Comparison of patient-collected and lab technician-collected nasopharyngeal and oropharyngeal swabs for detection of COVID-19 by RT-PCR

Abdollahi, Alireza; Shakoori, Abbas; Khoshnevis, Hoda; Arabzadeh, Mohammad; Manshadi, Seyed Ali Dehghan; Mohammadnejad, Esmaeil; Ghasemi, Dorsa; Aboksari, Maryam Safari; Alizadeh, Shaban; Mehrtash, Vahid; Eftekhar-Javadi, Arezoo; Safaei, Masoomeh

doi:10.30699/ijp.2020.127312.2387

Cited by 13 publications

(10 citation statements)

References 26 publications

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“…The 3 other studies ( 55 , 56 , 58 ) in this meta-analysis did not specify self-collection versus health care worker collection. There was one study ( 60 ) that compared self-collected versus lab technician-collected OP swabs and found that only 14/24 total positives were detected by self-collection versus 22/24 total positives for lab technician collected. This study was excluded from this meta-analysis, however, as the pairing of OP swabs to NP swabs was unclear.…”

Section: Resultsmentioning

confidence: 99%

Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis

et al. 2021

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Background: Nasopharyngeal (NP) swabs are considered the highest-yield sample for diagnostic testing for respiratory viruses, including SARS-CoV-2. The need to increase capacity for SARS-CoV-2 testing in a variety of settings, combined with shortages of sample collection supplies, have motivated a search for alternative sample types with high sensitivity. We systematically reviewed the literature to understand the performance of alternative sample types compared to NP swabs. Methods: We systematically searched PubMed, Google Scholar, medRxiv, and bioRxiv (last retrieval October 1st, 2020) for comparative studies of alternative specimen types [saliva, oropharyngeal (OP), and nasal (NS) swabs] versus NP swabs for SARS-CoV-2 diagnosis using nucleic acid amplification testing (NAAT). A logistic-normal random-effects meta-analysis was performed to calculate % positive alternative-specimen, % positive NP, and % dual positives overall and in sub-groups. The QUADAS 2 tool was used to assess bias. Results: From 1,253 unique citations, we identified 25 saliva, 11 NS, 6 OP, and 4 OP/NS studies meeting inclusion criteria. Three specimen types captured lower % positives [NS (82%, 95% CI: 73-90%), OP (84%, 95% CI: 57-100%), saliva (88%, 95% CI: 81 – 93%)] than NP swabs, while combined OP/NS matched NP performance (97%, 95% CI: 90-100%). Absence of RNA extraction (saliva) and utilization of a more sensitive NAAT (NS) substantially decreased alternative-specimen yield. Conclusions: NP swabs remain the gold standard for diagnosis of SARS-CoV-2, although alternative specimens are promising. Much remains unknown about the impact of variations in specimen collection, processing protocols, and population (pediatric vs. adult, late vs. early in disease course) and head-to head studies of sampling strategies are urgently needed.

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Section: Resultsmentioning

confidence: 99%

Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis

et al. 2021

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“…The 3 other studies (55, 56, 58) in this meta-analysis did not specify self-vs. healthcare-worker collection. There was one study (60) that compared self-versus lab-technician collected OP swabs and found that only 14/24 total positives were detected by self-collection versus 22/24 total positives for lab-technician-collected. This study was excluded from this meta-analysis, however, as the pairing of OP swabs to NP swabs was unclear.…”

Section: Resultsmentioning

confidence: 99%

Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: A Systematic Review and Meta-analysis

Lee

Herigon

Benedetti

et al. 2020

Preprint

102

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BackgroundNasopharyngeal (NP) swabs are considered the highest-yield sample for diagnostic testing for respiratory viruses, including SARS-CoV-2. The need to increase capacity for SARS-CoV-2 testing in a variety of settings, combined with shortages of sample collection supplies, have motivated a search for alternative sample types with high sensitivity. We systematically reviewed the literature to understand the performance of alternative sample types compared to NP swabs.MethodsWe systematically searched PubMed, Google Scholar, medRxiv, and bioRxiv (last retrieval October 1st, 2020) for comparative studies of alternative specimen types [saliva, oropharyngeal (OP), and nasal (NS) swabs] versus NP swabs for SARS-CoV-2 diagnosis using nucleic acid amplification testing (NAAT). A logistic-normal random-effects meta-analysis was performed to calculate % positive alternative-specimen, % positive NP, and % dual positives overall and in sub-groups. The QUADAS 2 tool was used to assess bias.ResultsFrom 1,253 unique citations, we identified 25 saliva, 11 NS, 6 OP, and 4 OP/NS studies meeting inclusion criteria. Three specimen types captured lower % positives [NS (0.82, 95% CI: 0.73-0.90), OP (0.84, 95% CI: 0.57-1.0), saliva (0.88, 95% CI: 0.81 – 0.93)] than NP swabs, while combined OP/NS matched NP performance (0.97, 95% CI: 0.90-1.0). Absence of RNA extraction (saliva) and utilization of a more sensitive NAAT (NS) substantially decreased alternative-specimen yield.ConclusionsNP swabs remain the gold standard for diagnosis of SARS-CoV-2, although alternative specimens are promising. Much remains unknown about the impact of variations in specimen collection, processing protocols, and population (pediatric vs. adult, late vs. early in disease course) and head-to head studies of sampling strategies are urgently needed.

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“…These findings differed from a study by Abdollahi et al . [ 24 ] with a sensitivity of less than 70% and a specificity of less than 95%, in which, it was concluded that samples collected by professionals were more reliable than self-collected samples. The study by Abdollahi, however, was carried out on a small sample size of 50 patients, which might be a factor in the result realized, also, the median age of participants was 56 years compared to our study which had a median age of 35 years.…”

Section: Discussionmentioning

confidence: 99%

“…The study by Abdollahi, however, was carried out on a small sample size of 50 patients, which might be a factor in the result realized, also, the median age of participants was 56 years compared to our study which had a median age of 35 years. Another factor that could be responsible for such a contradiction is that 9 out of 11 patients who reported having underlying conditions according to Abdollahi, [ 24 ] have severe medical conditions. They concluded that self-collection is not recommended for patients with severe medical conditions.…”

Section: Discussionmentioning

confidence: 99%

The use of DIY (Do it yourself) sampling and telemonitoring model for COVID-19 qPCR testing scale up

Amoo

Adewara²,

Tijani

et al. 2021

PLoS ONE

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The first case of COVID-19 in Nigeria was recorded on February 27, 2020, being an imported case by an Italian expatriate, to the country. Since then, there has been steady increase in the number of cases. However, the number of cases in Nigeria is low in comparison to cases reported by other countries with similar large populations, despite the poor health system prevailing in the country. This has been mainly attributed to the low testing capacity in Nigeria among other factors. Therefore, there is a need for innovative ways to increase the number of persons testing for COVID-19. The aim of the study was to pilot a nasopharyngeal swab self-sample collection model that would help increase COVID-19 testing while ensuring minimal person-to-person contact being experienced at the testing center. 216 participants took part in this study which was carried out at the Nigerian Institute of Medical Research between June and July 2020. Amongst the 216 participants, 174 tested negatives for both self-collected samples and samples collected by Professionals, 30 tested positive for both arms, with discrepancies occurring in 6 samples where the self-collected samples were positive while the ones collected by the professionals were negative. The same occurred in another set of 6 samples with the self-collected samples being negative and the professional—collected sample coming out positive, with a sensitivity of 83.3% and a specificity of 96.7%. The results of the interrater analysis are Kappa = 0.800 (95% CI, 0.690 to 0.910) which implies an outstanding agreement between the two COVID-19 sampling methods. Furthermore, since p< 0.001 Kappa (k) coefficient is statistically different from zero, our findings have shown that self-collected samples can be reliable in the diagnosis of COVID-19.

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Comparison of patient-collected and lab technician-collected nasopharyngeal and oropharyngeal swabs for detection of COVID-19 by RT-PCR

Cited by 13 publications

References 26 publications

Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis

Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis

Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: A Systematic Review and Meta-analysis

The use of DIY (Do it yourself) sampling and telemonitoring model for COVID-19 qPCR testing scale up

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