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Using record linkage to examine testing patterns for respiratory viruses among children born in Western Australia

  • F. J. LIM (a1), C. C. BLYTH (a1) (a2) (a3) (a4), A. D. KEIL (a4), N. DE KLERK (a1) and H. C. MOORE (a1)...

Changes in respiratory pathogen testing can affect disease burden estimates. Using linked data, we describe changes in respiratory virus testing among children born in Western Australia in 1996–2012. We extracted data on respiratory specimens from these children from birth to age 9 years. We estimated testing rates by age, year, Aboriginal status and geographical location. Predictors of testing among children hospitalised at least once before their 10th birthday were identified using logistic regression. We compared detection methods for respiratory viruses from nasal/nasopharyngeal (NP) specimens by age and year. Of 83 199 virology testing records in 2000–2012, 80% were nasal/NP specimens. Infants aged <1 month had the highest testing rates. Testing rates in all children increased over the study period with considerable yearly fluctuations. Among hospitalised children, premature children <32 weeks gestation had over three times the odds of being tested (95% CI 3·47–4·13) than those born at term. Testing using molecular methods increased from 5% to 87% over the study period. Proportion of positive samples increased from 36·3% to 44·4% (P < 0·01); this change was greatest in children aged 2–9 years. These findings will assist in interpreting results from future epidemiology studies assessing the pathogen-specific burden of disease.

Corresponding author
*Author for correspondence: F. J. Lim, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia. (Email:
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1. Nair H, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 2013; 381: 1380–90.
2. Rabon-Stith KM, et al. Laboratory testing trends for respiratory syncytial virus, 2007–2011. Journal of Clinical Virology 2013; 58: 575–8.
3. Stroparo E, et al. Adenovirus respiratory infection: significant increase in diagnosis using PCR comparing with antigen detection and culture methods. Revista do Instituto de Medicina Tropical de Sao Paulo 2010; 52: 317–21.
4. Drews SJ. The role of clinical virology laboratory and the clinical virology laboratorian in ensuring effective surveillance for influenza and other respiratory viruses: points to consider and pitfalls to avoid. Current Treatment Options in Infectious Diseases 2016; 8: 165176.
5. Holman CDJ, et al. Population-based linkage of health records in Western Australia: development of a health services research linked database. Australian and New Zealand Journal of Public Health 1999; 23: 453–9.
6. Data Linkage WA. Core Data Collections [Internet]. 2016 [cited 2016 Jan 11]
7. Moore HC, et al. Use of data linkage to investigate the aetiology of acute lower respiratory infection hospitalisations in children. Journal of Paediatrics and Child Health 2012; 48: 520–8.
8. Lim FJ, et al. Optimization is required when using linked hospital and laboratory data to investigate respiratory infections. Journal of Clinical Epidemiology 2016; 69: 2331.
9. PathWest Laboratory Medicine WA. PathWest Laboratory Medicine – About us [Internet]. [Cited 2015 Feb 18]
10. Codde J. Rates Calculator. 9·5·5. Perth, Western Australia: Health Information Centre, Department of Health; 2013.
11. Data Linkage WA. Linkage Quality [Internet]. [Cited 2016 Dec 15]
12. Christensen D, et al. Evidence for the use of an algorithm in resolving inconsistent and missing Indigenous status in administrative data collections. Australian Journal of Social Issues 2014; 49: 423–43.
13. Blair EM, Liu Y, Cosgrove P. Choosing the best estimate of gestational age from routinely collected population-based perinatal data. Paediatric and Perinatal Epidemiology 2004; 18: 270–6.
14. Moore HC, et al. Hospitalisation for bronchiolitis in infants is more common after elective caesarean delivery. Archives of Disease in Childhood 2012; 97: 410–4.
15. Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) [Internet]. 2013. [Cited 2016 May 25]
16. Moore HC, et al. Diverging trends for lower respiratory infections in non-Aboriginal and Aboriginal children. Journal of Paediatrics and Child Health Blackwell Publishing Asia; 2007; 43: 451–7.
17. Bailey EJ, et al. Risks of severity and readmission of Indigenous and non-Indigenous children hospitalised for bronchiolitis. Journal of Paediatrics and Child Health Blackwell Publishing Asia; 2009; 45: 593–7.
18. Juul S, Frydenberg M. EpiBasic. Aarhus University, Denmark; 2011.
19. World Health Organization. Evolution of a Pandemic – A(H1N1) 2009. Geneva, Switzerland; 2013.
20. Kaczmarek MC, Ware RS, Lambert SB. The contribution of PCR testing to influenza and pertussis notifications in Australia. Epidemiology and Infection 2016; 144: 306–14.
21. Chan MCW, et al. Clinical and virologic factors associated with reduced sensitivity of rapid influenza diagnostic tests in hospitalized elderly patients and young children. Journal of Clinical Microbiology 2014; 52: 497501.
22. Asner SA, et al. Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis. PLoS ONE 2014; 9: e99392.
23. Lim FJ, et al. Systematic review and meta-analysis of respiratory viral coinfections in children. Respirology 2016; 21: 648–55.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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