A rapid antigen triple test to detect SARS-CoV-2, respiratory syncytial virus (RSV), and influenza resulted in a viral diagnosis in 47.9% of children presenting with symptoms of influenza-like illness, bronchiolitis, otitis, and croup, according to study findings published in Open Forum Infectious Diseases.
The cross-sectional, prospective, multicenter study evaluated the diagnostic yield of a triple test for RSV, COVID-19, and influenza in children presenting with respiratory symptoms during the respiratory virus season before RSV preventive approaches were available.
The study was part of the VIGIL study, which enrolled symptomatic children aged younger than 15 years who presented with respiratory symptoms. The children received the COVID-Viro All-In Triplex (AAZ-LMB), a nasal triple test for SARS-CoV-2, influenza A/B, and RSV. The study was conducted from October 2022 to May 2023 at 116 pediatric centers in France.
Clinical syndromes were classified into 4 groups: bronchiolitis (dyspnea with or without wheezing, with or without otitis, croup, and fever), otitis (without bronchiolitis, with or without croup and fever), croup (without otitis/bronchiolitis, with or without fever), and influenza-like illness (with fever, without otitis/bronchiolitis/croup).
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The triple test allowed for a viral diagnosis in half of our cases.
A total of 8329 children (mean [SD] age, 3.7 [3.1] years, 54.2% male) were included. Influenza-like illness, bronchiolitis, otitis, and croup occurred in 65.3% (5440), 17.9% (1488), 8.8% (732), and 6.3% (525) of cases, respectively, with 144 children not included in these syndromes.
A diagnosis of virus infection was possible for 47.9% (3991) of the children. Prevalence rates of SARS-CoV-2, RSV, and influenza A and B infection were 3.1% (95% CI, 2.7-3.5), 9.2% (95% CI, 8.6-9.9), 21.3% (95% CI, 20.5-22.2), and 15.9% (95% CI, 15.1-16.7), respectively. Multiple positive test findings occurred in 0.7% (56) of patients.
A positive viral diagnosis rate was significantly less among children with otitis (40.9%) compared with flu-like illness (49.6%) or bronchiolitis (47.2%). Children with bronchiolitis had the highest RSV positivity (32.9%), and influenza A and B represented 14.1% of bronchiolitis cases. For children with flu-like illnesses, the main virus was influenza (A 24.6% and B 19.6%).
Children with SARS-COV-2 and RSV were significantly younger vs those with influenza (P <.001). Among children with bronchiolitis, 14.9% of cases were in those older than age 3 years.
SARS-CoV-2 always circulated throughout and was predominant for 2 weeks (maximum 15% of positive results: week 17, 2023). RSV and influenza A and B epidemics occurred over time with several overlap periods. The highest viral diagnosis (68.8%) was observed at week 51 during the peak of the influenza A epidemic.
“The triple test allowed for a viral diagnosis in half of our cases,” the study authors concluded. “Although the triple test used had a sensitivity for RSV which was lower than that of influenza or SARS-CoV-2, for children with bronchiolitis, during the epidemic peak, the rate of positive RSV test was very high and reached 60%,” stated the investigators. “From a clinical point of view, the sensitivity seems not optimal; however, from a public health point of view, because of the ease of use of the triple test and its low cost as compared with RT-PCR, it is an essential tool for epidemiological monitoring of epidemics.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
