Improving the accuracy of Respiratory Syncytial Virus (RSV) incidence among hospitalised adults in Bristol, UK
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Respiratory Syncytial Virus (RSV) burden in adults is of interest due to recently-licensed vaccines, however, estimates are affected by test characteristics.
We conducted a prospective cohort study of adults with acute lower respiratory tract disease (aLRTD) hospitalised in Bristol from April 2022–March 2023. RSV was detected by RT-PCR at standard-of-care and by additional nasopharyngeal, saliva, and sputum samples. Latent class analysis quantified and adjusted for test error and multiple testing.
6906/11445 aLRTD cases (60%) were tested and 251 were positive (3.6%). Test-positivity peaked in December (7.9-12.7%). Among cases, 43% had pneumonia and 55% had non-pneumonic infection. Due to low positivity-rates and imperfect specificity, test-positivity (3.6%) overestimated true prevalence (2.3%). Adjusted adult population incidence/1000-person-years was 0.33 (0.21-0.49), and 2.02 (1.10-3.06) in ≥75-year-olds.
RSV vaccines could reduce morbidity of hospitalised adult aLRTD, including non-pneumonic infection. Adult RSV burden accuracy is improved by adjustment for test characteristics, particularly estimates out-of-season.
