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Respiratory Syncytial Virus (RSV) in Adults Learning Zone

Diagnosing RSV

Read time: 25 mins
Last updated:27th Oct 2021
Published:27th Oct 2021

The number of people diagnosed with respiratory syncytial virus (RSV) is thought to be underestimated due to a lack of routine testing, impacting optimal RSV management and infection control. Continue reading to find out about:

  • The negative impact of underdiagnosing RSV
  • How RSV can be diagnosed

Unmet needs in diagnosing RSV

Diagnosis of RSV is key in identifying patients that need early treatment, to reduce both patient and socioeconomic burden, and in supporting infection control to minimise interactions between infected individuals and high-risk populations

Respiratory syncytial virus (RSV) is a common infection, occurring across all age ranges from infants to the elderly1–3. As symptoms often include a runny nose and/or cough, which are usually mild, routine testing for RSV rarely occurs. This can result in infected individuals coming into contact with populations at high-risk of severe RSV, leading to preventable transmission of RSV.

Why is RSV not routinely tested for?

RSV is considered to be a mild, manageable infection in the majority of people, and for this reason a laboratory diagnosis may not be considered necessary1. The symptoms are also very similar to other respiratory disorders, such as influenza, and in the absence of an RSV test, patients may be told they have a non-specific lower respiratory tract infection (LRTI)4–7. Most RSV testing in groups at risk of severe RSV is carried out in infants with respiratory infections; elderly patients may not frequently undergo specific testing, as their respiratory secretions have a lower viral load than the secretions of children1,7.

There is no approved treatment for RSV; the antiviral drug ribavirin has been used off-label in severely affected patients, although it is not used across all RSV patients due to its unfavourable safety profile8. Treatment is, therefore, usually based on relieving and managing symptoms, which in severe cases could involve hospitalisation, and ventilatory support1,8.

More on antivirals and RSV treatment

Testing for RSV can be expensive7, and the absence of an approved therapy is likely to have a negative impact on the extent of RSV testing, as current treatment options are not specific to RSV.

Impact of limited RSV testing

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How is RSV diagnosed?

The diagnostics landscape for respiratory syncytial virus (RSV) infection is a growing area, with historical methods being replaced by more sensitive, faster techniques that are able to provide healthcare professionals with the information they need to optimise care of a patient with RSV.

Diagnostic samples for RSV

Diagnostic samples are collected using nose, or nose and throat swabs (nasal swabs or nasopharyngeal swabs, respectively)1,13,18. These samples contain the virus that has been released from infected cells (viral shedding).

Viral shedding starts after RSV infection, and continues for about 10–11 days7,19

Serum samples can be used with the immunofluorescence diagnostic technique to detect the presence of RSV antibodies. This method doesn’t directly detect the virus, but can determine whether a patient has been infected; analysis of serum samples is not useful as a point-of-care (POC) test as it doesn’t identify patients who are still infected20.

Diagnostic methods for RSV

A range of methods can be used to diagnose RSV (Figure 2).

RSV_T2_Fig_2.png

Figure 2. Strategies to diagnose RSV7,10,13,20,21. DNA, deoxyribonucleic acid; RSV, respiratory syncytial virus.

Nucleic acid amplification testing (NAAT)7,10,13,22–25

  • The most common method is the polymerase chain reaction (PCR), which amplifies short specific sequences of RSV DNA that can be detected using a DNA-specific labelling chemical or fluorescence
  • This method is used for nose and throat samples
  • PCR must be performed in a laboratory
  • Methods based on PCR are usually considered to be more sensitive than antigen-based methods
  • In some cases, testing for multiple viruses and bacteria using PCR (multiplex PCR) may be more cost-effective than other methods designed to detect a single pathogen

Antigen detection7,10,12,21–25

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References

  1. Public Health England. Respiratory syncytial virus (RSV): Symptoms, transmission, prevention, treatment, 2021. https://www.gov.uk/government/publications/respiratory-syncytial-virus-rsv-symptoms-transmission-prevention-treatment. Accessed 20 September 2021.
  2. Shi T, McAllister DA, O’Brien KL, Simoes EAF, Madhi SA, Gessner BD, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. The Lancet. 2017;390(10098):946–58.
  3. Shi T, Denouel An, Tietjen AK, Campbell I, Moran E, Li X. Global disease burden estimates of respiratory syncytial virus-associated acute respiratory infection in older adults in 2015: A systematic review and meta-analysis. J Infect Dis. 2020;222(Suppl:S577–S583).
  4. Young M, Smitherman L. Socioeconomic impact of RSV hospitalization. Infectious Diseases and Therapy. 2021;10:35–45.
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  6. Johnson EK, Sylte D, Chaves SS, Li Y, Mahe C, Nair H, et al. Hospital utilization rates for influenza and RSV: a novel approach and critical assessment. Population Health Metrics. 2021;19(1):31.
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  21. Vos LM, Bruning AHL, Reitsma JB, Schuurman R, Riezebos-Brilman A, Hoepelman AIM, et al. Rapid Molecular Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review of Diagnostic Accuracy and Clinical Impact Studies. Clinical Infectious Diseases. 2019;69(7):1243–1253.
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