What is the clinical evidence from this study?

Study design: Cohort. Population: Acute respiratory illness (ARI) (n=3669). Intervention: Multiple specimen collection (NPS, saliva, sputum, and paired serology) vs. Nasopharyngeal swab (NPS) alone. Primary outcome: RSV detection rate (112% increase, 95% CI 86%-141%).

What does this research mean for the field?

Using four specimen types increases RSV detection by 112% compared to nasopharyngeal swab alone in adults hospitalized with acute respiratory illness, demonstrating that relying solely on nasopharyngeal swabs significantly underestimates RSV incidence. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 15, 2025Open Access

Detection of RSV using nasopharyngeal swabs alone underestimates RSV-related hospitalization incidence in adults: the Multispecimen study’s Final Analysis

EBElizabeth BegierPfizer (United States)NANegar AliabadiPfizer (United States)JRJulio A. RamírezUniversity Medical Center Groningen

Key Result

Using four specimen types increased RSV detection by 112% compared to nasopharyngeal swab alone in adults hospitalized with acute respiratory illness.

Study Design

Type

Cohort (n=3,669)

Multicenter

Yes

Structured PICO

Does multiple specimen collection improve RSV detection compared to nasopharyngeal swab alone in hospitalized adults with acute respiratory illness?

Population

3,669 hospitalized adults aged ≥40 years with acute respiratory illness (ARI) or ARI-compatible symptoms, median age 68, 45.1% male, in US and Canada.

Intervention

Multiple specimen collection (nasopharyngeal swab, saliva, sputum, and acute/convalescent sera) for RSV testing

Comparator

Nasopharyngeal swab (NPS) alone

Outcome

RSV detection rate (percentage of participants with at least one RSV positive study specimen)

Using multiple specimen types, including saliva, more than doubles the detection rate of RSV compared to nasopharyngeal swabs alone in hospitalized adults, particularly in those with cardiac conditions.

Main Result

Effect estimate: 112% increase (95% CI 86%-141%)

Absolute Event Rate: 6.9% vs 3.3%

Limitations

Many participants were unable to produce sputum.
Serology is less useful in the clinical setting because convalescent sera collection is required.
Potential less aggressive nasal sampling of participants on anticoagulants may have contributed to lower NPS yield.

Abstract

ABSTRACT Background RSV detection improves if an additional specimen is collected, but the impact of testing saliva and multiple specimen types has not been assessed. We quantified RSV detection increase with multiple specimen collection over nasopharyngeal swab (NPS) alone. Methods Prospectively enrolled hospitalized adults aged ≥40 years with acute respiratory illness in seven hospitals in US and Canada had NPS, saliva, sputa, and acute/convalescent sera collected and tested. Results Among 3,669 enrolled participants, 100% had NPS, 97.7% saliva, 33.0% sputum, and 33.4% paired serology. RSV detection was 112% higher (95% CI86%−141%) using all specimen types compared to NPS alone. Saliva had higher sensitivity than NPS (61.4% versus 47.2%). Among those with congestive heart failure exacerbations, additional specimens increased RSV detection by 267% (95% CI85%−625%) and saliva detected more infections than NPS. Among 1013 subjects with paired NPS from different timepoints tested on the same platform, specimens collected on average 1 day later detected 30% less RSV infections. Conclusions RSV detection increased over 100% using four specimen types versus NPS alone, suggesting a 2-fold correction factor is appropriate for incidence/prevalence studies relying on NPS alone. Saliva is more sensitive than NPS, warranting further study particularly in cardiac patients.

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