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Respiratory Viral Testing Rate Patterns in Young Children Attending Tertiary Care Across Western Australia: A
Belaynew W Taye1,2, Mohinder Sarna1,2, Huong Le1,2
1Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
Insights
Respiratory virus testing rates in young children vary significantly by location and age in Western Australia. Understanding these patterns is key to accurately estimating hospitalisation burdens from viruses like RSV and influenza.
Area of Science:
- Epidemiology
- Public Health
- Virology
Background:
- Accurate estimation of pathogen-specific hospitalisation burden requires understanding viral testing rates.
- Respiratory syncytial virus (RSV), influenza virus, parainfluenza virus (PIV), and human metapneumovirus (hMPV) are significant causes of childhood respiratory illness.
Purpose of the Study:
- To estimate testing patterns for RSV, influenza, PIV, and hMPV in children under 5 years old in Western Australia.
- To analyze testing variations by geographical location, age, and time period.
Main Methods:
- Population-based cohort study utilizing linked administrative data (birth, death, hospitalisation, viral surveillance) from 2010-2021.
- Survival analysis techniques were used to examine within-hospital testing rates.
- Binary logistic regression identified independent predictors of testing.
Main Results:
- A total of 46,553 tests were analyzed for 355,021 children.
- Metropolitan testing rates for RSV in infants declined from 2012 to 2018, then increased, while non-metropolitan rates generally increased.
- Key predictors for testing included age under 12 months, preterm birth (<32 weeks), and remote residence.
Conclusions:
- Current viral testing rates may lead to an underestimation of respiratory virus hospitalisations.
- There is a need to develop methods for estimating the true burden of respiratory virus admissions.
Background:
An understanding of viral testing rates is crucial to accurately estimate the pathogen-specific hospitalisation burden. We aimed to estimate the patterns of testing for respiratory syncytial virus (RSV), influenza virus, parainfluenza virus (PIV) and human metapneumovirus (hMPV) by geographical location, age and time in children <5 years old in Western Australia.
Methods:
We conducted a population-based cohort study of children born between 1 January 2010 and 31 December 2021, utilising linked administrative data incorporating birth and death records, hospitalisations and respiratory viral surveillance testing records from state-wide public pathology data. We examined within-hospital testing rates using survival analysis techniques and identified independent predictors of testing using binary logistic regression.
Results:
Our dataset included 46,553 laboratory tests for RSV, influenza, PIV, or hMPV from 355,021 children (52.5% male). Testing rates declined in the metropolitan region over the study period (RSV testing in infants: from 242.11/1000 child-years in 2012 to 155.47/1000 child-years in 2018) and increased thereafter. Conversely, rates increased in non-metropolitan areas (e.g., RSV in Goldfields: from 364.92 in 2012 to 504.37/1000 child-years in 2021). The strongest predictors of testing were age <12 months (adjusted odds ratio [aOR] = 2.25, 95% CI 2.20-2.31), preterm birth (<32 weeks: aOR = 2.90, 95% CI 2.76-3.05) and remote residence (aOR = 0.77, 95% CI 0.73-0.81).
Conclusion:
These current testing rates highlight the potential underestimation of respiratory virus hospitalisations by routine surveillance and the need for estimation of the true burden of respiratory virus admissions.
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