected by RT-PCR both by routine standard-of-care (SOC) testing, and by testing of additional nasopharyngeal swabs, saliva and sputum samples from a patient subset. Latent class analysis was used to quantify and adjust for test error rates, including effects of multiple testing. RSV test-positivity rates are reported, and after adjustment for test error, are used to calculate adult population incidence/1000 person-years.</p> Results <p>6906/11445 aLRTD cases (60%) were tested and 251 were positive (3.6%; 251/6906). Test-positivity peaked in December (95%CI 7.9–12.7%). Among cases, 43% had pneumonia, 55% had non-pneumonic infection, 59% chronic respiratory disease exacerbations, and 16% heart failure. Test-positivity was highest in 75–84-year-olds, and 30-day mortality was highest in ≥ 75-year-olds (7.1%; 9/127). Due to low positivity-rates and imperfect specificity (0.98–1.00), test-positivity (3.6%) overestimated inferred true prevalence (2.3%). After adjustment for test error, we estimate overall adult population incidence/1000-person-years to be 0.33 (0.21–0.49), and 2.02 (1.10–3.06) in ≥ 75-year-olds.</p> Conclusions <p>RSV contributes significantly to hospitalised adult aLRTD, particularly among the elderly. The implementation of effective RSV vaccines could reduce morbidity, mortality and associated costs of disease. Adult RSV burden accuracy is improved by adjustment for test characteristics due to the impact of imperfect specificity when positivity-rates are low, and this is particularly important for out-of-season estimates. Multiple samples can improve burden estimation accuracy only when tests have near-perfect specificity.</p>

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Improving the accuracy of Respiratory Syncytial Virus (RSV) incidence estimates among hospitalised adults in Bristol, UK

  • 期刊论文

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  • 发表日期：

    2025年8月21日

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  • Katie Lihou,
  • Robert Challen,
  • Anastasia Chatzilena,
  • George Qian,
  • Glenda Oben,
  • Jade King,
  • Serena McGuinness,
  • Begonia Morales-Aza,
  • Kaltun Duale,
  • Ainhoa Rodriguez Pereira,
  • William Healy,
  • Jennifer Oliver,
  • Nick Maskell,
  • Adam Finn,
  • Leon Danon,
  • Catherine Hyams,
  • Aaran Sinclair,
  • Amelia Langdon,
  • Amy Taylor,
  • Anabella Turner,
  • Anna Jones,
  • Anna Koi,
  • Anya Mattocks,
  • Bethany Osborne,
  • Brianna Dooley,
  • Callum Hawkins,
  • Charli Grimes,
  • Chloe Farren,
  • Christian Povey,
  • Claire Mitchell,
  • David Adegbite,
  • Dylan Thomas,
  • Elinor Balch,
  • Ella Ackroyd-Weldon,
  • Emma Bridgeman,
  • Emma Scott,
  • Felix Wright,
  • Ffion Davies,
  • Fiona Perkins,
  • Francesca Bayley,
  • Gabriella Ruffino,
  • Gabriella Valentine,
  • Georgina Mortimer,
  • Grace Tilzey,
  • Harriet Ibbotson,
  • Hanah Batholomew,
  • Hugo Swift,
  • Jacob Symanowski,
  • Ilana Kelland,
  • Imogen Ely,
  • Jake Whittle,
  • Jane Kinney,
  • Johanna Kellett Wright,
  • Jonathan Vowles,
  • Josephine Bonnici,
  • Josh Anderson,
  • Juan Garcia-Tello,
  • Julia Brzezinska,
  • Julie Cloake,
  • Katarina Milutinovic,
  • Kate Helliker,
  • Katie Maughan,
  • Kazminder Fox,
  • Kellie Pettinger,
  • Konstantina Minou,
  • Kyla Chandler,
  • Lana Ward,
  • Leah Fleming,
  • Leigh Morrison,
  • Liberty Smith,
  • Lily Smart,
  • Lisa Grimmer,
  • Louise Setter,
  • Louise Wright,
  • Lucy Grimwood,
  • Maddalena Bellavia,
  • Madeleine Clout,
  • Maia Lyall,
  • Malak Eghleilib,
  • Marianne Vasquez,
  • Maria Garcia Gonzalez,
  • Mariella Ardeshir,
  • Marta Mergulhao,
  • Martina Chmelarova,
  • Matthew Randell,
  • Michael Booth,
  • Milo Jeenes-Flanagan,
  • Miriama Resutikova,
  • Monika Chaulagain,
  • Natalie Chang,
  • Nefeli Tavira,
  • Nellie Farhoudi,
  • Niall Grace,
  • Nicola Manning,
  • Oliver Griffiths,
  • Olivia Pearce,
  • Pip Croxford,
  • Peter Sequenza,
  • Petronela Anchidin,
  • Rajeka Lazarus,
  • Rebecca Clemence,
  • Rosa Aldridge,
  • Rhian Walters,
  • Riley Cooper,
  • Robin Marlow,
  • Robyn Heath,
  • Rupert Antico,
  • Sandi Nammuni Arachchge,
  • Sarah Stollery,
  • Seevakumar Suppiah,
  • Sean Robinson,
  • Siddiqa Uddin,
  • Taslima Mona,
  • Tawassal Riaz,
  • Teagan Barrett,
  • Tom Long,
  • Tudor Dimofte,
  • Yassin Ben Khoud,
  • Vicki Mackay,
  • Zahra Hashmi,
  • Zandile Maseko,
  • Zoe Taylor,
  • Zsuzsa Szasz-Benczur,
  • Zsolt Friedrich

摘要

Background

The burden of Respiratory Syncytial Virus (RSV) infection in adults is of interest in the context of recently-licensed vaccines. However, burden estimates are affected by test error associated with the testing platform, and number and type of samples tested.

Methods

We conducted a prospective cohort study of adults with acute lower respiratory tract disease (aLRTD) hospitalised in Bristol, UK, from April 2022–March 2023. RSV was detected by RT-PCR both by routine standard-of-care (SOC) testing, and by testing of additional nasopharyngeal swabs, saliva and sputum samples from a patient subset. Latent class analysis was used to quantify and adjust for test error rates, including effects of multiple testing. RSV test-positivity rates are reported, and after adjustment for test error, are used to calculate adult population incidence/1000 person-years.

Results

6906/11445 aLRTD cases (60%) were tested and 251 were positive (3.6%; 251/6906). Test-positivity peaked in December (95%CI 7.9–12.7%). Among cases, 43% had pneumonia, 55% had non-pneumonic infection, 59% chronic respiratory disease exacerbations, and 16% heart failure. Test-positivity was highest in 75–84-year-olds, and 30-day mortality was highest in ≥ 75-year-olds (7.1%; 9/127). Due to low positivity-rates and imperfect specificity (0.98–1.00), test-positivity (3.6%) overestimated inferred true prevalence (2.3%). After adjustment for test error, we estimate overall adult population incidence/1000-person-years to be 0.33 (0.21–0.49), and 2.02 (1.10–3.06) in ≥ 75-year-olds.

Conclusions

RSV contributes significantly to hospitalised adult aLRTD, particularly among the elderly. The implementation of effective RSV vaccines could reduce morbidity, mortality and associated costs of disease. Adult RSV burden accuracy is improved by adjustment for test characteristics due to the impact of imperfect specificity when positivity-rates are low, and this is particularly important for out-of-season estimates. Multiple samples can improve burden estimation accuracy only when tests have near-perfect specificity.