Work

Optimizing the sensitivity of detection of respiratory syncytial virus infections in longitudinal studies using the combination of weekly sample testing and biannual serology

Year: 2025

Type: article

Abstract: Cohort studies are often challenged by incomplete adherence to sampling regimens, limiting the full capture of disease burden. We describe the detection of respiratory syncytial virus (RSV) infections achieved in a birth cohort using a combination of weekly nasal sample testing and serology. The Pediatric Respiratory and Enteric Viral Acquisition and Immunogenesis Longitudinal Cohort followed 245 maternal-child dyads from birth to age 18 to 24 months. Weekly mid-turbinate nasal swabs were tested for RSV using real-time polymerase chain reaction (RT-qPCR). Serum was tested for RSV pre-fusion F IgG and IgA antibody at age 6 weeks and biannually from 6 to 24 months. Mixed effects classification and regression trees identified antibody thresholds consistent with a RT-qPCR-identified RSV infection using a subset of participants having ≥90% weekly sample adherence (n = 53, 21%). Resulting thresholds were applied to participants with either ≥70% of weekly samples or serum at age 18 to 24 months (n = 194, 79%). Incidence rates were compared using Fisher's exact test. Classification and regression trees identified a log10 change in IgG > 0.32 or IgA > 0.20 as indicative of an RSV infection. Comparing RT-qPCR-only to a combination of RT-qPCR and serology, RSV cumulative incidence (49% vs 75%, P < .001) and incidence rate (0.33 vs 0.71 infections/child-year, P < .001) increased; these rates did not differ from those calculated in those with ≥90% sample adherence.

Source: American Journal of Epidemiology

DOI: 10.1093/aje/kwaf271