Low Levels of RSV Testing Among Adults Hospitalized for Lower Respiratory Tract Infection in the United States

Abstract

Introduction Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI)-related hospitalizations in older adults. Without RSV-specific treatment for adults, testing is uncommon, leading to potential underestimation of RSV incidence in real-world data studies. This study aimed to quantify the frequency of RSV testing during LRTI-related hospitalizations of older adults to inform interpretation of incidence estimates. Methods Administrative and billing data for hospitalizations of adults aged ≥ 65 years with a primary or secondary diagnosis of LRTI during the 2016–2019 RSV seasons (October–April) were extracted from the US all-payer Premier Healthcare Database (PHD). Billing codes identified RSV tests administered during eligible hospitalizations. The proportion of LRTI-related hospitalizations with a billed RSV test was calculated for each hospital in PHD, and summarized descriptively by hospital bed size, teaching status, and population served. Results Most of the 937 study hospitals performed RSV testing infrequently during LRTI hospitalization; median percentage of LRTI hospitalizations with RSV testing was 4.3%, and 78.4% of hospitals performed RSV testing in less than 25% of LRTI-related hospitalizations. RSV testing varied extensively by hospital type. Median percentage tested was significantly higher for hospitals with ≥ 200 beds (9.1%) versus < 200 beds (1.6%), for teaching (11.0%) versus non-teaching (2.5%) hospitals, and in urban (7.4%) versus rural (0.7%) settings. The median percentage of RSV testing increased over time, from 0.8% to 6.3% between the 2016/17 and 2018/19 seasons. Conclusion A small proportion of older adults hospitalized with LRTI are tested for RSV in US hospitals. Large variability occurs across hospital types. Consequently, retrospective database analyses likely result in a substantial underestimation of the true RSV-related hospitalization incidence. RSV incidence studies using real-world data need to assess for RSV testing frequency and adjust their results for under ascertainment associated with limited testing. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00758-5.

Estimated Incidence of Hospitalizations and Deaths Attributable to Respiratory Syncytial Virus Infections Among Adults in Germany Between 2015 and 2019

“…The indicator for the circulation of RSV was defined as a weekly number of RSV-related hospitalization counts (ICD-10-GM codes: B97.4, J21.0, J12.1, J20.5, J21.9) in children < 2 years. RSV circulation in children has been selected in multiple other model-based studies [ 18 , 28 , 65 ] and is a common approach due to more frequent testing and hospitalization and higher sensitivity of diagnostic tests in children than in adults [ 20 , 66 ]. We included J21.9 (acute bronchiolitis, unspecified) because RSV is the leading cause of bronchiolitis in this age group, accounting for the majority of bronchiolitis hospitalizations [ 67 – 69 ].…”

From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults

“…Almost all the works that attempted to estimate the RSV disease burden in older adults reported several limitations. These are basically due to the processing data from studies performed with very different methods and protocols [ 107 ]; being based on the case definition of influenza-like illness [ 108 ]; lacking the necessary data to stratify by age group; being based on data mainly derived from academic, high-income, in-hospital settings [ 31 , 67 ]; and underestimating the presence of other factors, such as coinfections or complications [ 15 ]. To address these limitations, the WHO published a document with the essential guidelines to be followed in estimating the RSV disease burden [ 109 ], but robust evidence is lacking.…”

Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

“…However, despite evidence of considerable RSV-associated morbidity, mortality, and health care expenditure, the potential severity of RSV infection in adults has historically been underappreciated by public health professionals and clinicians . Surveillance for RSV-associated illness in adults has been hampered by infrequent clinical testing, as clinicians may choose not to test because of limited awareness of RSV as an important pathogen in adults and because an RSV diagnosis does not typically change patient management. Additionally, until recently, limited tools were available to prevent RSV infection, although this changed in 2023 when the first RSV vaccines for adults aged 60 years or older were approved and recommended in the US via the use of shared clinical decision-making, which takes into account the risks and benefits of RSV disease and vaccination, the clinician’s knowledge and experience, and the patient’s values and preferences …”