Why Doctors Aren't Testing Adults for RSV—Even When They Should Be

Respiratory syncytial virus (RSV) testing among adults in outpatient settings is dramatically underutilized, with only 2.7% of patients with lower respiratory tract infections receiving an RSV test despite an estimated 1.36 million annual outpatient visits for RSV among adults aged 65 and older. This gap in testing may be causing doctors to miss RSV cases and preventing patients from accessing newly available vaccines and treatments.

How Common Is RSV Testing Right Now?

Researchers analyzed electronic health records from nearly 2.31 million adults who visited outpatient facilities between 2017 and 2024 with respiratory symptoms or chronic conditions. The findings paint a stark picture of how infrequently RSV testing occurs in everyday medical practice. Among patients with lower respiratory tract infections (LRTI), only 2.7% received RSV testing, compared to 15.1% who were tested for influenza. The disparity was even more dramatic for patients with chronic obstructive pulmonary disease (COPD) exacerbations, where just 1.9% received RSV testing versus 6.0% for influenza. For patients with congestive heart failure (CHF) exacerbations, the numbers dropped to 0.5% for RSV and 1.1% for influenza.

The good news is that RSV testing has been increasing over time. Between 2017 and 2024, RSV testing among LRTI patients rose from 0.6% to 9.4%. However, even with this improvement, testing rates remain consistently lower than influenza testing, which ranged from 7.1% to 31.7% during the same period.

Who Gets Tested for RSV, and Who Doesn't?

Testing patterns varied significantly depending on several factors. The study found that RSV testing occurred more frequently in specific circumstances:

• Care Setting: Emergency department visits resulted in higher testing rates than routine outpatient office visits
• Geographic Location: Patients in the Northeast were more likely to be tested for RSV than those in other regions
• Seasonal Timing: Winter and autumn months saw higher testing rates than spring and summer
• Insurance Type: Patients with Medicaid coverage were tested more frequently than those with other insurance plans
• Patient Age: Younger adults were tested more often than older adults, despite older adults having higher hospitalization risks
• Health Status: Patients with fewer existing medical conditions were tested more frequently than those with multiple comorbidities

This last finding is particularly concerning because patients with multiple chronic conditions—who are at greatest risk for severe RSV illness—were actually less likely to be tested.

Why Does This Testing Gap Matter?

The consequences of underutilization extend beyond simple diagnosis. According to the research team, "Underutilization of RSV testing may contribute to under-recognition of true disease burden and limit the use of new vaccines and therapies." This means that when doctors don't test for RSV, they may not recognize how common the virus actually is in their patient populations, and patients miss opportunities to benefit from recently approved RSV vaccines and antiviral treatments.

The stakes are particularly high for older adults. Among patients aged 75 and older who presented with lower respiratory tract infections, 21.0% required hospitalization within seven days of their outpatient visit, compared to just 5.8% of patients aged 18 to 49 years. Despite this elevated risk, older patients were actually less likely to receive RSV testing.

The study included approximately 2.31 million adult patients across three cohorts: 1.85 million with lower respiratory tract infections, 229,443 with COPD exacerbations, and 228,936 with congestive heart failure exacerbations. Women made up 59.1% of the LRTI group, 57.4% of the COPD group, and 47.2% of the CHF group.

What Could Improve RSV Testing Rates?

The research suggests that awareness and accessibility are key barriers. The fact that testing rates are higher in emergency departments than in routine office visits suggests that providers may not routinely think to test for RSV in outpatient settings. Additionally, the variation by geographic region and insurance type indicates that some healthcare systems and providers have adopted RSV testing more readily than others.

As new RSV vaccines become available and more treatment options emerge, increasing testing rates in outpatient settings could help more adults receive appropriate care. The study's findings highlight an opportunity for healthcare providers to reconsider their testing practices and ensure that patients with respiratory symptoms—particularly older adults and those with chronic conditions—have the chance to be tested for RSV and access the latest preventive and therapeutic options.