Prospective Study of the Performance of Parent-Collected Nasal and Saliva Swab Samples, Compared with Nurse-Collected Swab Samples, for the Molecular Detection of Respiratory Microorganisms

Woodall, Claire A.; Thornton, Hannah; Anderson, Emma; Ingle, Suzanne M; Muir, Peter; Vipond, Barry; Longhurst, Denise; Leeming, J.P.; Beck, Charles R.

doi:10.1128/spectrum.00164-21

Cited by 9 publications

(14 citation statements)

References 34 publications

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“…These different sensitivities of nasal swabs and saliva samples compared with that of NPSs may arise from differences among subjects, study periods, sampling and detection methods, and SARS-CoV-2 variants. However, few studies have simultaneously compared various samples, including nasal swabs, NPSs, and saliva samples, for the detection of other respiratory viruses using a consistent methodology [ 14 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Nasal Swabs, Nasopharyngeal Swabs, and Saliva Samples for the Detection of SARS-CoV-2 and other Respiratory Virus Infections

et al. 2023

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Background: Nasal swabs and saliva samples are being considered alternatives to nasopharyngeal swabs (NPSs) for detecting severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2); however, few studies have compared the usefulness of nasal swabs, NPSs, and saliva samples for detecting SARS-CoV-2 and other respiratory virus infections. We compared the positivity rates and concentrations of viruses detected in nasal swabs, NPSs, and saliva samples using cycle threshold (Ct) values from real-time PCR tests for respiratory viruses.Methods: In total, 236 samples (48 five-rub and 10 10-rub nasal swabs, 96 NPSs collected using two different products, 48 saliva swabs, and 34 undiluted saliva samples) from 48 patients (34 patients with SARS-CoV-2 and 14 with other respiratory virus infections) and 40 samples from eight healthy controls were obtained. The PCR positivity and Ct values were compared using Allplex Respiratory Panels 1/2/3 and Allplex SARS-CoV-2 real-time PCR.Results: NPSs showed the lowest Ct values (indicating the highest virus concentrations); however, nasal and saliva samples yielded positive results for SARS-CoV-2 and other respiratory viruses. The median Ct value for SARS-CoV-2 E gene PCR using nasal swab samples collected with 10 rubs was significantly different from that obtained using nasal swabs collected with five rubs (Ct = 24.3 vs. 28.9; P = 0.002), but not from that obtained using NPSs.Conclusions: Our results confirm that the NPS is the best sample type for detecting respiratory viruses, but nasal swabs and saliva samples can be alternatives to NPSs. Vigorously and sufficiently rubbed nasal swabs can provide SARS-CoV-2 concentrations similar to those obtained with NPSs.

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Section: Introductionmentioning

confidence: 99%

Comparison of Nasal Swabs, Nasopharyngeal Swabs, and Saliva Samples for the Detection of SARS-CoV-2 and other Respiratory Virus Infections

et al. 2023

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“…Only 15/45 (33%) of stage 2 participants reported being prescribed antibiotics for their sore throat and in those stage 2 participants with clinician-assessed FeverPAIN scores (using throat photographs taken by participants) (n=18), only 10% recommended immediate antibiotic prescriptions suggesting a low prevalence of bacterial infections. Suboptimal swabbing technique may have impacted on the detection rate, but self-swabbing without training in lay individuals has been shown to be accurate for detecting and some participants in this study had prior Streptococcus pyogenes detection in parent-collected swabs was 87.5% using nurse-collected swab as the reference (19). More recently, evidence has shown that Fusobacterium are commonly detected in patients with acute pharyngitis (20) and future evaluation of cytokines should consider this.…”

Section: Discussionmentioning

confidence: 77%

“…Finally, our low detection rate may have resulted from pathogens becoming non-viable during transit. The median time between sample collection and analysis was 3 days, compared with an average of 2.7 days in another study comparing parent-collected with nurse-collected nasal swabs where the sensitivity for Streptococcus pyogenes detection in parent-collected swabs was 87.5% using nurse-collected swab as the reference ( 19 ). More recently, evidence has shown that Fusobacterium are commonly detected in patients with acute pharyngitis ( 20 ) and future evaluation of cytokines should consider this.…”

Section: Discussionmentioning

confidence: 93%

Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: Feasibility study

Lown

Miles²,

Fisk³

et al. 2022

Front. Immunol.

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IntroductionSore throat is a common reason for overuse of antibiotics. The value of inflammatory or biomarkers in throat swab or saliva samples in predicting benefit from antibiotics is unknown.MethodsWe used the ‘person-based approach’ to develop an online tool to support self-swabbing and recruited adults and children with sore throats through participating general practices and social media. Participants took bacterial and viral swabs and a saliva sponge swab and passive drool sample. Bacterial swabs were cultured for streptococcus (Group A, B, C, F and G). The viral swab and saliva samples were tested using a routine respiratory panel PCR and Covid-19 PCR testing. We used remaining viral swab and saliva sample volume for biomarker analysis using a panel of 13 biomarkers.ResultsWe recruited 11 asymptomatic participants and 45 symptomatic participants. From 45 symptomatic participants, bacterial throat swab, viral throat swab, saliva sponge and saliva drool samples were returned by 41/45 (91.1%), 43/45 (95.6%), 43/45 (95.6%) and 43/45 (95.6%) participants respectively. Three saliva sponge and 6 saliva drool samples were of insufficient quantity. Two adult participants had positive bacterial swabs. Six participants had a virus detected from at least one sample (swab or saliva). All of the biomarkers assessed were detectable from all samples where there was sufficient volume for testing. For most biomarkers we found higher concentrations in the saliva samples. Due to low numbers, we were not able to compare biomarker concentrations in those who did and did not have a bacterial pathogen detected. We found no evidence of a difference between biomarker concentrations between the symptomatic and asymptomatic participants but the distributions were wide.ConclusionsWe have demonstrated that it is feasible for patients with sore throat to self-swab and provide saliva samples for pathogen and biomarker analysis. Typical bacterial and viral pathogens were detected but at low prevalence rates. Further work is needed to determine if measuring biomarkers using oropharyngeal samples can help to differentiate between viral and bacterial pathogens in patients classified as medium or high risk using clinical scores, in order to better guide antibiotic prescribing and reduce inappropriate prescriptions.

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“…While doctor-diagnosed otitis media and pneumonia were recorded in the illness-burden diary, the indication for prescribing antibiotics was not captured systematically. Second, although we and others have shown that with sensitive PCR assays, parent-collected nasal swabs mailed into the laboratory have at least similar virus detection rates to those collected by healthcare workers [35,51,52], suboptimal swabbing techniques may have still missed virus detections [32]. We therefore removed 3025 (27%) lower-quality swabs from incidence rate calculations to avoid underestimation of rates due to misclassification bias.…”

Section: Discussionmentioning

confidence: 99%

Human bocavirus-1 infections in Australian children aged < 2 years: a birth cohort study

Saha

Fozzard

Lambert

et al. 2022

Eur J Clin Microbiol Infect Dis

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To determine human bocavirus-1 (HBoV1) infection characteristics in young Australian children. Data were from the Observational Research in Childhood Infectious Diseases (ORChID) study, a Brisbane, Australia–based birth cohort of healthy, term, newborns followed prospectively for 2 years. Parents recorded daily symptoms, maintained an illness-burden diary, and collected weekly nasal swabs, which were tested for 17 respiratory viruses, including HBoV1, by real-time polymerase chain reaction (PCR) assays. Main outcomes measured were infection incidence, risk factors, symptoms, and healthcare use. One hundred fifty-eight children in the ORChID cohort provided 11,126 weekly swabs, of which 157 swabs were HBoV1 positive involving 107 incident episodes. Co-detections were observed in 65/157 (41.4%) HBoV1-positive swabs (or 41/107 [38.3%] infection episodes), principally with rhinovirus. Shedding duration was 1 week in 64.5% of episodes. The incidence of HBoV1 infections in the first 2 years of life was 0.58 episodes per child-year (95% confidence interval [CI] 0.47–0.71), including 0.38 episodes per child-year (95% CI 0.30–0.49) associated with respiratory symptoms. Recurrent episodes occurred in 18/87 (20.7%) children following their primary infection. In the first 2 years of life, incidence of HBoV1 episodes increased with age, during winter and with childcare attendance. Overall, 64.2% of HBoV1 episodes were symptomatic, with 26.4% having healthcare contact. Viral load estimates were higher when children were symptomatic than when asymptomatic (mean difference = 3.4; 95% CI 1.0–5.7 PCR cycle threshold units). After age 6 months, HBoV1 is detected frequently in the first 2 years of life, especially during winter. Symptoms are usually mild and associated with higher viral loads. Supplementary Information The online version contains supplementary material available at 10.1007/s10096-022-04529-x.

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Prospective Study of the Performance of Parent-Collected Nasal and Saliva Swab Samples, Compared with Nurse-Collected Swab Samples, for the Molecular Detection of Respiratory Microorganisms

Abstract: RTIs are ubiquitous among children. Diagnosis involves a swab sample being taken by a health professional, which places a considerable burden on community health care systems, given the number of cases involved.

Cited by 9 publications

References 34 publications

Comparison of Nasal Swabs, Nasopharyngeal Swabs, and Saliva Samples for the Detection of SARS-CoV-2 and other Respiratory Virus Infections

Comparison of Nasal Swabs, Nasopharyngeal Swabs, and Saliva Samples for the Detection of SARS-CoV-2 and other Respiratory Virus Infections

Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: Feasibility study

Human bocavirus-1 infections in Australian children aged < 2 years: a birth cohort study

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