Pediatric RSV Diagnostic Testing Performance: A Systematic Review and Meta-analysis

Chukwuemeka Onwuchekwa, Jessica Atwell, Laura Mora Moreo, Sonia Menon, Belen Machado, Mariana Siapka, Neha Agarwal, Michelle Rubbrecht, Zuleika Aponte-Torres, Mark Rozenbaum, Daniel Curcio, Harish Nair, Warren V Kalina, Hilde Vroling, Bradford Gessner, Elizabeth Begier*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Adding additional specimen types (e.g., serology or sputum) to nasopharyngeal swab (NPS) RT-PCR increases respiratory syncytial virus (RSV) detection among adults. We assessed if a similar increase occurs in children and quantified under-ascertainment associated with diagnostic testing.

Methods: 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.

Results: We included 157 studies. Added testing of additional specimens to NP aspirate (NPA), NPS and/or nasal swab (NS) RT-PCR resulted in statistically non-significant 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%.

Conclusions: 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.
Original languageEnglish
Article number jiad185
Pages (from-to)1516-1527
Number of pages24
JournalThe Journal of Infectious Diseases
Issue number11
Early online date7 Jun 2023
Publication statusPublished - 1 Dec 2023

Keywords / Materials (for Non-textual outputs)

  • Respiratory Syncytial Virus Infections
  • epidemiology
  • diagnosis
  • sensitivity and specificity
  • children


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