Epidemiology of Acute Respiratory Infection with SARS-CoV-2, Influenza A & B Viruses, Respiratory Syncytial Virus, and Adenovirus in VACCELERATE Volunteers in Germany

Abstract

Background: Acute respiratory infections (ARI) are the most common human infections. Etiologic diagnosis relies on virological testing restricted to larger institutions. Epidemiology and burden of ARI pathogens outside medical settings must be estimated.

Methods: Adults from the VACCELERATE-Volunteer-Registry received with the multiple respiratory antigen test-kit (MAK5, BioTeke, Wuxi, China), a laminar flow device (LFD) detecting adenovirus (ADV), influenza viruses A and B, respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a single nasal swab. Participants self-tested upon ARI symptoms for ≥24 hours, sent a photo of the LFD, and reported related symptoms, vaccination history, and underlying diseases. Participants remaining asymptomatic, self-tested on June 1st, 2023.

Findings: Between December 7th, 2022, and June 2nd, 2023, we processed results from 1,408 participants. A total of 1,098 (77·9%) individuals developed symptoms and self-tested until May 31st, 2023 and 310 (22·1%) self-tested on June 1st, 2023. Cumulative incidence was 12·6% for SARS-CoV-2, 7·9% for RSV, 5·3% for influenza A virus, 0·8% for ADV and 0·4% for influenza B virus. On June 1st, 2023, RSV point prevalence was 7%. Participants with influenza A presented significantly more symptoms, in particular cough, fever, conjunctivitis, and muscle pain.

Interpretation: High seasonal RSV incidence and point prevalence demonstrate that RSV represents a significant cause for ARI in adults. The symptom burden was highest in influenza A. This study type allows assessing the annual course of ARI pathogens irrespective of any medical attention.

Funding: ACCELERATE received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement 101037867.

Declaration of Interest: JSG has received speaker honoraria from Gilead and Pfizer. HJS has received consultancy or speaker honoraria from Pfizer. OAC reports grants or contracts from Cidara, F2G, Gilead, MedPace, MSD, Mundipharma, Octapharma, Pfizer, Scynexis; Consulting fees from Abbvie, AiCuris, Biocon, Cidara, Gilead, IQVIA, Janssen, Matinas, MedPace, Menarini, Moderna, Molecular Partners, MSG-ERC, Noxxon, Octapharma, Pfizer, PSI, Scynexis, Seres; Honoraria for lectures from Abbott, Abbvie, Al-Jazeera Pharmaceuticals/Hikma, Gilead, Grupo Biotoscana/United Medical/Knight, MedScape, MedUpdate, Merck/MSD, Noscendo, Pfizer, Shionogi, streamedup!; Payment for expert testimony from Cidara; Participation on a Data Safety Monitoring Board or Advisory Board from Boston Strategic Partners, Cidara, IQVIA, Janssen, MedPace, PSI, Pulmocide, Shionogi, The Prime Meridian Group; A patent at the German Patent and Trade Mark Office (DE 10 2021 113 007.7); Stocks from CoRe Consulting, EasyRadiology. JAN, LC, MZ, CT and ZDP have nothing to declare. JS has received research grants by the Ministry of Education and Research (BMBF) and Basilea Pharmaceuticals Inc.; has received speaker honoraria by Pfizer Inc., Gilead, and AbbVie; has been a consultant to Gilead, Produkt&Markt GmbH, Alvea Vax. and Micron Research and has received travel grants by German Society for Infectious Diseases (DGI e.V.) and Meta-Alexander Foundation. SM has received grants by DZIF, DMyKG and the Universoty Hospital of Cologne. She has received speaker honoraria from Pfizer. SM has been a consultant to Octapharma. All remaining authors declare no conflict of interest.

Ethical Approval: The VACCELERATE Volunteer Registry was approved by the Ethics Committee of the Medical Faculty of the University of Cologne, Germany (identifier 20–1536).

Keywords: Frequency, distribution, surveillance, winter season, viral infections, ARI pathogens, COVID-19, antigen rapid test, lateral flow, endemic outbreaks, burden of disease