Effectiveness of Patient-Collected Swabs for Influenza Testing

Abstract

Objective: To compare the effectiveness of self-collected and health care worker (HCW)-collected nasal swabs for detection of influenza viruses and determine the patients' preference for type of collection. Patients and Methods: We enrolled adult patients presenting with influenzalike illness to the Emergency Department at Mayo Clinic, Rochester, Minnesota, from January 28, 2011, through April 30, 2011. Patients self-collected a midturbinate nasal flocked swab from their right nostril following written instructions. A second swab was then collected by an HCW from the left nostril. Swabs were tested for influenza A and B viruses by real-time reverse transcription-polymerase chain reaction, and percent concordance between collection methods was determined. Results: Of the 72 paired specimens analyzed, 25 were positive for influenza A or B RNA by at least one of the collection methods (34.7% positivity rate). When the 14 patients who had prior health care training were excluded, the qualitative agreement between collection methods was 94.8% (55 of 58). Two of the 58 specimens (3.4%) from patients without health care training were positive only by HCW collection, and 1 of 58 (1.7%) was positive only by patient self-collection. A total of 53.4% of patients (31 of 58) preferred the self-collection method over the HCW collection, and 25.9% (15 of 58) had no preference. Conclusion: Self-collected midturbinate nasal swabs provide a reliable alternative to HCW collection for influenza A and B virus real-time reverse transcription-polymerase chain reaction.

Equal Performance of Self-Collected and Health Care Worker-Collected Pharyngeal Swabs for Group A Streptococcus Testing by PCR

“…Thoughtfully developed programs that allow appropriately selected patients or parents and other caregivers to collect throat swabs without requiring a health care visit can limit patient exposure to other sick individuals, improve health care access, increase convenience, and decrease reliance on more costly health care options such as evening urgent care clinics or emergency departments, while still restricting antibiotic use to patients with a positive GAS test result. Our findings are in keeping with those of other studies that have demonstrated success with self-swab collection options, such as influenza testing from midnasal turbinate specimens (17), sexually transmitted infection testing from vaginal swabs (18,19), and molecular testing of samples from buccal swabs (20,21), and provide the foundation for implementation of GAS self-swab programs.…”

Natural T Cell–mediated Protection against Seasonal and Pandemic Influenza. Results of the Flu Watch Cohort Study

“…Weekly follow-up minimized recall bias but was less intense than during human challenge studies likely leading to some under-ascertainment of influenza illnesses and viral shedding. PCR on self-submitted nasal swabs have been shown to have comparable sensitivity with samples taken by healthcare workers (32). Sensitivity analyses using the more sensitive but less specific outcome of respiratory illness show similar cross-protective immunity against illness in those infected with the 2009 pandemic strain, perhaps unsurprising given the virologic dominance of A(H1N1)pdm09 during 2009-2010 (1).…”

Understanding user requirements to improve adoption of influenza diagnostics in clinical care within Metro Manila

“…Current evidence suggests that trade‐offs exist between collection methods . Test developers looking to improve the usability of their tests may consider prioritizing innovations and features that simplify sample collection and preparation such as allowing for patient self‐swabbing, which has been demonstrated to be both effective and acceptable among patients …”