National and regional modeling of distinct RSV seasonality thresholds for antigen and PCR testing in the United States

Ambrose, Christopher S.; Steed, Lisa L.; Brandon, Mike; Frye, Kara; Olajide, Ifedapo R.; Thomson, Gina K.

doi:10.1016/j.jcv.2019.09.010

Cited by 7 publications

(13 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A limitation of an analysis that compares seasonality across countries might be the discrepancies in surveillance systems as previously described, 22 with factors such as case definitions and the surveillance setting potentially having implications on the estimation of RSV seasonality. 32 Another limitation of our study is the lack of representation of several regions of the world as no data from countries in North Africa or the Middle East were included.…”

Section: Discussionmentioning

confidence: 99%

Defining the seasonality of respiratory syncytial virus around the world: National and subnational surveillance data from 12 countries

Staadegaard

Caini

Wangchuk

et al. 2021

Influenza Resp Viruses

View full text Add to dashboard Cite

Background Respiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract infections and have a major burden on society. For prevention and control to be deployed effectively, an improved understanding of the seasonality of RSV is necessary. Objectives The main objective of this study was to contribute to a better understanding of RSV seasonality by examining the GERi multi‐country surveillance dataset. Methods RSV seasons were included in the analysis if they contained ≥100 cases. Seasonality was determined using the “average annual percentage” method. Analyses were performed at a subnational level for the United States and Brazil. Results We included 601 425 RSV cases from 12 countries. Most temperate countries experienced RSV epidemics in the winter, with a median duration of 10–21 weeks. Not all epidemics fit this pattern in a consistent manner, with some occurring later or in an irregular manner. More variation in timing was observed in (sub)tropical countries, and we found substantial differences in seasonality at a subnational level. No association was found between the timing of the epidemic and the dominant RSV subtype. Conclusions Our findings suggest that geographical location or climatic characteristics cannot be used as a definitive predictor for the timing of RSV epidemics and highlight the need for (sub)national data collection and analysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Defining the seasonality of respiratory syncytial virus around the world: National and subnational surveillance data from 12 countries

Staadegaard

Caini

Wangchuk

et al. 2021

Influenza Resp Viruses

View full text Add to dashboard Cite

show abstract

“…Our model may be underestimating RSV mortality in recent years owing to changes in case ascertainment. 46 Use of multipathogen PCR panels increases the RSV testing pool to include individuals unlikely to have RSV, thus decreasing the weekly percentage of positive test results. 19,46 Our sensitivity analysis showed that there was little difference in mean estimates over the 20-year period.…”

Section: Limitationsmentioning

confidence: 99%

“…46 Use of multipathogen PCR panels increases the RSV testing pool to include individuals unlikely to have RSV, thus decreasing the weekly percentage of positive test results. 19,46 Our sensitivity analysis showed that there was little difference in mean estimates over the 20-year period. Although we do not have data by test type for influenza, increased use of PCR testing has likely affected influenza surveillance.…”

Section: Limitationsmentioning

confidence: 99%

Mortality Associated With Influenza and Respiratory Syncytial Virus in the US, 1999-2018

et al. 2022

View full text Add to dashboard Cite

IMPORTANCERespiratory syncytial virus (RSV) mortality estimates have not been updated since 2009, and no study has assessed changes in influenza mortality after the 2009 pandemic. Updated burden estimates are needed to characterize long-term changes in the epidemiology of these viruses. OBJECTIVE To evaluate excess mortality from RSV and influenza in the US from 1999 to 2018. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from 50.3 million US death certificates from 1999 to 2018 to create age-specific linear regression models and assess weekly mortality fluctuations above a seasonal baseline associated with RSV and influenza. Statistical

show abstract

“…Both MarketScan and NREVSS also showed variation in positivity across regions. Furthermore, both databases had higher antigen positivity (NREVSS 16.0%, MarketScan 21.2%) compared to PCR positivity (NREVSS 7.9%, MarketScan 3.1%), an expected finding that has prompted the CDC to introduce different positivity thresholds to define RSV season onset (10% for antigen tests and 3% for PCR tests) [ 16 , 19 ]. Of note, these differences in positivity across test types are largely attributable to differences in the population for who the tests are ordered and not the sensitivity of the test (e.g., PCR may be ordered after a negative RSV antigen test [ 17 ]).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, NREVSS is a voluntary, passive system, which may not provide a representative sample of RSV tests nationwide. Finally, the four available types of RSV tests, including polymerase chain reaction (PCR), viral culture, immunofluorescence, and rapid antigen vary in sensitivity and specificity, availability, turnover time, and cost [16][17][18][19][20]. This can result in different choices of test types across clinical settings and patient populations, influencing overall RSV positivity and thus, incidence estimates.…”

Section: Open Accessmentioning

confidence: 99%

RSV testing practice and positivity by patient demographics in the United States: integrated analyses of MarketScan and NREVSS databases

et al. 2022

View full text Add to dashboard Cite

Background RSV-incidence estimates obtained from routinely-collected healthcare data (e.g., MarketScan) are commonly adjusted for under-reporting using test positivity reported in national Surveillance Systems (NREVSS). However, NREVSS lacks detail on patient-level characteristics and the validity of applying a single positivity estimate across diverse patient groups is uncertain. We aimed to describe testing practices and test positivity across subgroups of private health insurance enrollees in the US and illustrate the possible magnitude of misclassification when using NREVSS to correct for RSV under ascertainment. Methods Using billing records, we determined distributions of RSV-test claims and test positivity among a national sample of private insurance enrollees. Tests were considered positive if they coincided with an RSV-diagnosis. We illustrated the influence of positivity variation across sub-populations when accounting for untested acute respiratory infections. Results Most tests were for children (age 0–4: 65.8%) and outpatient encounters (78.3%). Test positivity varied across age (0–4: 19.8%, 5–17: 1.8%, adults: 0.7%), regions (7.6–16.1%), settings (inpatient 4.7%, outpatient 14.2%), and test indication (5.0–35.9%). When compared to age, setting or indication-specific positivity, bias due to using NREVSS positivity to correct for untested ARIs ranged from − 76% to 3556%. Conclusions RSV-test positivity depends on the characteristics of patients for whom those tests were ordered. NREVSS-based correction for RSV-under-ascertainment underestimates the true incidence among children and overestimate rates among adults. Demographic-specific detail on testing practice and positivity can improve the accuracy of RSV-incidence estimates.

show abstract

National and regional modeling of distinct RSV seasonality thresholds for antigen and PCR testing in the United States

Cited by 7 publications

References 13 publications

Defining the seasonality of respiratory syncytial virus around the world: National and subnational surveillance data from 12 countries

Defining the seasonality of respiratory syncytial virus around the world: National and subnational surveillance data from 12 countries

Mortality Associated With Influenza and Respiratory Syncytial Virus in the US, 1999-2018

RSV testing practice and positivity by patient demographics in the United States: integrated analyses of MarketScan and NREVSS databases

Contact Info

Product

Resources

About