{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:41:07Z","timestamp":1792726867628,"version":"4.5.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"6","funder":[{"DOI":"10.13039\/100000030","name":"US Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Use of rapid diagnostic tests (RDTs) may bias vaccine effectiveness (VE) estimates from test-negative design (TND) studies. We conducted individual-level simulations using national, US COVID-19 surveillance data to assess potential bias at varying likelihoods of visiting a healthcare facility and prevalence of RDT use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-one scenarios that varied the probabilities of visiting a healthcare facility and RDT use by vaccination status were simulated. VE was calculated as 100\u2009\u00d7\u2009(1\u2009\u2212\u2009odds ratio), comparing the odds of symptomatic SARS-CoV-2 infection between vaccinated and unvaccinated groups of people. VE estimates were compared to VE estimates from simulations without RDT testing to calculate the bias in percentage points (pp).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>VE was underestimated when either vaccinated people were more likely (probability of .5) than unvaccinated people (probability of .3) to visit a healthcare facility after a positive RDT [\u22125.8%age points (pp); 95% uncertainty interval (UI): \u22129.1, \u22122.4] or unvaccinated people were more likely than vaccinated people to visit a healthcare facility after a negative RDT (bias\u2009=\u2009\u22126.1 pp; UI: \u22129.9, \u22122.5). Conversely, VE was overestimated when either vaccinated people were more likely than unvaccinated people to visit a healthcare facility after a negative RDT (bias = 5.2; UI: 2.4, 7.7) or unvaccinated people were more likely than vaccinated people to visit a healthcare facility after a positive RDT (bias = 8.4 pp; UI: 5.6, 11.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VE estimates against symptomatic SARS-CoV-2 infection from a TND may be under- or overestimated, depending on differences in RDT usage between vaccination groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyag226","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:32:23Z","timestamp":1792726343000},"source":"Crossref","is-referenced-by-count":0,"title":["Differences in SARS-CoV-2 rapid diagnostic testing usage by COVID-19 vaccination status can bias vaccine effectiveness estimates against symptomatic SARS-CoV-2 infection from a test-negative design"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9486-1850","authenticated-orcid":false,"given":"Ryan E","family":"Wiegand","sequence":"first","affiliation":[{"name":"Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention , Atlanta, GA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3346-0770","authenticated-orcid":false,"given":"Gordana","family":"Derado","sequence":"additional","affiliation":[{"name":"Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention , Atlanta, GA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison Avrich","family":"Ciesla","sequence":"additional","affiliation":[{"name":"Coronavirus and Other Respiratory Viruses Division, 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