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Published on: January 26, 2019
Trends in RSV testing patterns among infants presenting with bronchiolitis: Results from four United States health
Adam Z Blatt1, Mina Suh2, Emmanuel B Walter3
1Duke University Health System, Durham, NC 27710, USA.
Insights
Respiratory syncytial virus (RSV) testing in infants with bronchiolitis has increased, especially post-COVID-19. However, low outpatient testing rates still hinder accurate RSV surveillance and assessment of new preventative agents.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health Surveillance
Background:
- Respiratory syncytial virus (RSV) bronchiolitis is a major cause of infant hospitalization in the US.
- RSV burden is underestimated due to inconsistent testing, especially in outpatient settings.
- The COVID-19 pandemic impacted RSV seasonality and may have influenced testing practices.
Purpose of the Study:
- To examine trends in RSV testing practices among infants with bronchiolitis.
- To compare testing rates across different healthcare settings and sociodemographic groups before and after the COVID-19 pandemic.
- To assess the impact of altered seasonality and testing on surveillance and evaluation of preventative agents.
Main Methods:
- Real-time clinical and viral surveillance data were analyzed.
- Infant bronchiolitis cases across four US healthcare systems were studied.
- Testing practices were examined pre- and post-COVID-19, stratified by healthcare setting and sociodemographics.
Main Results:
- RSV testing increased significantly from 2015 onwards, with a more pronounced rise post-COVID-19.
- Testing rates increased across all settings and sociodemographic groups.
- Outpatient RSV testing remained substantially lower than inpatient testing, with no significant sociodemographic disparities in testing frequency.
Conclusions:
- RSV testing in infants with bronchiolitis has improved.
- Low rates of outpatient RSV testing persist as a significant challenge for accurate surveillance.
- Addressing low outpatient testing is crucial for understanding RSV burden and evaluating interventions.
Background:
Bronchiolitis due to respiratory syncytial virus (RSV) is the leading cause of hospitalization among American infants. The overall burden of RSV among infants has been historically under-estimated due to variable testing practices, particularly in the outpatient setting. Universal masking and social distancing implemented during the coronavirus disease 2019 (COVID-19) pandemic altered RSV seasonality, however potential consequences on RSV testing practices across different healthcare settings and sociodemographic groups have not been described. Variable testing practices could also affect accurate assessment of the effects of two recently approved RSV preventative agents targeting infants.
Methods:
Utilizing real-time clinical and viral surveillance, we examined RSV testing practices among infants with bronchiolitis within four United States healthcare systems across different healthcare settings and sociodemographic groups pre- and post-COVID-19.
Results:
RSV testing among infants with bronchiolitis increased since 2015 within each healthcare system across all healthcare settings and sociodemographic groups, with a more dramatic increase since the COVID-19 pandemic. Outpatient testing remained disproportionately low compared to hospital-based testing, although there were no major differences in testing frequency among sociodemographic groups in either setting.
Conclusions:
Although RSV testing increased among infants with bronchiolitis, relatively low outpatient testing rates remain a key barrier to accurate RSV surveillance.
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