Lihou Katie, Challen Robert, Chatzilena Anastasia, Qian George, Oben Glenda, King Jade, McGuinness Serena, Morales-Aza Begonia, Duale Kaltun, Pereira Ainhoa Rodriguez, Healy William, Oliver Jennifer, Maskell Nick, Finn Adam, Danon Leon, Hyams Catherine
Bristol Vaccine Centre, Schools of Population Health Sciences & Cellular and Molecular Medicine, University of Bristol, St Michael's Hill, Bristol, BS2 8AE, UK.
Engineering Mathematics, University of Bristol, Bristol, UK.
BMC Infect Dis. 2025 Aug 21;25(1):1050. doi: 10.1186/s12879-025-11292-9.
The burden of Respiratory Syncytial Virus (RSV) infection in adults is of interest in the context of recently-licensed vaccines. However, burden estimates are affected by test error associated with the testing platform, and number and type of samples tested.
We conducted a prospective cohort study of adults with acute lower respiratory tract disease (aLRTD) hospitalised in Bristol, UK, from April 2022-March 2023. RSV was detected by RT-PCR both by routine standard-of-care (SOC) testing, and by testing of additional nasopharyngeal swabs, saliva and sputum samples from a patient subset. Latent class analysis was used to quantify and adjust for test error rates, including effects of multiple testing. RSV test-positivity rates are reported, and after adjustment for test error, are used to calculate adult population incidence/1000 person-years.
6906/11445 aLRTD cases (60%) were tested and 251 were positive (3.6%; 251/6906). Test-positivity peaked in December (95%CI 7.9-12.7%). Among cases, 43% had pneumonia, 55% had non-pneumonic infection, 59% chronic respiratory disease exacerbations, and 16% heart failure. Test-positivity was highest in 75-84-year-olds, and 30-day mortality was highest in ≥ 75-year-olds (7.1%; 9/127). Due to low positivity-rates and imperfect specificity (0.98-1.00), test-positivity (3.6%) overestimated inferred true prevalence (2.3%). After adjustment for test error, we estimate overall adult population incidence/1000-person-years to be 0.33 (0.21-0.49), and 2.02 (1.10-3.06) in ≥ 75-year-olds.
RSV contributes significantly to hospitalised adult aLRTD, particularly among the elderly. The implementation of effective RSV vaccines could reduce morbidity, mortality and associated costs of disease. Adult RSV burden accuracy is improved by adjustment for test characteristics due to the impact of imperfect specificity when positivity-rates are low, and this is particularly important for out-of-season estimates. Multiple samples can improve burden estimation accuracy only when tests have near-perfect specificity.
在最近获批的疫苗背景下，成人呼吸道合胞病毒（RSV）感染的负担备受关注。然而，负担估计受到与检测平台相关的检测误差以及检测样本数量和类型的影响。
我们对2022年4月至2023年3月在英国布里斯托尔住院的急性下呼吸道疾病（aLRTD）成人进行了一项前瞻性队列研究。通过常规标准护理（SOC）检测以及对患者亚组的额外鼻咽拭子、唾液和痰液样本进行检测，采用逆转录聚合酶链反应（RT-PCR）检测RSV。使用潜在类别分析来量化和调整检测误差率，包括多次检测的影响。报告了RSV检测阳性率，并在调整检测误差后，用于计算成人人口发病率/每1000人年。
6906/11445例aLRTD病例（60%）接受了检测，251例呈阳性（3.6%；251/6906）。检测阳性率在12月达到峰值（95%置信区间7.9 - 12.7%）。在这些病例中，43%患有肺炎，55%患有非肺炎感染，59%患有慢性呼吸道疾病加重，16%患有心力衰竭。检测阳性率在75 - 84岁人群中最高，30天死亡率在≥75岁人群中最高（7.1%；9/127）。由于阳性率低且特异性不完善（0.98 - 1.00），检测阳性率（3.6%）高估了推断的真实患病率（2.3%）。调整检测误差后，我们估计总体成人人口发病率/每1000人年为0.33（0.21 - 0.49），在≥75岁人群中为2.02（1.10 - 3.06）。
RSV对住院成人aLRTD有显著贡献，尤其是在老年人中。实施有效的RSV疫苗可降低发病率、死亡率和相关疾病成本。由于阳性率低时特异性不完善的影响，通过调整检测特征可提高成人RSV负担的准确性，这对于非流行季节估计尤为重要。只有当检测具有近乎完美的特异性时，多个样本才能提高负担估计的准确性。
