Adequacy of Nasal Self-Swabbing for SARS-CoV-2 Testing in Children

Abstract

BackgroundThe goal of this study was to characterize the ability of school-aged children to self-collect adequate anterior nares (AN) swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.MethodsFrom July to August 2021, 287 children, age 4-14 years-old, were prospectively enrolled in the Atlanta area. Symptomatic (n=197) and asymptomatic (n=90) children watched a short instructional video before providing a self-collected AN specimen. Health care workers (HCWs) then collected a second specimen, and useability was assessed by the child and HCW. Swabs were tested side-by-side for SARS-CoV-2. RNase P RNA detection was investigated as a measure of specimen adequacy.ResultsAmong symptomatic children, 87/196 (44.4%) tested positive for SARS-CoV-2 by both self- and HCW-swab. Two children each were positive by self- or HCW-swab; one child had an invalid HCW-swab. Compared to HCW-swabs, self-collected swabs had 97.8% and 98.1% positive and negative percent agreements, respectively, and SARS-CoV-2 Ct values did not differ significantly between groups. Participants ≤8 years-old were less likely than those >8 to be rated as correctly completing self-collection, but SARS-CoV-2 detection did not differ. Based on RNase P RNA detection, 270/287 children (94.1%) provided adequate self-swabs versus 277/287 (96.5%) HCW-swabs (p=0.24) with no difference when stratified by age.ConclusionsChildren, aged 4-14 years-old, can provide adequate AN specimens for SARS-CoV-2 detection when presented with age-appropriate instructional material, consisting of a video and a handout, at a single timepoint. These data support the use of self-collected AN swabs among school-age children for SARS-CoV-2 testing.

A novel anterior nasal swab to detect respiratory viruses: a prospective study of diagnostic sensitivity and specificity

“…Moreover, self-collected samples for respiratory viruses have the advantage of earlier collection timed with the onset of symptoms, which may allow better detection 19 . Previous studies have highlighted potential improved uptake, higher satisfaction and reassuring diagnostic accuracy in self and caregiver collected samples 20,21 . In this study, the median age of participants was 6.9 years, and yet 57% of participants inserted the ANS independently, highlighting the potential for self-collection in young children.…”

K–8 Classroom Self-Collection Using XpressCollect Nasal Swab: A Usability and Efficacy Study

“…There was a correlation between preferences for longer or shorter instructions and the grade level of the intended students, with eight steps suggested for younger students who may need more guidance. Parents and teachers were shown an animated instruction clip and an instructional video developed by researchers at Emory University for their study on children's self-collection [10]. An instructional video featuring children using XpressCollect was identified as more relatable and effective as an instructional tool than an animation.…”

“…Recent studies have demonstrated that adult self-collection and parent sample collection with a nasal swab produces adequate samples for COVID-19 testing that are comparable to clinician collected nasal swab specimens [7][8][9]. Moreover, a recent study conducted by Waggoner et al found that with an instructional video and handout, children ages 4-14 could also self-collect an adequate sample for SARS-CoV-2 detection [10]. However, students' ability to self-collect using nasal swabs in a classroom setting with teacher guidance and the required support materials has not been well established.…”