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Azziz-Baumgartner E, Hirsch A, Yoo YM, Peretz A, Greenberg D, Avni YS, Glatman-Freedman A, Mandelboim M, MacNeil A, Martin ET, Newes-Adeyi G, Thompson M, Monto AS, Balicer RD, Levine MZ, Katz MA. Incidence of laboratory-confirmed influenza and RSV and associated presenteeism and absenteeism among healthcare personnel, Israel, influenza seasons 2016 to 2019. Euro Surveill 2024; 29. [PMID: 39092531 PMCID: PMC11295438 DOI: 10.2807/1560-7917.es.2024.29.31.2300580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
BackgroundHealthcare personnel (HCP) are at high risk for respiratory infections through occupational exposure to respiratory viruses.AimWe used data from a prospective influenza vaccine effectiveness study in HCP to quantify the incidence of acute respiratory infections (ARI) and their associated presenteeism and absenteeism.MethodsAt the start and end of each season, HCP at two Israeli hospitals provided serum to screen for antibodies to influenza virus using the haemagglutination inhibition assay. During the season, active monitoring for the development of ARI symptoms was conducted twice a week by RT-PCR testing of nasal swabs for influenza and respiratory syncytial virus (RSV). Workplace presenteeism and absenteeism were documented. We calculated incidences of influenza- and RSV-associated ARI and applied sampling weights to make estimates representative of the source population.ResultsThe median age of 2,505 participating HCP was 41 years, and 70% were female. Incidence was 9.1 per 100 person-seasons (95% CI: 5.8-14.2) for RT-PCR-confirmed influenza and 2.5 per 100 person-seasons (95% CI: 0.9-7.1) for RSV illness. Each season, 18-23% of unvaccinated and influenza-negative HCP seroconverted. The incidence of seroconversion or RT-PCR-confirmed influenza was 27.5 per 100 person-seasons (95% CI: 17.8-42.5). Work during illness occurred in 92% (95% CI: 91-93) of ARI episodes, absence from work in 38% (95% CI: 36-40).ConclusionInfluenza virus and RSV infections and associated presenteeism and absenteeism were common among HCP. Improving vaccination uptake among HCP, infection control, and encouraging sick HCP to stay home are important strategies to reduce ARI incidence and decrease the risk of in-hospital transmission.
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Affiliation(s)
| | - Avital Hirsch
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Young M Yoo
- United States Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Alon Peretz
- Rabin Medical Center, Clalit Health Services, Petah Tikva, Israel
| | - David Greenberg
- Soroka University Medical Center, Clalit Health Services, Beersheba, Israel
| | - Yonat Shemer Avni
- Soroka University Medical Center, Clalit Health Services, Beersheba, Israel
| | - Aharona Glatman-Freedman
- School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control, Ramat Gan, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
- School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Adam MacNeil
- United States Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Mark Thompson
- United States Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | - Ran D Balicer
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Min Z Levine
- United States Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Mark A Katz
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
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2
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Fowler T, Chapman D, Futschik ME, Tunkel SA, Blandford E, Turek E, Kolade O, da Cunha SS, Dodgson A, Klapper P, Sudhanva M, Davies L, Hill S, Hopkins S, Peto T. Self-swabbing versus assisted swabbing for viral detection by qRT-PCR: the experience from SARS-CoV-2 based on a meta-analysis of six prospectively designed evaluations conducted in a UK setting. Eur J Clin Microbiol Infect Dis 2024; 43:1621-1630. [PMID: 38856828 PMCID: PMC11271363 DOI: 10.1007/s10096-024-04866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE In April 2020, the UK Government implemented NHS Test and Trace to provide SARS-CoV-2 quantitative reverse transcription polymerase chain reaction (qRT-PCR) testing for the public, with nose-and-throat swabbing for samples performed by trained staff. Self-swabbing (SS) would allow rapid scale-up of testing capacity and access. Six studies were undertaken to determine whether SS was as effective for detecting SARS-CoV-2 as swabbing performed by trained staff. METHODS Six prospective studies were conducted between April-October 2020, using six swab/media combinations. Differences between assisted swabbing (AS) and SS were evaluated for concordance, positivity, sensitivity, cycle threshold (Ct) values and void rates. Statistical analysis was performed using 95% confidence intervals (CIs), paired t-tests and model-based methods. RESULTS Overall, 3,253 individuals were recruited (median age 37 years, 49% female), with 2,933 having valid paired qRT-PCR results. Pooled concordance rate was 98% (95% CI: 96%, 99%). Positivity rate differences for SS (8.1%) and AS (8.4%) and differences in pooled sensitivities between SS (86%; 95% CI: 78%, 92%) and AS (91%; 95% CI: 78%, 96%) were nonsignificant. Both types of swabbing led to pooled void rates below 2% and strongly correlated Ct values. Age, sex and previous swabbing experience did not have a significant impact on concordance or sensitivity. CONCLUSION The UK adopted a policy to promote self-testing for SARS-CoV-2 based on data demonstrating equivalence of SS versus AS. Positive outcomes with SS are likely generalisable to testing for other respiratory pathogens, and we consider self-sampling and self-testing essential for future pandemic preparedness.
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Affiliation(s)
- Tom Fowler
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK.
- William Harvey Research Institute and the Barts Cancer Institute, Queen Mary University of London, London, UK.
| | | | - Matthias E Futschik
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sarah A Tunkel
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | - Edward Blandford
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | | | - Olumide Kolade
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | | | - Andrew Dodgson
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | - Paul Klapper
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
- University of Manchester, Manchester, UK
| | - Malur Sudhanva
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Lindsey Davies
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | - Sue Hill
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
- NHS England, London, UK
| | - Susan Hopkins
- UK Health Security Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
- Health Protection Research Unit in Healthcare Associate Infections and Antimicrobial Resistance, National Institute for Health Research, Oxford, UK
| | - Tim Peto
- University of Oxford, Oxford, UK
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3
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Haddadin S, Wilhelm D, Wahrmann D, Tenebruso F, Sadeghian H, Naceri A, Haddadin S. Autonomous swab robot for naso- and oropharyngeal COVID-19 screening. Sci Rep 2024; 14:142. [PMID: 38167977 PMCID: PMC10762007 DOI: 10.1038/s41598-023-50291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
The COVID-19 outbreak has triggered a global health and economic crisis, necessitating widespread testing to control viral spread amidst rising cases and fatalities. The recommended testing method, a combined naso- and oropharyngeal swab, poses risks and demands limited protective gear. In response to the COVID-19 pandemic, we developed and tested the first autonomous swab robot station for Naso- and Oropharyngeal Coronavirus Screening (SR-NOCS). A force-sensitive robot running under a Cartesian impedance controller is employed to drive the swab to the sampling area. This groundbreaking device underwent two clinical studies-one conducted during the initial pandemic lockdown in Europe (early 2021) and the other, more recently, in a public place after the pandemic had subsided earlier in the year 2023. In total, 52 patients suspected of COVID-19 infection were included in these clinical studies. The results revealed a complete positive correlation between autonomous and manual sampling. The test subjects exhibited a high acceptance rate, all expressing a willingness to undergo future tests with SR-NOCS. Based on our findings, such systems could enhance testing capabilities, potentially conducting up to 300 tests per robot per day with consistent precision. The tests can be carried out with minimal supervision, reducing infection risks and effectively safeguarding patients and healthcare workers.
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Affiliation(s)
| | - Dirk Wilhelm
- School for Medicine and Health, Klinikum rechts der Isar, Department of Surgery, Technical University Munich, Munich, Germany
| | | | | | - Hamid Sadeghian
- Chair of Robotics and Systems Intelligence, School of Computation, Information and Technologies, Munich Institute of Robotics and Machine Intelligence, Technical University Munich, Munich, Germany
| | - Abdeldjallil Naceri
- Chair of Robotics and Systems Intelligence, School of Computation, Information and Technologies, Munich Institute of Robotics and Machine Intelligence, Technical University Munich, Munich, Germany
| | - Sami Haddadin
- Chair of Robotics and Systems Intelligence, School of Computation, Information and Technologies, Munich Institute of Robotics and Machine Intelligence, Technical University Munich, Munich, Germany.
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4
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Soto R, Paul L, Porucznik CA, Xie H, Stinnett RC, Briggs B, Biggerstaff M, Stanford J, Schlaberg R. Effectiveness of Self-Collected, Ambient Temperature-Preserved Nasal Swabs Compared to Samples Collected by Trained Staff for Genotyping of Respiratory Viruses by Shotgun RNA Sequencing: Comparative Study. JMIR Form Res 2023; 7:e32848. [PMID: 37999952 DOI: 10.2196/32848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has underscored the need for field specimen collection and transport to diagnostic and public health laboratories. Self-collected nasal swabs transported without dependency on a cold chain have the potential to remove critical barriers to testing, expand testing capacity, and reduce opportunities for exposure of health professionals in the context of a pandemic. OBJECTIVE We compared nasal swab collection by study participants from themselves and their children at home to collection by trained research staff. METHODS Each adult participant collected 1 nasal swab, sampling both nares with the single swab, after which they collected 1 nasal swab from 1 child. After all the participant samples were collected for the household, the research staff member collected a separate single duplicate sample from each individual. Immediately after the sample collection, the adult participants completed a questionnaire about the acceptability of the sampling procedures. Swabs were placed in temperature-stable preservative and respiratory viruses were detected by shotgun RNA sequencing, enabling viral genome analysis. RESULTS In total, 21 households participated in the study, each with 1 adult and 1 child, yielding 42 individuals with paired samples. Study participants reported that self-collection was acceptable. Agreement between identified respiratory viruses in both swabs by RNA sequencing demonstrated that adequate collection technique was achieved by brief instructions. CONCLUSIONS Our results support the feasibility of a scalable and convenient means for the identification of respiratory viruses and implementation in pandemic preparedness for novel respiratory pathogens.
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Affiliation(s)
- Raymond Soto
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Litty Paul
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Christina A Porucznik
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Heng Xie
- IDbyDNA, Salt Lake City, UT, United States
| | | | | | - Matthew Biggerstaff
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Robert Schlaberg
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
- IDbyDNA, Salt Lake City, UT, United States
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5
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Nahar K, Begum MN, Tony SR, Jubair M, Hossain MA, Karim Y, Faisal AA, Hossain ME, Rahman MZ, Rahman M. Nasal swab as an alternative specimen for the detection of severe acute respiratory syndrome coronavirus 2. Health Sci Rep 2023; 6:e1213. [PMID: 37077182 PMCID: PMC10106929 DOI: 10.1002/hsr2.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background and Aims The coronavirus disease 2019 (COVID-19) has brought serious threats to public health worldwide. Nasopharyngeal, nasal swabs, and saliva specimens are used to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, limited data are available on the performance of less invasive nasal swab for testing COVID-19. This study aimed to compare the diagnostic performance of nasal swabs with nasopharyngeal swabs using real-time reverse transcription polymerase chain reaction (RT-PCR) considering viral load, onset of symptoms, and disease severity. Methods A total of 449 suspected COVIDCOVID-19 individuals were recruited. Both nasopharyngeal and nasal swabs were collected from the same individual. Viral RNA was extracted and tested by real-time RT-PCR. Metadata were collected using structured questionnaire and analyzed by SPSS and MedCalc software. Results The overall sensitivity of the nasopharyngeal swab was 96.6%, and the nasal swab was 83.4%. The sensitivity of nasal swabs was more than 97.7% for low and moderate C t values. Moreover, the performance of nasal swab was very high (>87%) for hospitalized patients and at the later stage >7 days of onset of symptoms. Conclusion Less invasive nasal swab sampling with adequate sensitivity can be used as an alternative to nasopharyngeal swabs for the detection of SARS-CoV-2 by real-time RT-PCR.
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Affiliation(s)
- Kamrun Nahar
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mst. Noorjahan Begum
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Selim R. Tony
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mohammad Jubair
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Md. Abir Hossain
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Yeasir Karim
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Abdullah Al. Faisal
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mohammad Enayet Hossain
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mohammed Ziaur Rahman
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mustafizur Rahman
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
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6
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Tran HH, Nguyen HAT, Tran HB, Vu BNT, Nguyen TCT, Tacoli C, Tran TP, Trinh TS, Cai THN, Nadjm B, Tran KHT, Pham QD, Nguyen THT, Nguyen TT, Pham TD, Kesteman T, Dang DA, Tran TD, van Doorn HR, Lewycka S. Feasibility, acceptability, and bacterial recovery for community-based sample collection to estimate antibiotic resistance in commensal gut and upper respiratory tract bacteria. Sci Rep 2022; 12:22512. [PMID: 36581706 PMCID: PMC9797900 DOI: 10.1038/s41598-022-27084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Vietnam has high rates of antibiotic use and resistance. Measuring resistance in commensal bacteria could provide an objective indicator for evaluating the impact of interventions to reduce antibiotic use and resistance. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for different sampling strategies. We conducted a cross-sectional mixed methods study in a rural community in Ha Nam Province, northern Vietnam, and collected structured interviews, samples, and in-depth interviews from households. Out of 389 households invited, 324 participated (83%), representing 1502 individuals. Samples were collected from these individuals (1498 stool, 1002 self-administered nasal swabs, and 496 HW-administered nasopharyngeal swabs). Pneumococci were recovered from 11.1% (128/1149) of the total population and 26.2% (48/183) of those under 5-years. Recovery was higher for health-worker (HW)-administered swabs (13.7%, 48/350) than self-administered swabs (10.0%, 80/799) (OR 2.06, 95% CI 1.07-3.96). Cost per swab was cheaper for self-administered ($7.26) than HW-administered ($8.63) swabs, but the overall cost for 100 positive samples was higher ($7260 and $6300 respectively). Qualitative interviews revealed that HW-administered nasopharyngeal swabs took longer to collect, caused more discomfort, and were more difficult to take from children. Factors affecting participation included sense of contribution, perceived trade-offs between benefits and effort, and peer influence. Reluctance was related to stool sampling and negative perceptions of research. This study provides important evidence for planning community-based carriage studies, including cost, logistics, and acceptability. Self-administered swabs had lower recovery, and though cheaper and quicker, this would translate to higher costs for large population-based studies. Recovery might be improved by swab-type, transport medium, and better cold-chain to lab.
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Affiliation(s)
- Hoang Huy Tran
- National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | | | | | | | | | - Tung Son Trinh
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Serekunda, The Gambia
| | | | | | | | | | - Thai Duy Pham
- National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thomas Kesteman
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Duc Anh Dang
- National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tien Dac Tran
- Centre for Disease Control, Phu Ly, Ha Nam Province, Vietnam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Hanoi, Vietnam. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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7
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Self-collected gargle fluids and nasopharyngeal swabs as a strategy for molecular diagnostics of respiratory viruses. JOURNAL OF CLINICAL VIROLOGY PLUS 2022. [DOI: 10.1016/j.jcvp.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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8
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Affiliation(s)
- Ilan Youngster
- Pediatric Division, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Nguyen TT, Zeger WG, Wadman MC, Schnaubelt AT, Barksdale AN. Pandemic driven innovation: A pilot evaluation of an alternative respiratory pathogen collection device. Am J Emerg Med 2022; 61:111-116. [PMID: 36087464 PMCID: PMC9423874 DOI: 10.1016/j.ajem.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/21/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Methods Results Conclusion
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10
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Mannan N, Raihan R, Parvin US, Fazle Akbar SM, Reza MS, Islam S, Kundu J, Noman AA, Fakhruddin M, Billaha M, Anik M, Hasan T, Tudu N, Rahim A, Mim F, Rahman Khan MJ. Detection of SARS-CoV-2 RNA by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) on Self-Collected Nasal Swab Compared With Professionally Collected Nasopharyngeal Swab. Cureus 2022; 14:e25618. [PMID: 35784954 PMCID: PMC9249011 DOI: 10.7759/cureus.25618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Self-collection of nasal swabs for the detection of SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) would considerably increase the testing capability and decrease the risk of transmission among healthcare workers (HCW) and the use of personal protective equipment (PPE). Objectives: This study aimed to evaluate the performance of self-collected nasal swabs compared with professionally collected nasopharyngeal (NP) swabs for detection of SARS-CoV-2 RNA by RT-PCR. Materials and methods: We performed a cross-sectional study where the suspected cases of coronavirus disease 2019 (COVID-19) were instructed about the self-collection of nasal swabs from their mid-turbinate. The results were compared to a nasopharyngeal swab collected by a trained healthcare worker in the same patient at the same sitting. Results: We enrolled 100 participants, of which, 69 (69%) were male and 31 (31%) were female. The median age of the study participant was 36 years. Of the participants, 58 (58%) were symptomatic, and the commonest clinical presentation was cough, which was present in 42 (42%) participants. Out of 100 samples, 31 (31%) professionally collected nasopharyngeal swabs and 28 (28%) self-collected nasal swabs were positive for SARS-CoV-2 by RT-PCR. Out of 31 professionally collected positive samples, three samples were negative in self-collection. Out of 28 self-collected positive samples, no sample was negative in the professional collection. The sensitivity and specificity of self-collected nasal swabs compared to professionally collected nasopharyngeal swabs were 90.32% and 100.00%, respectively. The sensitivity of self-collected nasal was 100% when the cycle threshold (Ct) value of the professionally collected NP swab was less than 30. Conclusion: Our study showed that self-collected nasal swabs' sensitivities were similar to professionally collected NP swabs with a high viral load (low Ct value). Hence, this method could be used when the patient is symptomatic and come to the health providers in the early stage of COVID-19 illness.
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11
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Geyer RE, Kotnik JH, Lyon V, Brandstetter E, Zigman Suchsland M, Han PD, Graham C, Ilcisin M, Kim AE, Chu HY, Nickerson DA, Starita LM, Bedford T, Lutz B, Thompson MJ. Diagnostic Accuracy of an At-Home, Rapid Self-test for Influenza: Prospective Comparative Accuracy Study. JMIR Public Health Surveill 2022; 8:e28268. [PMID: 35191852 PMCID: PMC8905479 DOI: 10.2196/28268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/02/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Rapid diagnostic tests (RDTs) for influenza used by individuals at home could potentially expand access to testing and reduce the impact of influenza on health systems. Improving access to testing could lead to earlier diagnosis following symptom onset, allowing more rapid interventions for those who test positive, including behavioral changes to minimize spread. However, the accuracy of RDTs for influenza has not been determined in self-testing populations. Objective This study aims to assess the accuracy of an influenza RDT conducted at home by lay users with acute respiratory illness compared with that of a self-collected sample by the same individual mailed to a laboratory for reference testing. Methods We conducted a comparative accuracy study of an at-home influenza RDT (Ellume) in a convenience sample of individuals experiencing acute respiratory illness symptoms. Participants were enrolled in February and March 2020 from the Greater Seattle region in Washington, United States. Participants were mailed the influenza RDT and reference sample collection materials, which they completed and returned for quantitative reverse-transcription polymerase chain reaction influenza testing in a central laboratory. We explored the impact of age, influenza type, duration, and severity of symptoms on RDT accuracy and on cycle threshold for influenza virus and ribonuclease P, a marker of human DNA. Results A total of 605 participants completed all study steps and were included in our analysis, of whom 87 (14.4%) tested positive for influenza by quantitative reverse-transcription polymerase chain reaction (70/87, 80% for influenza A and 17/87, 20% for influenza B). The overall sensitivity and specificity of the RDT compared with the reference test were 61% (95% CI 50%-71%) and 95% (95% CI 93%-97%), respectively. Among individuals with symptom onset ≤72 hours, sensitivity was 63% (95% CI 48%-76%) and specificity was 94% (95% CI 91%-97%), whereas, for those with duration >72 hours, sensitivity and specificity were 58% (95% CI 41%-74%) and 96% (95% CI 93%-98%), respectively. Viral load on reference swabs was negatively correlated with symptom onset, and quantities of the endogenous marker gene ribonuclease P did not differ among reference standard positive and negative groups, age groups, or influenza subtypes. The RDT did not have higher sensitivity or specificity among those who reported more severe illnesses. Conclusions The sensitivity and specificity of the self-test were comparable with those of influenza RDTs used in clinical settings. False-negative self-test results were more common when the test was used after 72 hours of symptom onset but were not related to inadequate swab collection or severity of illness. Therefore, the deployment of home tests may provide a valuable tool to support the management of influenza and other respiratory infections.
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Affiliation(s)
- Rachel E Geyer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Jack Henry Kotnik
- Department of Family Medicine, University of Washington, Seattle, WA, United States.,Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Victoria Lyon
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Elisabeth Brandstetter
- Department of Medicine, University of Washington, Seattle, WA, United States.,Brotman Baty Institute, University of Washington, Seattle, WA, United States
| | | | - Peter D Han
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Chelsey Graham
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Misja Ilcisin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Ashley E Kim
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, WA, United States.,Brotman Baty Institute, University of Washington, Seattle, WA, United States
| | - Deborah A Nickerson
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Lea M Starita
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Trevor Bedford
- Brotman Baty Institute, University of Washington, Seattle, WA, United States.,Department of Genome Sciences, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Barry Lutz
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Brotman Baty Institute, University of Washington, Seattle, WA, United States
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, United States
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12
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Flu@home: The comparative accuracy of an at-home influenza rapid diagnostic test, using a pre-positioned test kit, mobile app, mail-in reference sample, and symptom-based testing trigger. J Clin Microbiol 2022; 60:e0207021. [PMID: 35107302 PMCID: PMC8925896 DOI: 10.1128/jcm.02070-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
At-home testing with rapid diagnostic tests (RDTs) for respiratory viruses could facilitate early diagnosis, guide patient care, and prevent transmission. Such RDTs are best used near the onset of illness when viral load is highest and clinical action will be most impactful, which may be achieved by at-home testing. We evaluated the diagnostic accuracy of the QuickVue Influenza A + B RDT in an at-home setting. A convenience sample of 5,229 individuals who were engaged with an on-line health research platform were prospectively recruited throughout the United States. "flu@home" test kits containing a QuickVue RDT and reference sample collection and shipping materials were pre-positioned with participants at the beginning of the study. Participants responded to daily symptom surveys. If they reported experiencing cough along with aches, fever, chills, and/or sweats, they used their flu@home kit following instructions on a mobile app and indicated what lines they saw on the RDT. Of the 976 participants who met criteria to use their self-collection kit and completed study procedures, 202 (20.7%) were positive for influenza by qPCR. The RDT had a sensitivity of 28% (95% CI: 21-36) and specificity of 99% (98-99) for influenza A, and 32% (95% CI: 20-46) and 99% (95% CI: 98-99), for influenza B. Our results support the concept of app-supported, pre-positioned at-home RDT kits using symptom-based triggers, although it cannot be recommended with the RDT used in this study. Further research is needed to determine ways to improve the accuracy and utility of home-based testing for influenza.
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13
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Requirements and study designs for US regulatory approval of influenza home tests. J Clin Microbiol 2021; 60:e0188421. [PMID: 34911365 PMCID: PMC9116184 DOI: 10.1128/jcm.01884-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Home testing for infectious disease has come to the forefront during the COVID-19 pandemic. There is now considerable commercial interest in developing complete home tests for a variety of viral and bacterial pathogens. However, the regulatory science around home infectious disease test approval, and procedures test manufacturers and laboratory professionals will need to follow, have not yet been formalized by US FDA, with the exception of EUA guidance for COVID-19 tests. We describe the state of home-based testing for influenza with a focus on sample-to-result home tests, discuss the various regulatory pathways by which these products can reach populations, and provide recommendations for study designs, patient samples, and other important features necessary to gain market access. These recommendations have potential application for home use tests being developed for other viral respiratory infections, such as COVID-19, as guidance moves from EUA designation into 510(k) requirements.
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Muñoz-Ramírez S, Escribano-López B, Rodrigo-Casares V, Vergara-Hernández C, Gil-Mary D, Sorribes-Monrabal I, Garcés-Sánchez M, Muñoz-Del-Barrio MJ, Albors-Fernández AM, Úbeda-Sansano MI, Planelles-Cantarino MV, Largo-Blanco EM, Suárez-Vicent E, García-Rubio J, Bruijning-Verhagen P, Orrico-Sánchez A, Díez-Domingo J. Feasibility of a hybrid clinical trial for respiratory virus detection in toddlers during the influenza season. BMC Med Res Methodol 2021; 21:273. [PMID: 34865624 PMCID: PMC8645221 DOI: 10.1186/s12874-021-01474-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional clinical trials are conducted at investigator sites. Participants must visit healthcare facilities several times for the trial procedures. Decentralized clinical trials offer an interesting alternative. They use telemedicine and other technological solutions (apps, monitoring devices or web platforms) to decrease the number of visits to study sites, minimise the impact on daily routine, and decrease geographical barriers for participants. Not much information is available on the use of decentralization in randomized clinical trials with vaccines. METHODS A hybrid clinical trial may be assisted by parental recording of symptoms using electronic log diaries in combination with home collected nasal swabs. During two influenza seasons, children aged 12 to 35 months with a history of recurrent acute respiratory infections were recruited in 12 primary health centers of the Valencia Region in Spain. Parents completed a symptom diary through an ad hoc mobile app that subsequently assessed whether it was an acute respiratory infection and requested collection of a nasal swab. Feasibility was measured using the percentage of returned electronic diaries and the validity of nasal swabs collected during the influenza season. Respiratory viruses were detected by real-time PCR. RESULTS Ninety-nine toddlers were enrolled. Parents completed 10,476 electronic diaries out of the 10,804 requested (97%). The mobile app detected 188 potential acute respiratory infections (ARIs) and requested a nasal swab. In 173 (92%) ARI episodes a swab was taken. 165 (95.4%) of these swabs were collected at home and 144 (87.3%) of them were considered valid for laboratory testing. Overall, 152 (81%) of the ARIs detected in the study had its corresponding valid sample collected. CONCLUSIONS Hybrid procedures used in this clinical trial with the influenza vaccine in toddlers were considered adequate, as we diagnosed most of the ARI cases on time, and had a valid swab in 81% of the cases. Hybrid clinical trials improve participant adherence to the study procedures and could improve recruitment and quality of life of the participants and the research team by decreasing the number of visits to the investigator site. This report emphasises that the conduct of hybrid CTs is a valid alternative to traditional CTs with vaccines. This hybrid CT achieved high adherence of participant to the study procedures. TRIAL REGISTRATION 2019-001186-33 (EudraCT).
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Affiliation(s)
- Soledad Muñoz-Ramírez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain.
| | - Begoña Escribano-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Vallivana Rodrigo-Casares
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Carlos Vergara-Hernández
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | | | | | | | | | | | | | | | | | - Javier García-Rubio
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | | | - Alejandro Orrico-Sánchez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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15
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Doumit M, Cox A, Butler J, Luxton N, Jaffe A, Chuang S. Parent-Collected Oropharyngeal Swabs in Cystic Fibrosis. Pediatrics 2021; 148:e2021053822. [PMID: 34814163 DOI: 10.1542/peds.2021-053822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/24/2022] Open
Abstract
The validity of oropharyngeal swabs obtained by parents is described, and a case for parent-collection to be used as part of remote care is presented.
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Affiliation(s)
- Michael Doumit
- Respiratory Medicine Department, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- Department of Health Sciences, Macquarie University, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Aiden Cox
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Jane Butler
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Nia Luxton
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Adam Jaffe
- Respiratory Medicine Department, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Sandra Chuang
- Respiratory Medicine Department, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
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16
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Tonen-Wolyec S, Dupont R, Awaida N, Batina-Agasa S, Hayette MP, Bélec L. Evaluation of the Practicability of Biosynex Antigen Self-Test COVID-19 AG+ for the Detection of SARS-CoV-2 Nucleocapsid Protein from Self-Collected Nasal Mid-Turbinate Secretions in the General Public in France. Diagnostics (Basel) 2021; 11:2217. [PMID: 34943454 PMCID: PMC8700066 DOI: 10.3390/diagnostics11122217] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022] Open
Abstract
Due to their ease-of-use, lateral flow assay SARS-CoV-2 antigen-detecting rapid diagnostic tests could be suitable candidates for antigen-detecting rapid diagnostic self-test (Ag-RDST). We evaluated the practicability of the Ag-RDST BIOSYNEX Antigen Self-Test COVID-19 Ag+ (Biosynex Swiss SA, Freiburg, Switzerland), using self-collected nasal secretions from the turbinate medium (NMT), in 106 prospectively included adult volunteers living in Paris, France. The majority of the participants correctly understood the instructions for use (94.4%; 95% confidence interval (CI): 88.3-97.4), showing a great ability to perform the entire self-test procedure to obtain a valid and interpretable result (100%; 95% CI: 96.5-100), and demonstrated the ability to correctly interpret test results (96.2%; 95% CI: 94.2-97.5) with a high level of general satisfaction. About one in eight participants (# 15%) needed verbal help to perform or interpret the test, and only 3.8% of test results were misinterpreted. By reference to multiplex real-time RT-PCR, the Ag-RDST showed 90.9% and 100% sensitivity and specificity, respectively, and high agreement (98.1%), reliability (0.94), and accuracy (90.9%) to detect SARS-CoV-2 antigen. Taken together, our study demonstrates the high usability and accuracy of BIOSYNEX Antigen Self-Test COVID-19 Ag+ for supervised self-collected NMT sampling in an unselected adult population living in France.
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Affiliation(s)
- Serge Tonen-Wolyec
- Ecole Doctorale Régionale D’Afrique Centrale en Infectiologie Tropicale, Franceville 876, Gabon;
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani 2012, Congo;
| | - Raphaël Dupont
- Laboratoire Paris XV, 75015 Paris, France; (R.D.); (N.A.)
| | - Natalio Awaida
- Laboratoire Paris XV, 75015 Paris, France; (R.D.); (N.A.)
| | - Salomon Batina-Agasa
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani 2012, Congo;
| | - Marie-Pierre Hayette
- Department of Clinical Microbiology, University Hospital of Liege, 4000 Liege, Belgium;
| | - Laurent Bélec
- Laboratoire de Virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université of Paris, Sorbonne Paris Cité, 75015 Paris, France
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17
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Amoo OS, Adewara F, Tijani B, Onuigbo TI, Ikemefuna AS, Oraegbu JI, Rizvi T, Okwuraiwe A, Onwuamah C, Shaibu J, James A, Ohihoin G, Ige F, Kareithi D, David A, Karera S, Agboola H, Adeniyi A, Obi J, Achanya D, Odewale E, Oforomeh O, Liboro G, Nwogbe O, Ezechi O, Adegbola R, Audu R, Salako B. The use of DIY (Do it yourself) sampling and telemonitoring model for COVID-19 qPCR testing scale up. PLoS One 2021; 16:e0259398. [PMID: 34735503 PMCID: PMC8568151 DOI: 10.1371/journal.pone.0259398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
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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Affiliation(s)
- Olufemi Samuel Amoo
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | | | | | | | - Joy Isioma Oraegbu
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Tazeen Rizvi
- Mobihealth International Limited, Abuja, Nigeria
| | - Azuka Okwuraiwe
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Chika Onwuamah
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Joseph Shaibu
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ayorinde James
- Department of Biochemistry, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Greg Ohihoin
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Fehintola Ige
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - Agatha David
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - Hammed Agboola
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Anthony Adeniyi
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Josephine Obi
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Dominic Achanya
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ebenezer Odewale
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Osaga Oforomeh
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Gideon Liboro
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Olayemi Nwogbe
- Department of Library and Information Technology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Oliver Ezechi
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Richard Adegbola
- Department of Biochemistry, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Rosemary Audu
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Babatunde Salako
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
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Strong LE, Middendorf I, Turner M, Sama V, Edwards V DK, Mou J, Adams KC. Usability of an At-Home Anterior Nares SARS-CoV-2 RT-PCR Sample Collection Kit: Human Factors Feasibility Study. JMIR Hum Factors 2021; 8:e29234. [PMID: 34609947 PMCID: PMC8673714 DOI: 10.2196/29234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/13/2021] [Accepted: 10/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Readily available testing for SARS-CoV-2 is necessary to mitigate COVID-19 disease outbreaks. At-home collection kits, in which samples are self-collected without requiring a laboratory or clinic visit and sent to an external laboratory for testing, can provide convenient testing to those with barriers to access. They can prevent unnecessary exposure between patient and clinical staff, increase access for patients with disabilities or remote workers, and decrease burdens on health care resources, such as provider time and personal protective equipment. Exact Sciences developed an at-home collection kit for samples to be tested to detect SARS-CoV-2 that includes an Instructions for Use (IFU) document, which guides people without prior experience on collecting a nasal swab sample. Demonstrating successful sample collection and usability is critical to ensure that these samples meet the same high-quality sample collection standards as samples collected in clinics. Objective The aim of this study was to determine the usability of a SARS-CoV-2 at-home nasal swab sample collection kit. Methods A human factors usability study was conducted with 30 subjects without prior medical, laboratory, or health care training and without COVID-19 sample self-collection experience. Subjects were observed while they followed the IFU for the at-home sample collection portion of the SARS-CoV-2 test in a setting that simulated a home environment. IFU usability was further evaluated by requiring the subjects to complete a survey, answer comprehension questions, provide written feedback, and respond to questions from the observer about problems during use. Results All 30 subjects successfully completed the sample collection process, and all 30 samples were determined by reverse transcription–polymerase chain reaction (RT-PCR) testing to meet quality standards for SARS-CoV-2 testing. The subjects’ written feedback and comments revealed several recommendations to improve the IFU. Conclusions The study demonstrated the overall usability of an at-home SARS-CoV-2 collection kit. Various feedback mechanisms provided opportunities to improve the wording and graphics for some critical tasks, including placing the label correctly on the tube. A modified IFU was prepared based on study outcomes.
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19
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Nguyen TT, Zeger WG, Wadman MC, Barksdale AN. Accuracy and Acceptance of a Self-Collection Model for Respiratory Tract Infection Diagnostics: A Concise Clinical Literature Review. J Emerg Nurs 2021; 47:798-806. [PMID: 34530972 PMCID: PMC8238690 DOI: 10.1016/j.jen.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/06/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
Background Nurses are the primary clinicians who collect specimens for respiratory tract infection testing. The specimen collection procedure is time and resource-consuming, but more importantly, it places nurses at risk for potential infection. The practice of allowing patients to self-collect their diagnostic specimens may provide an alternative testing model for the current COVID-19 outbreaks. The objective of this paper was to evaluate the accuracy and patient perception of self-collected specimens for respiratory tract infection diagnostics. Methods A concise clinical review of the recently published literature was conducted. Results A total of 11 articles were included the review synthesis. The concept of self-collected specimens has a high patient acceptance rate of 83-99%. Self-collected nasal-swab specimens demonstrated strong diagnostic fidelity for respiratory tract infections with a sensitivity between 80-100%, this is higher than the 76% sensitivity observed with self-collected throat specimens. In a comparative study evaluating a professionally collected to a self-collected specimen for COVID-19 testing, a high degree of agreement (k = 0.89) was observed between the two methods. Conclusion As we continue to explore for testing models to combat the COVID-19 pandemic, self-collected specimens is a practical alternative to nurse specimen collection.
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Malfatti G, Racano E, Delle Site R, Gios L, Micocci S, Dianti M, Molini PB, Allegrini F, Ravagni M, Moz M, Nicolini A, Romanelli F. Enabling teleophthalmology during the COVID-19 pandemic in the Province of Trento, Italy: Design and implementation of a mHealth solution. PLoS One 2021; 16:e0257250. [PMID: 34506578 PMCID: PMC8432860 DOI: 10.1371/journal.pone.0257250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients. OBJECTIVE In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative-albeit restricted-experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits. METHODS A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician's requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow. RESULTS Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems. CONCLUSIONS The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.
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Affiliation(s)
- Giulia Malfatti
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Elisabetta Racano
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Roberta Delle Site
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Lorenzo Gios
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | | | - Marco Dianti
- Fondazione Bruno Kessler, Digital Health Lab, Povo, Italy
| | | | - Francesca Allegrini
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Mariangela Ravagni
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Monica Moz
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Andrea Nicolini
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Federica Romanelli
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
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21
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Influenza vaccine effectiveness within prospective cohorts of healthcare personnel in Israel and Peru 2016-2019. Vaccine 2021; 39:6956-6967. [PMID: 34509322 DOI: 10.1016/j.vaccine.2021.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are limited data on influenza vaccine effectiveness (IVE) in preventing laboratory-confirmed influenza illness among healthcare personnel (HCP). METHODS HCP with direct patient contact working full-time in hospitals were followed during three influenza seasons in Israel (2016-2017 to 2018-2019) and Peru (2016 to 2018). Trivalent influenza vaccines were available at all sites, except during 2018-2019 when Israel used quadrivalent vaccines; vaccination was documented by electronic medical records, vaccine registries, and/or self-report (for vaccinations outside the hospital). Twice-weekly active surveillance identified acute respiratory symptoms or febrile illness (ARFI); self-collected respiratory specimens were tested by real-time reverse transcription polymerase chain reaction (PCR) assay. IVE was 100 × 1-hazard ratio (adjusted for sex, age, occupation, and hospital). RESULTS Among 5,489 HCP who contributed 10,041 person-seasons, influenza vaccination coverage was 47% in Israel and 32% in Peru. Of 3,056 ARFIs in Israel and 3,538 in Peru, A or B influenza virus infections were identified in 205 (7%) in Israel and 87 (2.5%) in Peru. IVE against all viruses across seasons was 1% (95% confidence interval [CI] = -30%, 25%) in Israel and 12% (95% CI = -61%, 52%) in Peru. CONCLUSION Estimates of IVE were null using person-time models during six study seasons in Israel and Peru.
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22
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Suntarattiwong P, Mott JA, Mohanty S, Sinthuwattanawibool C, Srisantiroj N, Patamasingh Na Ayudhaya O, Klungthong C, Fernandez S, Kim L, Hunt D, Hombroek D, Brummer T, Chotpitayasunondh T, Dawood FS, Kittikraisak W. Feasibility and Performance of Self-Collected Nasal Swabs for Detection of Influenza Virus, Respiratory Syncytial Virus, and Human Metapneumovirus. J Infect Dis 2021; 224:831-838. [PMID: 34467984 DOI: 10.1093/infdis/jiab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed performance of participant-collected midturbinate nasal swabs compared to study staff-collected midturbinate nasal swabs for the detection of respiratory viruses among pregnant women in Bangkok, Thailand. METHODS We enrolled pregnant women aged ≥18 years and followed them throughout the 2018 influenza season. Women with acute respiratory illness self-collected midturbinate nasal swabs at home for influenza viruses, respiratory syncytial viruses (RSV), and human metapneumoviruses (hMPV) real-time RT-PCR testing and the study nurse collected a second midturbinate nasal swab during home visits. Paired specimens were processed and tested on the same day. RESULTS The majority (109, 60%) of 182 participants were 20-30 years old. All 200 paired swabs had optimal specimen quality. The median time from symptom onsets to participant-collected swabs was 2 days and to staff-collected swabs was also 2 days. The median time interval between the 2 swabs was 2 hours. Compared to staff-collected swabs, the participant-collected swabs were 93% sensitive and 99% specific for influenza virus detection, 94% sensitive and 99% specific for RSV detection, and 100% sensitive and 100% specific for hMPV detection. CONCLUSIONS Participant-collected midturbinate nasal swabs were a valid alternative approach for laboratory confirmation of influenza-, RSV-, and hMPV-associated illnesses among pregnant women in a community setting.
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Affiliation(s)
| | - Joshua A Mott
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarita Mohanty
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chalinthorn Sinthuwattanawibool
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Lindsay Kim
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Fatimah S Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
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23
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Lucas TCD, Davis EL, Ayabina D, Borlase A, Crellen T, Pi L, Medley GF, Yardley L, Klepac P, Gog J, Déirdre Hollingsworth T. Engagement and adherence trade-offs for SARS-CoV-2 contact tracing. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200270. [PMID: 34053257 PMCID: PMC8165588 DOI: 10.1098/rstb.2020.0270] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/23/2022] Open
Abstract
Contact tracing is an important tool for allowing countries to ease lockdown policies introduced to combat SARS-CoV-2. For contact tracing to be effective, those with symptoms must self-report themselves while their contacts must self-isolate when asked. However, policies such as legal enforcement of self-isolation can create trade-offs by dissuading individuals from self-reporting. We use an existing branching process model to examine which aspects of contact tracing adherence should be prioritized. We consider an inverse relationship between self-isolation adherence and self-reporting engagement, assuming that increasingly strict self-isolation policies will result in fewer individuals self-reporting to the programme. We find that policies which increase the average duration of self-isolation, or that increase the probability that people self-isolate at all, at the expense of reduced self-reporting rate, will not decrease the risk of a large outbreak and may increase the risk, depending on the strength of the trade-off. These results suggest that policies to increase self-isolation adherence should be implemented carefully. Policies that increase self-isolation adherence at the cost of self-reporting rates should be avoided. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'.
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Affiliation(s)
- Tim C. D. Lucas
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Emma L. Davis
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Diepreye Ayabina
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Anna Borlase
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Thomas Crellen
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Li Pi
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Graham F. Medley
- MathSys CDT, University of Warwick, Coventry, UK
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Petra Klepac
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department for Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Julia Gog
- Department for Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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24
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A Systematic Review and Meta-analysis of Upper Airway Swab Collection for Detection of Viral and Bacterial Pathogens by Individuals or Caregivers Compared to Health Care Workers. J Clin Microbiol 2021; 59:e0230420. [PMID: 33468606 DOI: 10.1128/jcm.02304-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Self- or caregiver collection of upper airway swabs reduces infectious exposures of health care workers (HCWs) and the need to redeploy clinical staff to testing roles. We aimed to determine whether self- or caregiver collection has adequate diagnostic performance for detection of viral and bacterial upper airway pathogens. We did a systematic review and meta-analysis of studies comparing diagnostic accuracy of self- or caregiver-collected upper airway swabs collected by patients or caregivers compared to HCWs. All study types except case reports and series were included if sufficient data were presented to calculate sensitivity, specificity, and Cohen's kappa. Studies published from 1946 to 17 August 2020 were included in the search. We did a meta-analysis to assess pooled sensitivity and specificity. Twenty studies were included in the systematic review and 15 in the meta-analysis. The overall sensitivity of swabs collected by patients or caregivers compared to HCWs was 91% (95% confidence interval [CI], 87 to 94), and specificity was 98% (95% CI, 96 to 99). Sensitivity ranged from 65% to 100% and specificity from 73% to 100% across the studies. All but one study concluded that self- or caregiver-collected swabs were acceptable for detection of upper airway pathogens. Self- and caregiver collection of upper airway swabs had reassuring diagnostic performance for multiple pathogens. There are numerous potential benefits of self- and caregiver-collected swabs for patients, families, researchers, and health systems. Further research to optimize implementation of sample collection by patients and caregivers is warranted.
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Leung VKY, Fox A, Carolan LA, Aban M, Laurie KL, Druce J, Deng YM, Slavin MA, Marshall C, Sullivan SG. Impact of prior vaccination on antibody response and influenza-like illness among Australian healthcare workers after influenza vaccination in 2016. Vaccine 2021; 39:3270-3278. [PMID: 33985853 DOI: 10.1016/j.vaccine.2021.04.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Epidemiological studies suggest that influenza vaccine effectiveness decreases with repeated administration. We examined antibody responses to influenza vaccination among healthcare workers (HCWs) by prior vaccination history and determined the incidence of influenza infection. METHODS HCWs were vaccinated with the 2016 Southern Hemisphere quadrivalent influenza vaccine. Serum samples were collected pre-vaccination, 21-28 days and 7 months post-vaccination. Influenza antibody titres were measured at each time-point using the haemagglutination inhibition (HI) assay. Immunogenicity was compared by prior vaccination history. RESULTS A total of 157 HCWs completed the study. The majority were frequently vaccinated, with only 5 reporting no prior vaccinations since 2011. Rises in titres for all vaccine strains among vaccine-naïve HCWs were significantly greater than rises observed for HCWs who received between 1 and 5 prior vaccinations (p < 0.001, respectively). Post-vaccination GMTs against influenza A but not B strains decreased as the number of prior vaccinations increased from 1 to 5. There was a significant decline in GMTs post-season for both B lineages. Sixty five (41%) HCWs reported at least one influenza-like illness episode, with 6 (4%) identified as influenza positive. CONCLUSIONS Varying serological responses to influenza vaccination were observed among HCWs by prior vaccination history, with vaccine-naïve HCWs demonstrating greater post-vaccination responses against A(H3N2).
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Affiliation(s)
- Vivian K Y Leung
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Annette Fox
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Louise A Carolan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Malet Aban
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Karen L Laurie
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Julian Druce
- Victorian Infectious Disease Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Yi-Mo Deng
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Monica A Slavin
- Victorian Infectious Disease Service, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Caroline Marshall
- Victorian Infectious Disease Service, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Melbourne, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Fielding School of Public Health, University of California, Los Angeles, USA; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
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Evaluation of Specimen Types and Saliva Stabilization Solutions for SARS-CoV-2 Testing. J Clin Microbiol 2021; 59:JCM.01418-20. [PMID: 33674284 PMCID: PMC8091857 DOI: 10.1128/jcm.01418-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
Identifying SARS-CoV-2 infections through aggressive diagnostic testing remains critical to tracking and curbing the spread of the COVID-19 pandemic. Collection of nasopharyngeal swabs (NPS), the preferred sample type for SARS-CoV-2 detection, has become difficult due to the dramatic increase in testing and consequent supply strain. Identifying SARS-CoV-2 infections through aggressive diagnostic testing remains critical to tracking and curbing the spread of the COVID-19 pandemic. Collection of nasopharyngeal swabs (NPS), the preferred sample type for SARS-CoV-2 detection, has become difficult due to the dramatic increase in testing and consequent supply strain. Therefore, alternative specimen types have been investigated that provide similar detection sensitivity with reduced health care exposure and the potential for self-collection. In this study, the detection sensitivity of SARS-CoV-2 in nasal swabs (NS) and saliva was compared to that of NPS using matched specimens from two outpatient cohorts in New York State (total n = 463). The first cohort showed only a 5.4% positivity, but the second cohort (n = 227) had a positivity rate of 41%, with sensitivity in NPS, NS, and saliva of 97.9%, 87.1%, and 87.1%, respectively. Whether the reduced sensitivity of NS or saliva is acceptable must be assessed in the settings where they are used. However, we sought to improve on it by validating a method to mix the two sample types, as the combination of nasal swab and saliva resulted in 94.6% SARS-CoV-2 detection sensitivity. Spiking experiments showed that combining them did not adversely affect the detection sensitivity in either. Virus stability in saliva was also investigated, with and without the addition of commercially available stabilizing solutions. The virus was stable in saliva at both 4°C and room temperature for up to 7 days. The addition of stabilizing solutions did not enhance stability and, in some situations, reduced detectable virus levels.
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27
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Evaluating Specimen Quality and Results from a Community-Wide, Home-Based Respiratory Surveillance Study. J Clin Microbiol 2021; 59:JCM.02934-20. [PMID: 33563599 PMCID: PMC8091861 DOI: 10.1128/jcm.02934-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/05/2021] [Indexed: 01/11/2023] Open
Abstract
While influenza and other respiratory pathogens cause significant morbidity and mortality, the community-based burden of these infections remains incompletely understood. The development of novel methods to detect respiratory infections is essential for mitigating epidemics and developing pandemic-preparedness infrastructure. While influenza and other respiratory pathogens cause significant morbidity and mortality, the community-based burden of these infections remains incompletely understood. The development of novel methods to detect respiratory infections is essential for mitigating epidemics and developing pandemic-preparedness infrastructure. From October 2019 to March 2020, we conducted a home-based cross-sectional study in the greater Seattle, WA, area, utilizing electronic consent and data collection instruments. Participants received nasal swab collection kits via rapid delivery within 24 hours of self-reporting respiratory symptoms. Samples were returned to the laboratory and were screened for 26 respiratory pathogens and a housekeeping gene. Participant data were recorded via online survey at the time of sample collection and 1 week later. Of the 4,572 consented participants, 4,359 (95.3%) received a home swab kit and 3,648 (83.7%) returned a nasal specimen for respiratory pathogen screening. The 3,638 testable samples had a mean RNase P relative cycle threshold (Crt) value of 19.0 (SD, 3.4), and 1,232 (33.9%) samples had positive results for one or more pathogens, including 645 (17.7%) influenza-positive specimens. Among the testable samples, the median time between shipment of the home swab kit and completion of laboratory testing was 8.0 days (interquartile range [IQR], 7.0 to 14.0). A single adverse event occurred and did not cause long-term effects or require medical attention. Home-based surveillance using online participant enrollment and specimen self-collection is a safe and feasible method for community-level monitoring of influenza and other respiratory pathogens, which can readily be adapted for use during pandemics.
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28
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Petersen JM, Ranker LR, Barnard-Mayers R, MacLehose RF, Fox MP. A systematic review of quantitative bias analysis applied to epidemiological research. Int J Epidemiol 2021; 50:1708-1730. [PMID: 33880532 DOI: 10.1093/ije/dyab061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Quantitative bias analysis (QBA) measures study errors in terms of direction, magnitude and uncertainty. This systematic review aimed to describe how QBA has been applied in epidemiological research in 2006-19. METHODS We searched PubMed for English peer-reviewed studies applying QBA to real-data applications. We also included studies citing selected sources or which were identified in a previous QBA review in pharmacoepidemiology. For each study, we extracted the rationale, methodology, bias-adjusted results and interpretation and assessed factors associated with reproducibility. RESULTS Of the 238 studies, the majority were embedded within papers whose main inferences were drawn from conventional approaches as secondary (sensitivity) analyses to quantity-specific biases (52%) or to assess the extent of bias required to shift the point estimate to the null (25%); 10% were standalone papers. The most common approach was probabilistic (57%). Misclassification was modelled in 57%, uncontrolled confounder(s) in 40% and selection bias in 17%. Most did not consider multiple biases or correlations between errors. When specified, bias parameters came from the literature (48%) more often than internal validation studies (29%). The majority (60%) of analyses resulted in >10% change from the conventional point estimate; however, most investigators (63%) did not alter their original interpretation. Degree of reproducibility related to inclusion of code, formulas, sensitivity analyses and supplementary materials, as well as the QBA rationale. CONCLUSIONS QBA applications were rare though increased over time. Future investigators should reference good practices and include details to promote transparency and to serve as a reference for other researchers.
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Affiliation(s)
- Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynsie R Ranker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ruby Barnard-Mayers
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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29
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Griesemer SB, Van Slyke G, Ehrbar D, Strle K, Yildirim T, Centurioni DA, Walsh AC, Chang AK, Waxman MJ, St George K. Evaluation of Specimen Types and Saliva Stabilization Solutions for SARS-CoV-2 Testing. J Clin Microbiol 2021; 59:JCM.01418-20. [PMID: 33674284 DOI: 10.1101/2020.06.16.20133041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/24/2021] [Indexed: 05/23/2023] Open
Abstract
Identifying SARS-CoV-2 infections through aggressive diagnostic testing remains critical to tracking and curbing the spread of the COVID-19 pandemic. Collection of nasopharyngeal swabs (NPS), the preferred sample type for SARS-CoV-2 detection, has become difficult due to the dramatic increase in testing and consequent supply strain. Therefore, alternative specimen types have been investigated that provide similar detection sensitivity with reduced health care exposure and the potential for self-collection. In this study, the detection sensitivity of SARS-CoV-2 in nasal swabs (NS) and saliva was compared to that of NPS using matched specimens from two outpatient cohorts in New York State (total n = 463). The first cohort showed only a 5.4% positivity, but the second cohort (n = 227) had a positivity rate of 41%, with sensitivity in NPS, NS, and saliva of 97.9%, 87.1%, and 87.1%, respectively. Whether the reduced sensitivity of NS or saliva is acceptable must be assessed in the settings where they are used. However, we sought to improve on it by validating a method to mix the two sample types, as the combination of nasal swab and saliva resulted in 94.6% SARS-CoV-2 detection sensitivity. Spiking experiments showed that combining them did not adversely affect the detection sensitivity in either. Virus stability in saliva was also investigated, with and without the addition of commercially available stabilizing solutions. The virus was stable in saliva at both 4°C and room temperature for up to 7 days. The addition of stabilizing solutions did not enhance stability and, in some situations, reduced detectable virus levels.
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Affiliation(s)
- Sara B Griesemer
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Greta Van Slyke
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Dylan Ehrbar
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Klemen Strle
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Tugba Yildirim
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Dominick A Centurioni
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Anne C Walsh
- Directors Office, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Andrew K Chang
- Department of Emergency Medicine, Albany Medical Center, Albany, New York, USA
| | - Michael J Waxman
- Department of Emergency Medicine, Albany Medical Center, Albany, New York, USA
| | - Kirsten St George
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, SUNY, Albany, New York, USA
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30
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Cockerill FR, Wohlgemuth JG, Radcliff J, Sabol CE, Kapoor H, Dlott JS, Marlowe EM, Clarke NJ. Evolution of Specimen Self-Collection in the COVID-19 Era: Implications for Population Health Management of Infectious Disease. Popul Health Manag 2021; 24:S26-S34. [PMID: 33544647 PMCID: PMC7875129 DOI: 10.1089/pop.2020.0296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Laboratory testing is an important component in the diagnosis of respiratory tract infections such as with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, specimen collection not only risks exposure of health care workers and other patients to infection, but also necessitates use of personal protective equipment that may be in short supply during periods of heightened disease activity. Self-collection of nasal or oropharyngeal swabs offers an alternative to address these drawbacks. Although studies in the past decade have demonstrated the utility of this approach for respiratory infections, it has not been widely adopted in routine clinical practice. The rapid spread of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has focused attention on the need for safe, convenient, timely, and scalable methods for collecting upper respiratory specimens for testing. The goals of this article are to highlight the literature regarding self-collected nasal or oropharyngeal specimens for respiratory pathogen testing; discuss the role of self-collection in helping prevent the spread of the COVID-19 disease from infected patients and facilitating a shift toward “virtual” medicine or telemedicine; and describe the current and future state of self-collection for infectious agents, and the impacts these approaches can have on population health management and disease diagnosis and prevention.
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Affiliation(s)
| | | | | | | | - Hema Kapoor
- Quest Diagnostics, Secaucus, New Jersey, USA
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31
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Lokuge K, Banks E, Davis S, Roberts L, Street T, O'Donovan D, Caleo G, Glass K. Exit strategies: optimising feasible surveillance for detection, elimination, and ongoing prevention of COVID-19 community transmission. BMC Med 2021; 19:50. [PMID: 33596902 PMCID: PMC7887417 DOI: 10.1186/s12916-021-01934-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Following implementation of strong containment measures, several countries and regions have low detectable community transmission of COVID-19. We developed an efficient, rapid, and scalable surveillance strategy to detect remaining COVID-19 community cases through exhaustive identification of every active transmission chain. We identified measures to enable early detection and effective management of any reintroduction of transmission once containment measures are lifted to ensure strong containment measures do not require reinstatement. METHODS We compared efficiency and sensitivity to detect community transmission chains through testing of the following: hospital cases; fever, cough and/or ARI testing at community/primary care; and asymptomatic testing; using surveillance evaluation methods and mathematical modelling, varying testing capacities, reproductive number (R) and weekly cumulative incidence of COVID-19 and non-COVID-19 respiratory symptoms using data from Australia. We assessed system requirements to identify all transmission chains and follow up all cases and primary contacts within each chain, per million population. RESULTS Assuming 20% of cases are asymptomatic and 30% of symptomatic COVID-19 cases present for testing, with R = 2.2, a median of 14 unrecognised community cases (8 infectious) occur when a transmission chain is identified through hospital surveillance versus 7 unrecognised cases (4 infectious) through community-based surveillance. The 7 unrecognised community upstream cases are estimated to generate a further 55-77 primary contacts requiring follow-up. The unrecognised community cases rise to 10 if 50% of cases are asymptomatic. Screening asymptomatic community members cannot exhaustively identify all cases under any of the scenarios assessed. The most important determinant of testing requirements for symptomatic screening is levels of non-COVID-19 respiratory illness. If 4% of the community have respiratory symptoms, and 1% of those with symptoms have COVID-19, exhaustive symptomatic screening requires approximately 11,600 tests/million population using 1/4 pooling, with 98% of cases detected (2% missed), given 99.9% sensitivity. Even with a drop in sensitivity to 70%, pooling was more effective at detecting cases than individual testing under all scenarios examined. CONCLUSIONS Screening all acute respiratory disease in the community, in combination with exhaustive and meticulous case and contact identification and management, enables appropriate early detection and elimination of COVID-19 community transmission. An important component is identification, testing, and management of all contacts, including upstream contacts (i.e. potential sources of infection for identified cases, and their related transmission chains). Pooling allows increased case detection when testing capacity is limited, even given reduced test sensitivity. Critical to the effectiveness of all aspects of surveillance is appropriate community engagement, messaging to optimise testing uptake and compliance with other measures.
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Affiliation(s)
- K Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia.
| | - E Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - S Davis
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - L Roberts
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - T Street
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - D O'Donovan
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - G Caleo
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - K Glass
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
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32
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Lokuge K, Banks E, Davis S, Roberts L, Street T, O'Donovan D, Caleo G, Glass K. Exit strategies: optimising feasible surveillance for detection, elimination, and ongoing prevention of COVID-19 community transmission. BMC Med 2021; 19:50. [PMID: 33596902 DOI: 10.1101/2020.04.19.20071217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/02/2021] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Following implementation of strong containment measures, several countries and regions have low detectable community transmission of COVID-19. We developed an efficient, rapid, and scalable surveillance strategy to detect remaining COVID-19 community cases through exhaustive identification of every active transmission chain. We identified measures to enable early detection and effective management of any reintroduction of transmission once containment measures are lifted to ensure strong containment measures do not require reinstatement. METHODS We compared efficiency and sensitivity to detect community transmission chains through testing of the following: hospital cases; fever, cough and/or ARI testing at community/primary care; and asymptomatic testing; using surveillance evaluation methods and mathematical modelling, varying testing capacities, reproductive number (R) and weekly cumulative incidence of COVID-19 and non-COVID-19 respiratory symptoms using data from Australia. We assessed system requirements to identify all transmission chains and follow up all cases and primary contacts within each chain, per million population. RESULTS Assuming 20% of cases are asymptomatic and 30% of symptomatic COVID-19 cases present for testing, with R = 2.2, a median of 14 unrecognised community cases (8 infectious) occur when a transmission chain is identified through hospital surveillance versus 7 unrecognised cases (4 infectious) through community-based surveillance. The 7 unrecognised community upstream cases are estimated to generate a further 55-77 primary contacts requiring follow-up. The unrecognised community cases rise to 10 if 50% of cases are asymptomatic. Screening asymptomatic community members cannot exhaustively identify all cases under any of the scenarios assessed. The most important determinant of testing requirements for symptomatic screening is levels of non-COVID-19 respiratory illness. If 4% of the community have respiratory symptoms, and 1% of those with symptoms have COVID-19, exhaustive symptomatic screening requires approximately 11,600 tests/million population using 1/4 pooling, with 98% of cases detected (2% missed), given 99.9% sensitivity. Even with a drop in sensitivity to 70%, pooling was more effective at detecting cases than individual testing under all scenarios examined. CONCLUSIONS Screening all acute respiratory disease in the community, in combination with exhaustive and meticulous case and contact identification and management, enables appropriate early detection and elimination of COVID-19 community transmission. An important component is identification, testing, and management of all contacts, including upstream contacts (i.e. potential sources of infection for identified cases, and their related transmission chains). Pooling allows increased case detection when testing capacity is limited, even given reduced test sensitivity. Critical to the effectiveness of all aspects of surveillance is appropriate community engagement, messaging to optimise testing uptake and compliance with other measures.
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Affiliation(s)
- K Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia.
| | - E Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - S Davis
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - L Roberts
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - T Street
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - D O'Donovan
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - G Caleo
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - K Glass
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
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Fragala MS, Goldberg ZN, Goldberg SE. Return to Work: Managing Employee Population Health During the COVID-19 Pandemic. Popul Health Manag 2021; 24:S3-S15. [PMID: 33347795 PMCID: PMC7875125 DOI: 10.1089/pop.2020.0261] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has abruptly transformed the outlook of employer health benefits plans for 2020 and 2021. Containing the spread of the virus and facilitating care of those infected have quickly emerged as immediate priorities. Employers have adjusted health benefits coverage to make COVID-19 testing and treatment accessible and remove barriers to care in order to facilitate the containment of the disease. Employers also are introducing strategies focused on testing, surveillance, workplace modifications, and hygiene to keep workforces healthy and workplaces safe. This paper is intended to provide evidence-based perspectives for self-insured employers for managing population health during the COVID-19 pandemic. Such considerations include (1) return to work practices focused on mitigating the spread of COVID-19 through safety practices, testing and surveillance; and (2) anticipating the impact of COVID-19 on health benefits and costs (including adaptations in delivery of care, social and behavioral health needs, and managing interrupted care for chronic conditions).
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Edelstein M, Obi C, Chand M, Hopkins S, Brown K, Ramsay M. SARS-CoV-2 infection in London, England: changes to community point prevalence around lockdown time, March-May 2020. J Epidemiol Community Health 2021; 75:185-188. [PMID: 33004659 PMCID: PMC7815898 DOI: 10.1136/jech-2020-214730] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The UK has been one of the European countries most affected by COVID-19 pandemic. The UK implemented a lockdown in March 2020, when testing policy at the time was focusing on hospitalised cases. Limited information is therefore available on the impact of the lockdown on point prevalence in the community. We assessed COVID-19 point prevalence in London between early April and early May 2020, which approximately reflect infection around the time of the lockdown and 3-5 weeks into lockdown. METHODS We tested 1064 participants of a community surveillance cohort for acute COVID-19 infection using PCR in London in April and May 2020 and described positivity as well as characteristics and symptoms of the participants. RESULTS Point prevalence decreased from 2.2% (95% CI 1.4 to 3.5) in early April to 0.2% (95% CI 0.03 to 1.6) in early May. 22% of those who tested positive in April were asymptomatic. Extrapolation from reports of confirmed cases suggest that 5-7.6% of total infections were confirmed by testing during this period. CONCLUSION COVID-19 point prevalence in the community sharply decreased after lockdown was implemented. This study is based on a small sample and regular seroprevalence studies are needed to better characterise population-level immunity.
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Affiliation(s)
| | - Chinelo Obi
- National Infection Service, Public Health England, London, UK
| | - Meera Chand
- National Infection Service, Public Health England, London, UK
| | - Susan Hopkins
- National Infection Service, Public Health England, London, UK
| | - Kevin Brown
- National Infection Service, Public Health England, London, UK
| | - Mary Ramsay
- National Infection Service, Public Health England, London, UK
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Lyon V, Zigman Suchsland M, Chilver M, Stocks N, Lutz B, Su P, Cooper S, Park C, Lavitt LR, Mariakakis A, Patel S, Graham C, Rieder M, LeRouge C, Thompson M. Diagnostic accuracy of an app-guided, self-administered test for influenza among individuals presenting to general practice with influenza-like illness: study protocol. BMJ Open 2020; 10:e036298. [PMID: 33444172 PMCID: PMC7678361 DOI: 10.1136/bmjopen-2019-036298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Diagnostic tests for influenza in Australia are currently only authorised for use in clinical settings. At-home diagnostic testing for influenza could reduce the need for patient contact with healthcare services, which potentially could contribute to symptomatic improvement and reduced spread of influenza. We aim to determine the accuracy of an app-guided nasal self-swab combined with a lateral flow immunoassay for influenza conducted by individuals with influenza-like illness (ILI). METHODS AND ANALYSIS Adults (≥18 years) presenting with ILI will be recruited by general practitioners (GP) participating in Australian Sentinel Practices Research Network. Eligible participants will have a nasal swab obtained by their GP for verification of influenza A/B status using reverse transcription polymerase chain reaction (RT-PCR) test at an accredited laboratory. Participants will receive an influenza test kit and will download an app that collects self-reported symptoms and influenza risk factors, then instructs them in obtaining a low-nasal self-swab, running a QuickVue influenza A+B lateral flow immunoassay (Quidel Corporation) and interpreting the results. Participants will also interpret an enhanced image of the test strip in the app. The primary outcome will be the accuracy of participants' test interpretation compared with the laboratory RT-PCR reference standard. Secondary analyses will include accuracy of the enhanced test strip image, accuracy of an automatic test strip reader algorithm and validation of prediction rules for influenza based on self-reported symptoms. A post-test survey will be used to obtain participant feedback on self-test procedures. ETHICS AND DISSEMINATION The study was approved by the Human Research and Ethic Committee (HREC) at the University of Adelaide (H-2019-116). Protocol details and any amendments will be reported to https://www.tga.gov.au/. Results will be published in the peer-reviewed literature, and shared with stakeholders in the primary care and diagnostics communities. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trial Registry (U1111-1237-0688).
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Affiliation(s)
- Victoria Lyon
- Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Monique Chilver
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Barry Lutz
- Bioengineering, University of Washington, Seattle, Washington, USA
| | | | | | - Chunjong Park
- Computer Science, University of Washington, Seattle, Washington, USA
| | - Libby Rose Lavitt
- Computer Science, University of Washington, Seattle, Washington, USA
| | - Alex Mariakakis
- Computer Science, University of Washington, Seattle, Washington, USA
| | - Shwetak Patel
- Computer Science, University of Washington, Seattle, Washington, USA
| | - Chelsey Graham
- Brotman Bay Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Mark Rieder
- Brotman Bay Institute for Precision Medicine, University of Washington, Seattle, Washington, USA
| | - Cynthia LeRouge
- College of Business, Florida International University, Miami, Florida, USA
| | - Matthew Thompson
- Family Medicine, University of Washington, Seattle, Washington, USA
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Therchilsen JH, von Buchwald C, Koch A, Dam Nielsen S, Rasmussen DB, Thudium RF, Kirkby NS, Raaschou-Pedersen DET, Bundgaard JS, Iversen K, Bundgaard H, Todsen T. Self-Collected versus Healthcare Worker-Collected Swabs in the Diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2. Diagnostics (Basel) 2020; 10:diagnostics10090678. [PMID: 32916801 PMCID: PMC7554687 DOI: 10.3390/diagnostics10090678] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to compare the sensitivity of self-collected versus healthcare worker (HCW)-collected swabs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing. Symptomatic individuals referred for SARS-CoV-2 testing were invited to provide mobile-phone video-instructed self-collected oropharyngeal and nasal samples followed by a HCW-collected oropharyngeal sample. All samples were sent for analysis to the same microbiology laboratory, and the number of SARS-CoV-2-positive participants in the two tests was compared. A total of 109 participants were included, and 19 participants had SARS-CoV-2-positive results. The diagnostic sensitivity of the self-collected and HCW-collected swabs was 84.2% and 89.5%, respectively, with an acceptable agreement, Cohens kappa 0.82, p < 0.001. Further, results from a questionnaire answered by the participants found that loss of smell as a self-reported symptom was a strong predictor for a SARS-CoV-2-positive test. In conclusion, we found that self-collected oropharyngeal and nasal swabs for SARS-CoV-2 testing can be reliable compared to HCW-collected oropharyngeal samples.
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Affiliation(s)
- Johan H. Therchilsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (C.v.B.); (T.T.)
- Correspondence: ; Tel.: +45-26250191
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (C.v.B.); (T.T.)
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (A.K.); (S.D.N.); (D.B.R.); (R.F.T.)
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (A.K.); (S.D.N.); (D.B.R.); (R.F.T.)
| | - Daniel B. Rasmussen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (A.K.); (S.D.N.); (D.B.R.); (R.F.T.)
| | - Rebekka Faber Thudium
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (A.K.); (S.D.N.); (D.B.R.); (R.F.T.)
| | - Nikolai S. Kirkby
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | - Daniel E. T. Raaschou-Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (D.E.T.R.-P.); (J.S.B.); (H.B.)
| | - Johan S. Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (D.E.T.R.-P.); (J.S.B.); (H.B.)
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark;
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (D.E.T.R.-P.); (J.S.B.); (H.B.)
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (C.v.B.); (T.T.)
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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Tu YP, Jennings R, Hart B, Cangelosi GA, Wood RC, Wehber K, Verma P, Vojta D, Berke EM. Swabs Collected by Patients or Health Care Workers for SARS-CoV-2 Testing. N Engl J Med 2020; 383:494-496. [PMID: 32492294 PMCID: PMC7289274 DOI: 10.1056/nejmc2016321] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abdollahi A, shakoori A, Khoshnevis H, Arabzadeh M, Dehghan Manshadi SA, Mohammadnejad E, Ghasemi D, Safari Aboksari M, Alizadeh S, Mehrtash V, Eftekhar-javadi A, Safaei M. Comparison of Patient-collected and Lab Technician-collected Nasopharyngeal and Oropharyngeal Swabs for Detection of COVID-19 by RT-PCR. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:313-319. [PMID: 32944044 PMCID: PMC7477688 DOI: 10.30699/ijp.2020.127312.2387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & OBJECTIVE A simple approach to prevent close contact in healthcare settings during the COVID-19 outbreak is to train patients to collect their own nasopharyngeal and oropharyngeal swabs and deliver them to medical laboratories to have them processed. The aim of our study was to compare lab technician- with patient- collected oropharyngeal and nasopharyngeal samples for detection of the coronavirus disease 2019 (COVID 19) using rapid real-time polymerase chain reaction (rRT-PCR). METHODS Fifty adult patients with flu-like symptoms and radiologic findings compatible with atypical pneumonia who were admitted to the infectious diseases ward of Imam Khomeini Hospital Complex, Tehran, Iran, with a clinical diagnosis of COVID-19 from February 28 to April 27 of 2020 were randomly selected and entered in our study. Two sets of naso- and oropharyngeal swabs were collected, one set by a lab technician and the other by the patients, and the COVID-19 rRT-PCR test was performed. RESULTS Of 50 selected cases, in seven patients all collected naso- and oropharyngeal swabs tested positive, and in 22 patients all samples tested negative for COVID-19 in rRT-PCR. Discrepancies between rRT-PCR results of lab technician- and patient-collected swabs were observed in 12 nasopharyngeal and 13 oropharyngeal specimens. Positive lab technician-collected and negative patient-collected samples were observed in 10 and 5 nasopharyngeal and oropharyngeal specimens, respectively. Negative lab technician-collected and positive patient-collected samples were observed in two and seven nasopharyngeal and oropharyngeal specimens, respectively. The overall percentage of agreement among both nasopharyngeal and oropharyngeal swabs taken by a lab technician and patients was 76% with a kappa value of 0.49 (P=0.001). CONCLUSION Based on our findings, lab technician-collected naso- and oropharyngeal swabs cannot be replaced by patient-collected ones with regard to COVID-19 rRT-PCR.
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Affiliation(s)
- Alireza Abdollahi
- Department of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas shakoori
- Medical Genetic Ward, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Khoshnevis
- Supervisor of Genetic Ward, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arabzadeh
- Laboratory Senior Technical Associate of Genetic Ward, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Department of Infectious Diseases and Tropical Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadnejad
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Dorsa Ghasemi
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Safari Aboksari
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaban Alizadeh
- Hematology Department, Allied medical school, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Mehrtash
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Eftekhar-javadi
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Safaei
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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McCulloch DJ, Kim AE, Wilcox NC, Logue JK, Greninger AL, Englund JA, Chu HY. Comparison of Unsupervised Home Self-collected Midnasal Swabs With Clinician-Collected Nasopharyngeal Swabs for Detection of SARS-CoV-2 Infection. JAMA Netw Open 2020; 3:e2016382. [PMID: 32697321 PMCID: PMC7376392 DOI: 10.1001/jamanetworkopen.2020.16382] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Denise J. McCulloch
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | - Ashley E. Kim
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | - Naomi C. Wilcox
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | - Jennifer K. Logue
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | - Alex L. Greninger
- Department of Laboratory Medicine, University of Washington, Seattle
| | | | - Helen Y. Chu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle
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Hanson KE, Caliendo AM, Arias CA, Englund JA, Lee MJ, Loeb M, Patel R, El Alayli A, Kalot MA, Falck-Ytter Y, Lavergne V, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19. Clin Infect Dis 2020:ciaa760. [PMID: 32556191 PMCID: PMC7337674 DOI: 10.1093/cid/ciaa760] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19). Direct detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acids in respiratory tract specimens informs patient, healthcare institution and public health level decision-making. The numbers of available SARS-CoV-2 nucleic acid detection tests are rapidly increasing, as is the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) recognized a significant need for frequently updated systematic reviews of the literature to inform evidence-based best practice guidance. OBJECTIVE The IDSA's goal was to develop an evidence-based diagnostic guideline to assists clinicians, clinical laboratorians, patients and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss the nuance of test result interpretation in a variety of practice settings, and highlight important unmet research needs in the COVID-19 diagnostic testing space. METHODS IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. RESULTS The panel agreed on 15 diagnostic recommendations. CONCLUSIONS Universal access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention and the public response to the COVID-19 pandemic. Information on the clinical performance of available tests is rapidly emerging, but the quality of evidence of the current literature is considered low to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is recommended for asymptomatic individuals with known or suspected contact with a COVID-19 case. Testing asymptomatic individuals without known exposure is suggested when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions, dictate eligibility for surgery, or inform administration of immunosuppressive therapy. Ultimately, prioritization of testing will depend on institutional-specific resources and the needs of different patient populations.
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Affiliation(s)
- Kimberly E Hanson
- Department of Internal Medicine and Pathology, University of Utah, Salt Lake City, Utah
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cesar A Arias
- Division of Infectious Diseases, Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health McGovern Medical School, Center for Infectious Diseases, University of Texas Health School of Public Health, Houston, TX
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, Washington
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina
| | - Mark Loeb
- Divinsion of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Abdallah El Alayli
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mohamad A Kalot
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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Wehrhahn MC, Robson J, Brown S, Bursle E, Byrne S, New D, Chong S, Newcombe JP, Siversten T, Hadlow N. Self-collection: An appropriate alternative during the SARS-CoV-2 pandemic. J Clin Virol 2020; 128:104417. [PMID: 32403007 PMCID: PMC7198188 DOI: 10.1016/j.jcv.2020.104417] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022]
Abstract
First study providing evidence of equivalence of self-collection for SARS-CoV-2. Self-collection has potential to increase accessibility and detection of SARS-CoV-2. Self-collection has potential to preserve PPE supplies. Self-collection has potential to reduce exposure to others. Self-collection was easy to perform and preferred by the majority of participants.
Objectives To evaluate the reliability of self-collection for SARS-CoV-2 and other respiratory viruses because swab collections for SARS-CoV-2 put health workers at risk of infection and require use of personal protective equipment (PPE). Methods In a prospective study, patients from two states in Australia attending dedicated COVID-19 collection clinics were offered the option to first self-collect (SC) nasal and throat swabs (SCNT) prior to health worker collect (HC) using throat and nasal swabs (Site 1) or throat and nasopharyngeal swabs (Site 2). Samples were analysed for SARS-CoV-2 as well as common respiratory viruses. Concordance of results between methods was assessed using Cohen's kappa (κ) and Cycle threshold (Ct) values were recorded for all positive results as a surrogate measure for viral load. Results Of 236 patients sampled by HC and SC, 25 had SARS-CoV-2 (24 by HC and 25 by SC) and 63 had other respiratory viruses (56 by HC and 58 by SC). SC was highly concordant with HC (κ = 0.890) for all viruses including SARS-CoV-2 and more concordant than HC to positive results by any method (κ = 0.959 vs 0.933). Mean SARS-CoV-2 E-gene and N-gene, rhinovirus and parainfluenza Ct values did not differ between HC and SCNT. Conclusions Self-collection of nasal and throat swabs offers a reliable alternative to health worker collection for the diagnosis of SARS-CoV-2 and other respiratory viruses and provides patients with easier access to testing, reduces exposure of the community and health workers to those being tested and reduces requirement for PPE.
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Affiliation(s)
- Michael C Wehrhahn
- Douglass Hanly Moir Pathology, 14 Giffnock Ave, Macquarie Park, NSW, 2113, Australia.
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, 24 Hurworth St, Bowen Hills, QLD, 4006, Australia
| | - Suzanne Brown
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia
| | - Evan Bursle
- Sullivan Nicolaides Pathology, 24 Hurworth St, Bowen Hills, QLD, 4006, Australia
| | - Shane Byrne
- Sullivan Nicolaides Pathology, 24 Hurworth St, Bowen Hills, QLD, 4006, Australia
| | - David New
- Clinipath Pathology, 310 Selby St, North Osborne Park, WA, 6017, Australia
| | - Smathi Chong
- Clinipath Pathology, 310 Selby St, North Osborne Park, WA, 6017, Australia
| | - James P Newcombe
- Douglass Hanly Moir Pathology, 14 Giffnock Ave, Macquarie Park, NSW, 2113, Australia
| | - Terri Siversten
- Douglass Hanly Moir Pathology, 14 Giffnock Ave, Macquarie Park, NSW, 2113, Australia
| | - Narelle Hadlow
- Clinipath Pathology, 310 Selby St, North Osborne Park, WA, 6017, Australia
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42
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Affiliation(s)
- Shantanu Nundy
- Accolade Inc., Plymouth Meeting, Pennsylvania
- Milken Institute School of Public Health, The George Washington University, Washington, DC
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