COVID-19 rapid antigen testing strategies require careful evaluation

Dinnes, Jacqueline

doi:10.1016/j.ebiom.2021.103491

Cited by 13 publications

(10 citation statements)

References 13 publications

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“…Since its widespread uptake as a SARS-CoV-2 surveillance intervention, there has been substantial debate about whether the potential health-economic efficiency of Ag-RDT justifies an elevated risk of false-negative diagnosis 37 , 38 . Our findings are consistent with the view that Ag-RDT is on its own insufficient to eliminate nosocomial SARS-CoV-2 outbreak risk, but that it is nonetheless an effective component of multi-modal infection prevention strategies 39 . We demonstrate that reactive Ag-RDT screening is a potentially efficient public health response to surges in outbreak risk in the LTCF setting, but that its health and economic benefits scale by orders of magnitude depending on other epidemiological risk factors, including the facility’s inter-individual contact patterns, infection prevention measures, and vaccine coverage.…”

Section: Discussionsupporting

confidence: 90%

Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk

Duval

Zahar

et al. 2022

Nat Commun

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Healthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks. Antigen rapid diagnostic testing (Ag-RDT) is widely used for population screening, but its health and economic benefits as a reactive response to local surges in outbreak risk are unclear. We simulate SARS-CoV-2 transmission in a long-term care hospital with varying COVID-19 containment measures in place (social distancing, face masks, vaccination). Across scenarios, nosocomial incidence is reduced by up to 40-47% (range of means) with routine symptomatic RT-PCR testing, 59-63% with the addition of a timely round of Ag-RDT screening, and 69-75% with well-timed two-round screening. For the latter, a delay of 4-5 days between the two screening rounds is optimal for transmission prevention. Screening efficacy varies depending on test sensitivity, test type, subpopulations targeted, and community incidence. Efficiency, however, varies primarily depending on underlying outbreak risk, with health-economic benefits scaling by orders of magnitude depending on the COVID-19 containment measures in place.

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Section: Discussionsupporting

confidence: 90%

Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk

Duval

Zahar

et al. 2022

Nat Commun

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“…However, not all real-world settings with vaccinated individuals still aim to identify the presence of molecular viral genetic material. The use of RT-PCR in this case was to provide a traditional comparison for laboratory testing purposes 24 , that may not be relevant in a post-vaccine pragmatic setting 25 . It should be noted that the use of RTB for RT-PCR testing avoids the additional nasal and throat collections for Ag-RDT and molecular testing.…”

Section: Discussionmentioning

confidence: 99%

Investigating sensitivity of nasal or throat (ISNOT): A combination of both swabs increases sensitivity of SARS-CoV-2 rapid antigen tests

Goodall

LeBlanc

Hatchette

et al. 2022

Preprint

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The COVID-19 pandemic has been hallmarked by several waves of variants of concern (VoCs), each with novel challenges. Currently, the highly transmissible Omicron VOC is predominant worldwide, and sore throat is common among other cold-like symptoms. Anecdotes on social media suggested sampling ones throat can increase sensitivity for Omicron detection by antigen-based rapid testing devices (Ag-RDTs). This work determines whether the sensitivity of Ag-RDTs designed for nasal sampling is altered with use of self-administered throat swabs in self-perceived asymptomatic individuals. This investigation compared results of a common Ag-RDT (i.e. Abbott Panbio COVID-19 Ag Rapid Test Device) using three sampling sites: nasal swab; throat swab and; combined nasal/throat. All Ag-RDT results were confirmed with molecular testing. Compared to RT-PCR, samples from nasal or throat swabs each detected 64.5% of SARS-CoV-2 cases; however, combining the contributions of each swab increased sensitivity to 88.7%. This trend was also evident with the Rapid Response Ag-RDT (BTNX), which uses a more flexible swabs than Panbio. When nasal swab collection was compared to paired sampling of the nasal/throat using a single swab with the Panbio Ag-RDT, the sensitivity of each was 68.4% and 81.6%, respectively. No false-positive results were observed with nasal, throat, or combined nasal/throat sampling. Self-administered throat and nasal/throat swabs both had >90% acceptability. These findings support the use of self-collected combined nasal/throat sampling for Ag-RDT based SARS-CoV-2 detection in self perceived asymptomatic individuals.

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“…The antigen rapid diagnostic test (Ag-RDT) is a useful diagnostic tool that can help detect and manage COVID-19 spread in terms of short turnaround times and favorable performance in detecting SARS-CoV-2 VOCs [ 4 , 5 ]. Although numerous brands of Ag-RDTs are available worldwide, reliable and research-supported Ag-RDTs are needed [ 6 , 7 ]. The protein target of the Ag-RDTs is a critical feature of detecting SARS-CoV-2 infection by variants of concern.…”

Section: Introductionmentioning

confidence: 99%

Development, Analytical, and Clinical Evaluation of Rapid Immunochromatographic Antigen Test for SARS-CoV-2 Variants Detection

et al. 2022

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The antigen rapid diagnostic test (Ag-RDT) is a useful diagnostic tool for the detection and management of COVID-19 spread. Global SARS-CoV-2 variant outbreaks have highlighted the need for a test capable of detecting SARS-CoV-2 variants with high sensitivity and a low limit of detection. This study aimed to develop and evaluate, both analytically and clinically, an antigen rapid diagnostic test (the KestrelTM COVID-19 Ag Rapid Test) for professional use. A lateral flow immunoassay-based diagnostic test kit was developed, and various aspects of its analytical performance were evaluated. This test kit was clinically evaluated by two independent laboratories and showed closely related results of 96.49% and 98.33% of sensitivity, 100% and 100% of specificity, and 99.01% and 99.44% of accuracy, respectively. A limit of detection was observed at values as low as 0.156 ng/mL for recombinant SARS-CoV-2 nucleocapsid protein. Moreover, the test kit successfully detected the recombinant SARS-CoV-2 nucleocapsid protein (NP) of wild-type, Alpha-, Beta-, Gamma-, Delta-, Epsilon-, Kappa-, and Omicron-variants as positive results. Therefore, the KestrelTM COVID-19 Ag Rapid Test may have potential use for effective COVID-19 screening, surveillance, and infection control in a variety of global SARS-CoV-2 variant outbreaks.

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COVID-19 rapid antigen testing strategies require careful evaluation

Cited by 13 publications

References 13 publications

Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk

Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk

Investigating sensitivity of nasal or throat (ISNOT): A combination of both swabs increases sensitivity of SARS-CoV-2 rapid antigen tests

Development, Analytical, and Clinical Evaluation of Rapid Immunochromatographic Antigen Test for SARS-CoV-2 Variants Detection

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