Effectiveness of rapid antigen testing for screening of asymptomatic individuals to limit the transmission of SARS‐CoV‐2: A rapid review

Abstract

Rapid antigen detection tests (RADTs) offer advantages over gold‐standard reverse transcription polymerase chain reaction (RT‐PCR) tests in that they are cheaper and provide faster results, thus enabling prompt isolation of positive SARS‐CoV‐2 cases and quarantine of close contacts. The aim of this study was to collate and synthesise empirical evidence on the effectiveness of rapid antigen testing for the screening (including serial testing) and surveillance of asymptomatic individuals to limit the transmission of SARS‐CoV‐2. A rapid review was undertaken in MEDLINE (EBSCO), EMBASE (OVID), Cochrane Library, Europe PMC and Google Scholar up until 19 July 2021, supplemented by a grey literature search. Of the identified 1222 records, 19 reports referring to 16 studies were included. Eight included studies examined the effectiveness of RADTs for population‐level screening, four for pre‐event screening and four for serial testing (schools, a prison, a university sports programme and in care homes). Overall, there is uncertainty regarding the effectiveness of rapid antigen testing for the screening of asymptomatic individuals to limit the transmission of SARS‐CoV‐2. This uncertainty is due to the inconsistent results, the relatively low number of studies identified, the predominantly observational and/or uncontrolled nature of the study designs used, and concerns regarding methodological quality. Given this uncertainty, more real‐world research evidence in relevant settings, which is of good quality and timely, as well as economic evaluation, is required to inform public policy on the widespread use of RADTs in asymptomatic individuals.

Point-of-care detection of SARS-CoV-2 antigen among symptomatic vs. asymptomatic persons: Testing for COVID-19 vs. infectivity

“…In asymptomatic individuals at risk of exposure, testing is recommended in various settings ( 24 ) however, recommendations on the testing strategy is inconsistent or no recommendation is given due to the lack of evidence ( 22 , 23 ). Thus, the benefits of PoC Ag-RDT at a population health level remain uncertain as available data is scarce and inconsistent, mainly due to deficient study designs ( 28 ). Even less is known about their performance in subjects who did not have contact with an index case and who are therefore likely to show a lower prevalence of SARS-CoV-2 infection as compared to symptomatic individuals, which positively correlates with test sensitivity ( 29 ).…”

A diagnostic accuracy study comparing RNA LAMP, direct LAMP, and rapid antigen testing from nasopharyngeal swabs

“…Earlier results are similar to the current findings: an in vitro experiment conducted by the Japanese government revealed that, compared to RT-PCR, RAT showed a sensitivity that varied from 50% to 66.7% ( Nagura-Ikeda et al, 2020 ). A recent assessment of the literature, which included 16 trials, found that fast antigen testing for screening of asymptomatic persons can help reduce the spread of the disease ( Loeffelholz and Tang, 2020 ; Walsh et al, 2022 ), suggesting the clinical application value of RATs. Considering that the direct LAMP assay has a higher sensitivity than RAT, we suppose that the LAMP assay could also play an important role in population screening.…”

Clinical microbiology in detection and identification of emerging microbial pathogens: past, present and future

“…Rapid antigen tests are cheaper and provide faster results, thus potentially enabling prompt isolation of positive cases and quarantine of close contacts. A recent literature review covering a total of 16 studies reported on the effectiveness of rapid antigen testing for screening of asymptomatic individuals to limit the transmission [ 9 , 28 ]. Eight included studies examining the effectiveness of rapid antigen testing for population-level screening, four for pre-event screening and four for serial testing.…”

“…This uncertainty is due to the inconsistent results, the relatively low number of studies identified, the predominantly observational and/or uncontrolled nature of the study designs used, and concerns regarding methodological quality. Given this uncertainty, more real-world research evidence in relevant settings, which is of good quality and timely, as well as economic evaluation, is required to inform public policy on the widespread use of rapid antigen tests in asymptomatic individuals [ 28 ].…”