Evaluating Specimen Quality and Results from a Community-Wide, Home-Based Respiratory Surveillance Study

Abstract

Introduction. While influenza and other respiratory pathogens cause significant morbidity and mortality, the community-based burden of these infections remains incompletely understood. The development of novel methods to detect respiratory infections is essential for mitigating epidemics and developing pandemic-preparedness infrastructure. Methods. From October 2019 to March 2020, we conducted a home-based cross-sectional study in the greater Seattle area, utilizing electronic consent and data collection instruments. Participants received nasal swab collection kits via rapid delivery within 24 hours of self-reporting respiratory symptoms. Samples were returned to the laboratory and were screened for 26 respiratory pathogens and a housekeeping gene. Participant data were recorded via online survey at the time of sample collection and one week later. Results. Of the 4,572 consented participants, 4,359 (95.3%) received a home swab kit, and 3,648 (83.7%) returned a nasal specimen for respiratory pathogen screening. The 3,638 testable samples had a mean RNase P CRT value of 19.0 (SD: 3.4) and 1,232 (33.9%) samples had positive results for one or more pathogens, including 645 (17.7%) influenza-positive specimens. Among the testable samples, the median time between shipment of the home swab kit and completion of laboratory testing was 8 days [IQR: 7.0-14.0]. A single adverse event occurred and did not cause long-term effects or require medical attention. Discussion. Home-based surveillance using online participant enrollment and specimen self-collection is a safe and feasible method for community-level monitoring of influenza and other respiratory pathogens, which can readily be adapted for use during pandemics.

SwabExpress: An end-to-end protocol for extraction-free COVID-19 testing

“…S2), individuals who tested positive for SARS-CoV-2 through routine clinical testing were identified and recruited into a study of home-based, self-collected home swabs (27). After providing consent, enrolled participants were supplied a swab and send kit (19) containing two swabs (Copan FloqSwab 56380CS01) delivered to their home via 2-hour delivery and were provided instructions to self collect two mid-turbinate swabs. Participants placed one swab in a tube with UTM (Becton Dickinson PN 220220) and the other in an empty, dry 15 mL conical tube for transport.…”

“…The US Cotton #3 swabs fit these specifications; a polyester AN swab that resembles consumer-brand Q-tips (17). For the purposes of scaled observed or at-home self specimen collection or specimen collection for a child, swabbing the anterior nares anatomical site would be more comfortable, accessible and easier to describe to test users leading to fewer mistakes and better specimen collection (18,19).…”

“…Therefore, we conducted a usability study to determine both the accuracy and ease of AN swabs in a Swab-and-Send program where at-home specimen collection kits were delivered to participant residences, the participants swabbed themselves or a child while being virtually monitored by clinical study coordinators and then packaged the specimen for return to the molecular testing lab (19,20). After using the specimen collection kit, study participants completed a survey reporting their level of confidence, the kit's ease of use, and the level of discomfort experienced during swabbing.…”

Comparable Specimen Collection from Both Ends of At-Home Midturbinate Swabs

“…However, questions remain as to whether unsupervised upper respiratory specimen collection by individuals in their homes reliably produce specimens that are of high enough quality for pathogen testing. From October 2019 through May 2020, the Seattle Flu Study ( 1 , 2 ) and the greater Seattle Coronavirus Assessment Network (SCAN; scanpublichealth.org ) screened 16,785 midturbinate swabs that were self-collected by participants at home for respiratory pathogens. The at-home kits contained a flocked, midturbinate swab (Copan 56380CS01 or 56750CS01), either adult or pediatric, a tube of universal transport media (UTM), and instructions on how to self-collect a specimen or collect a specimen for a child and return it to the lab ( 2 ).…”

“…From October 2019 through May 2020, the Seattle Flu Study ( 1 , 2 ) and the greater Seattle Coronavirus Assessment Network (SCAN; scanpublichealth.org ) screened 16,785 midturbinate swabs that were self-collected by participants at home for respiratory pathogens. The at-home kits contained a flocked, midturbinate swab (Copan 56380CS01 or 56750CS01), either adult or pediatric, a tube of universal transport media (UTM), and instructions on how to self-collect a specimen or collect a specimen for a child and return it to the lab ( 2 ). Of the kits distributed to individuals in the Seattle metropolitan area, most resulted in swabs returned appropriately according to the instructions in the kit, but 138/16,785 (0.8%) kits were returned to the lab with the swab handle in the UTM tube rather than the swab itself.…”