Detection of RSV using nasopharyngeal swabs alone underestimates RSV-related hospitalization incidence in adults: the Multispecimen study’s Final Analysis
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Background
RSV detection improves if an additional specimen is collected, but the impact of testing saliva and multiple specimen types has not been assessed. We quantified RSV detection increase with multiple specimen collection over nasopharyngeal swab (NPS) alone.
Methods
Prospectively enrolled hospitalized adults aged ≥40 years with acute respiratory illness in seven hospitals in US and Canada had NPS, saliva, sputa, and acute/convalescent sera collected and tested.
Results
Among 3,669 enrolled participants, 100% had NPS, 97.7% saliva, 33.0% sputum, and 33.4% paired serology. RSV detection was 112% higher (95% CI86%−141%) using all specimen types compared to NPS alone. Saliva had higher sensitivity than NPS (61.4% versus 47.2%). Among those with congestive heart failure exacerbations, additional specimens increased RSV detection by 267% (95% CI85%−625%) and saliva detected more infections than NPS. Among 1013 subjects with paired NPS from different timepoints tested on the same platform, specimens collected on average 1 day later detected 30% less RSV infections.
Conclusions
RSV detection increased over 100% using four specimen types versus NPS alone, suggesting a 2-fold correction factor is appropriate for incidence/prevalence studies relying on NPS alone. Saliva is more sensitive than NPS, warranting further study particularly in cardiac patients.
