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. 2022 Aug 15;226(Suppl 2):S213-S224.
doi: 10.1093/infdis/jiac203.

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

Naimisha Movva  1 , Mina Suh  1 , Lauren C Bylsma  1 , Jon P Fryzek  1 , Christopher B Nelson  2
Affiliations

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

Naimisha Movva et al. J Infect Dis. .

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.

Keywords: PCR; RSV; bronchiolitis; children; incidence; infants; laboratory testing; pediatric; respiratory syncytial virus; systematic literature review.

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Conflict of interest statement

Potential conflicts of interest . N. M., M. S., L. C. B., and J. P. F. are employees of EpidStrategies. C. B. N. is an employee of Sanofi and may hold shares and/or stock options in the company. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram of the study selection process. aPubMed, Embase, and Web of Science databases. bExcluded for not meeting the predefined eligibility criteria. Abbreviations: RSV, respiratory syncytial virus; US, United States.
Figure 2.
Figure 2.
Histograms of included studies (n = 80). A, Data years vs publication years. B, By healthcare setting. Numbers do not sum to 80 because studies including multiple settings were counted more than once. Healthcare setting is based on the testing outcomes reported in each study. Abbreviations: ED, emergency department; IP, inpatient; NR, not reported; OP, outpatient; UC, urgent care.
Figure 3.
Figure 3.
Respiratory syncytial virus testing laboratory incidence proportion in the emergency department, United States infants and children aged <5 years (n = 7). The x-axis shows the author (publication year) and reporting data years. Studies are presented in increasing age order of the study population in each study. Study references are provided in Supplementary Table 2. Populations across the studies were heterogeneous; thus, testing patterns may not be uniform across the studies. *The Jamieson (2022) study was published electronically in 2020 and was captured in our literature search. Abbreviations: EIA, enzyme immunoassay; LRTI, lower respiratory tract infection.
Figure 4.
Figure 4.
Respiratory syncytial virus testing laboratory incidence proportion in the outpatient setting, United States infants and children aged <5 years (n = 6). The x-axis shows the author (publication year) and reporting data years. Studies are presented in increasing age order of the study population in each study. Study references are provided in Supplementary Table 2. Populations across the studies were heterogeneous; thus, testing patterns may not be uniform across the studies. Abbreviations: IISP, Influenza Incidence Surveillance Project; ITT, intention to treat; LRTI, lower respiratory tract infection; MoSAIC, Mobile Surveillance for Acute Respiratory Infections and Influenza-like Illness in the Community; RCT, randomized controlled trial; URI, upper respiratory illness.
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