P95 Epidemiology and Pharmacovigilance, Leuven, Belgium.
Pfizer, Inc, New York, USA.
J Infect Dis. 2023 Nov 28;228(11):1516-1527. doi: 10.1093/infdis/jiad185.
Adding additional specimen types (eg, serology or sputum) to nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) increases respiratory syncytial virus (RSV) detection among adults. We assessed if a similar increase occurs in children and quantified underascertainment associated with diagnostic testing.
We searched databases for studies involving RSV detection in persons <18 years using ≥2 specimen types or tests. We assessed study quality using a validated checklist. We pooled detection rates by specimen and diagnostic tests and quantified performance.
We included 157 studies. Added testing of additional specimens to NP aspirate (NPA), NPS, and/or nasal swab (NS) RT-PCR resulted in statistically nonsignificant increases in RSV detection. Adding paired serology testing increased RSV detection by 10%, NS by 8%, oropharyngeal swabs by 5%, and NPS by 1%. Compared to RT-PCR, direct fluorescence antibody tests, viral culture, and rapid antigen tests were 87%, 76%, and 74% sensitive, respectively (pooled specificities all ≥98%). Pooled sensitivity of multiplex versus singleplex RT-PCR was 96%.
RT-PCR was the most sensitive pediatric RSV diagnostic test. Adding multiple specimens did not substantially increase RSV detection, but even small proportional increases could result in meaningful changes in burden estimates. The synergistic effect of adding multiple specimens should be evaluated.
在鼻咽拭子（NPS）逆转录聚合酶链反应（RT-PCR）中添加额外的标本类型（例如血清学或痰液）可增加成人呼吸道合胞病毒（RSV）的检测率。我们评估了这种方法在儿童中的效果，以及评估诊断检测中存在的漏诊情况。
我们检索了使用≥2种标本类型或检测方法检测<18 岁人群 RSV 的研究。我们使用经过验证的清单评估了研究质量。我们根据标本和诊断检测方法对检测率进行了汇总，并对性能进行了量化。
我们纳入了 157 项研究。将额外标本（包括鼻咽抽吸物、NPS 和/或鼻拭子）的检测添加到 NP 抽吸、NPS 和/或 NS RT-PCR 中，可使 RSV 的检测率略有升高，但差异无统计学意义。添加配对血清学检测可使 RSV 检测率提高 10%，NS 提高 8%，口咽拭子提高 5%，NPS 提高 1%。与 RT-PCR 相比，直接荧光抗体检测、病毒培养和快速抗原检测的敏感性分别为 87%、76%和 74%（特异性均≥98%）。多重 RT-PCR 比单重 RT-PCR 的敏感性高 96%。
RT-PCR 是最敏感的儿科 RSV 诊断检测方法。添加多个标本并不能显著增加 RSV 的检测率，但即使比例很小的增加也可能导致负担估计值发生有意义的变化。应评估添加多个标本的协同作用。
