Concordance of SARS-CoV-2 Results in Self-collected Nasal Swabs vs Swabs Collected by Health Care Workers in Children and Adolescents

Abstract

IMPORTANCEDespite the expansion of SARS-CoV-2 testing, available tests have not received Emergency Use Authorization for performance with self-collected anterior nares (nasal) swabs from children younger than 14 years because the effect of pediatric self-swabbing on SARS-CoV-2 test sensitivity is unknown.OBJECTIVE To characterize the ability of school-aged children to self-collect nasal swabs for SARS-CoV-2 testing compared with collection by health care workers.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 197 symptomatic children and adolescents aged 4 to 14 years old. Individuals were recruited based on results of testing in the Children's Healthcare of Atlanta system from July to August 2021.EXPOSURES Children and adolescents were given instructional material consisting of a short instructional video and a handout with written and visual steps for self-swab collection. Participants first provided a self-collected nasal swab. Health care workers then collected a second specimen. MAIN OUTCOMES AND MEASURESThe primary outcome was SARS-CoV-2 detection and relative quantitation by cycle threshold (Ct) in self-vs health care worker-collected nasal swabs when tested with a real-time reverse transcriptase-polymerase chain reaction test with Emergency Use Authorization. RESULTS Among the study participants, 108 of 194 (55.7%) were male and the median age was 9 years (IQR,(6)(7)(8)(9)(10)(11). Of the 196 participants, 87 (44.4%) tested positive for SARS-CoV-2 and 105 (53.6%) tested negative by both self-and health care worker-collected swabs. Two children tested positive by self-or health care worker-collected swab alone; 1 child had an invalid health care worker swab. Compared with health care worker-collected swabs, self-collected swabs had 97.8% (95% CI, 94.7%-100.0%) and 98.1% (95% CI, 95.6%-100.0%) positive and negative percent agreement, respectively, and SARS-CoV-2 Ct values did not differ significantly between groups (mean [SD] Ct, self-swab: 26.7 [5.4] vs health care worker swab: 26.3 [6.0]; P = .65). CONCLUSIONS AND RELEVANCEAfter hearing and seeing simple instructional materials, children and adolescents aged 4 to 14 years self-collected nasal swabs that closely agreed on SARS-CoV-2 detection with swabs collected by health care workers.

SARS-CoV-2 Results in Self-collected Nasal Swabs vs Swabs Collected by Health Care Workers in Children and Adolescents—Reply

“…Thus, because we used the most sensitive method and sample type for determining positive or negative status, we included individuals with a range of SARS-CoV-2 viral loads. Although viral load was not specifically quantified, Figure 2 of the article showed that children enrolled in our study exhibited a range of N2 cycle threshold values extending from 15.3 to 38.1 in self-collected samples, consistent with viral loads ranging across 6 orders of magnitude (assuming a change of 3.3 cycles per log 10 change in RNA). Therefore, our results spanned both “low positives” and “strong positives” as defined by the Centers for Disease Control and Prevention and are unlikely to result only from enrollment of positive individuals with high viral loads (low cycle threshold values).…”

“…In Reply We appreciate the letter from Drs Hong and Sung about our study, which demonstrated the ability of children and adolescents to self-collect samples for respiratory virus testing and independently participate in their medical care.…”

SARS-CoV-2 Results in Self-collected Nasal Swabs vs Swabs Collected by Health Care Workers in Children and Adolescents

“…To the Editor We have several comments about the recent study that concluded that nasal swabs collected by children and adolescents have similar diagnostic performance to those collected by health care professionals.…”

“…In contrast, symptomatic patients with a negative nasopharyngeal swab PCR result obtained during their symptomatic period have a low probability of having COVID-19. Therefore, this study group might have been composed of only patients with a high COVID-19 viral load and patients without COVID-19. This stark dichotomy may have affected the results of this study.…”

Changing times in public health: The new wave of self‐collection of invasive samples

“…4 It is now known that children as young as eight are capable of collecting naso-pharyngeal samples that only two years ago were considered only possible to be taken effectively (sometimes with the exercise of naked force) by a doctor or nurse. 5 Unsurprisingly, a similar experience of paternalism has characterised the field of women's health for many years. While cervical screening has been a key -and undoubtedly effective -disease prevention and harm mitigation measure since its introduction in the 1970s, first in the form of Pap smears and now of screening for the presence of human papillomavirus, around the world, public health programs have always struggled to convince women to participate.…”