Systematic Literature Review of Respiratory Syncytial Virus Laboratory Testing Practices and Incidence in United States Infants and Children <5 Years of Age

Abstract

Background Respiratory syncytial virus (RSV) can cause serious illness in those aged <5 years in the United States, but uncertainty remains around which populations receive RSV testing. We conducted a systematic literature review of RSV testing patterns in studies published from 2000 to 2021. Methods Studies of RSV, medically attended RSV lower respiratory tract infections (LRTIs), and bronchiolitis were identified using standard methodology. Outcomes were clinical decisions to test for RSV, testing frequency, and testing incidence proportions in inpatient (IP), emergency department (ED), outpatient (OP), and urgent care settings. Results Eighty good-/fair-quality studies, which reported data from the period 1988–2020, were identified. Twenty-seven described the clinical decision to test, which varied across and within settings. Two studies reported RSV testing frequency for multiple settings, with higher testing proportions in IP (n = 2, range: 83%–85%, 1996–2009) compared with ED (n = 1, 25%, 2006–2009) and OP (n = 2, 15%–25%, 1996–2009). Higher RSV testing incidence proportions were observed among LRTI infant populations in the ED (n = 1, 74%, 2007–2008) and OP (n = 2, 54%–69%, 1995–2008). Incidence proportions in LRTI populations were not consistently higher in the IP setting (n = 13). Across studies and time, there was heterogeneity in RSV testing patterns, which may reflect varying detection methods, populations, locations, time periods, and healthcare settings. Conclusions Not all infants and children with LRTI are tested for RSV, highlighting underestimation of RSV burden across all settings.

All Infants Are at Risk of Developing Medically Attended Respiratory Syncytial Virus Lower Respiratory Tract Infection and Deserve Protection

“…Furthermore, even when RSV-positive laboratory results are available, they may not be captured in the coding for LRTI and bronchiolitis, thus contributing further to the underestimation of the burden [ 22 ]. Arriola et al [ 19 ] sought to address this by applying multipliers.…”

The Burden of Respiratory Syncytial Virus Lower Respiratory Tract Disease in Infants in the United States: A Synthesis

“…Not surprisingly, there were no nationally available data on ED usage or OP burden of RSV disease [ 19 ], probably due to the low rates of testing in these locations [ 25 ]. Gantenberg et al [ 26 ] used 3 separate claims databases (Marketscan Commercial, Marketscan Medicaid, and Optum Clinformatics) to include a birth cohort of almost 2 million infants born between April 2016 and February 2020 to try and address this lacuna.…”

“…Undoubtedly, it is the dictum “testing makes no difference to the management of the patient” that drives this variability. The systematic literature review of RSV laboratory testing practices thus reflects the vast variability in testing [ 25 ]. As would be expected, testing occurs more frequently in the inpatient setting than in the ED or OP settings.…”

“…Most other sites tested between 30% and 70% of admitted subjects. In contrast, except for outliers, in EDs approximately 27%–32% and in OPs approximately 15%–20% of infants’ samples with LRTI were tested in reported studies [ 25 ]. In most private and public practices around the country, pediatricians and family practitioners rarely have access to nucleic acid tests in their offices, and for most pediatricians, the compensation offered for rapid testing—if it is offered at all—does not appear to economically justify its use.…”

A Systematic Literature Review of the Burden of Respiratory Syncytial Virus and Health Care Utilization Among United States Infants Younger Than 1 Year

“…Furthermore, as this SLR included studies published since 2000, the observed changes in RSV burden and HCU may be also impacted by heterogeneity in testing practices and type (viral culture, molecular diagnostics, etc.) across time and regions [ 63 ]. Another challenge to describe the true burden of RSV and HCU is the potential underestimation of RSV cases as systematic laboratory testing for RSV in the United States is not recommended [ 9 ].…”