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An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Utility of RSV rapid diagnostic assays in hospitalized children in Amman, Jordan
Megan C Freeman1, Zaid Haddadin2, Lindsey Lawrence2
1Division of Pediatric Infectious Diseases, The UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Rapid diagnostic assays (RDAs) for respiratory syncytial virus (RSV) show high specificity but low sensitivity in children. Positive RSV RDA results indicate more severe disease, aiding management in developing countries.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Virology
- Global Health Diagnostics
Background:
- Respiratory syncytial virus (RSV) is a major cause of childhood respiratory infections and hospitalizations globally.
- Rapid diagnostic assays (RDAs) for RSV are underutilized in developing countries.
- This study compares RSV RDAs with molecular diagnostics in hospitalized children in Jordan.
Purpose of the Study:
- To evaluate the performance of RSV RDAs compared to quantitative reverse transcription-polymerase chain reaction (qRT-PCR).
- To assess the association between positive RSV RDA results and disease severity in hospitalized children.
- To determine the utility of RSV RDAs for guiding management in resource-limited settings.
Main Methods:
- Prospective enrollment of children under 2 years with respiratory symptoms from March 2010 to 2012.
- Collection of demographic and clinical data via interviews and chart abstraction.
- Performance of RSV RDAs and qRT-PCR on nasal/throat swabs from 1271 subjects.
Main Results:
- RSV RDAs demonstrated high specificity (99%) but low sensitivity (26%) compared to qRT-PCR.
- Positive RSV RDA was linked to more severe disease indicators: lower birth weight, oxygen use, and longer hospitalization.
- Lower birth weight, lack of cyanosis, and lower qRT-PCR cycle threshold were independently associated with positive RDA.
Conclusions:
- RSV RDAs offer high specificity but limited sensitivity when compared to molecular methods.
- Positive RSV RDA results correlate with increased disease severity, including higher viral load and longer hospital stays.
- Implementing RSV RDAs in developing countries can be a cost-effective approach to predict disease severity and inform clinical management.
Background:
Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections in children worldwide and a frequent cause of hospitalization. Rapid diagnostic assays (RDAs) are available for RSV and they help guide management; however, they are underutilized in developing countries. We compared molecular diagnostics to RSV RDA in hospitalized children in Amman, Jordan.
Materials And Methods:
Children under 2 years of age, admitted with fever and/or respiratory symptoms were enrolled prospectively from March 2010 to 2012. Demographic and clinical data were collected through parent/guardian interviews and medical chart abstraction. RSV RDAs were performed, and nasal/throat swabs were tested for RSV using quantitative reverse transcription-polymerase chain reaction (qRT-PCR).
Results:
RSV RDA and PCR were performed on specimens from 1271 subjects. RSV RDA had a sensitivity of 26% and a specificity of 99%, with positive and negative predictive values of 98.6% and 43%, respectively. RDA-positive patients had fewer days of symptoms at presentation and were more likely to have a history of prematurity, lower birth weight, require supplemental oxygen, and a longer hospitalization as compared with subjects with negative RDA. Multivariate analysis showed only lower birth weight, lack of cyanosis on examination, and lower cycle threshold to be independently associated with positive RDA (p ≤ .001).
Conclusion:
RSV RDAs had high specificity, but low sensitivity as compared with qRT-PCR. Positive RDA was associated with patients with a more severe disease, as indicated by oxygen use, longer length of stay, and higher viral load. Implementation of RDAs in developing countries could be an inexpensive and expedient method for predicting RSV disease severity and guiding management.
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