SARS-CoV-2 rapid antigen tests provide benefits for epidemic control – observations from Austrian schools

Polechová, Jitka; Johnson, Kory D.; Payne, Pavel; Crozier, Alex; Beiglböck, Mathias; Plevka, Pavel; Schernhammer, Eva

doi:10.1016/j.jclinepi.2022.01.002

Cited by 24 publications

(14 citation statements)

References 46 publications

(77 reference statements)

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“…More frequent testing would then give rise to logistical challenges and increased costs and could further slow RT-PCR turnaround times, resulting in a positive-feedback loop concerning delays and exacerbating negative outcomes. Our estimate argues for the efficacy of testing every two to three days with a RA test is consistent with empirical studies that have found this frequency of testing to provide an effective tool for infection surveillance within schools 67 . Therefore, rapid turnaround times for testing are essential to the utility of a surveillance program intended to suppress the spread of disease.…”

Section: Discussionsupporting

confidence: 86%

Comparative analyses of eighteen rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation

et al. 2022

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Background Rapid antigen (RA) tests are being increasingly employed to detect SARS-CoV-2 infections in quarantine and surveillance. Prior research has focused on RT-PCR testing, a single RA test, or generic diagnostic characteristics of RA tests in assessing testing strategies. Methods We have conducted a comparative analysis of the post-quarantine transmission, the effective reproduction number during serial testing, and the false-positive rates for 18 RA tests with emergency use authorization from The United States Food and Drug Administration and an RT-PCR test. To quantify the extent of transmission, we developed an analytical mathematical framework informed by COVID-19 infectiousness, test specificity, and temporal diagnostic sensitivity data. Results We demonstrate that the relative effectiveness of RA tests and RT-PCR testing in reducing post-quarantine transmission depends on the quarantine duration and the turnaround time of testing results. For quarantines of two days or shorter, conducting a RA test on exit from quarantine reduces onward transmission more than a single RT-PCR test (with a 24-h delay) conducted upon exit. Applied to a complementary approach of performing serial testing at a specified frequency paired with isolation of positives, we have shown that RA tests outperform RT-PCR with a 24-h delay. The results from our modeling framework are consistent with quarantine and serial testing data collected from a remote industry setting. Conclusions These RA test-specific results are an important component of the tool set for policy decision-making, and demonstrate that judicious selection of an appropriate RA test can supply a viable alternative to RT-PCR in efforts to control the spread of disease.

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Section: Discussionsupporting

confidence: 86%

Comparative analyses of eighteen rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation

et al. 2022

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“…More frequent testing would then give rise to logistical challenges and increased costs and could further slow RT-PCR turnaround times, resulting in a positive-feedback loop concerning delays and exacerbating negative outcomes. Consistent with our estimate of testing every two to three days with a RA test, the use of rapid antigen testing two to three times a week--has been empirically validated as an effective tool for disease surveillance within schools 67 . Therefore, rapid turnaround times for testing are essential to the utility of a surveillance program intended to suppress the spread of disease.…”

Section: Discussionsupporting

confidence: 63%

Comparative analyses of FDA EUA-approved rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation

Wells

Pandey

Moghadas

et al. 2021

Preprint

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Rapid antigen (RA) tests are being increasingly employed for detection of COVID-19 infections in implementations of quarantine and surveillance. We conducted a comparative analysis of quarantine durations, testing frequencies, and false-positive rates for all of the 18 RA tests for which emergency use authorization (EUA) has been given by the FDA and a nasopharyngeal RT-PCR test. For each test, we employed a mathematical model of imminent infections to calculate the effective reproductive number in the context of the test used for quarantine or serial testing strategy. We informed the model with data on test specificity and temporal diagnostic sensitivity, convolved with a data-driven profile of COVID-19 infectiousness across the disease time course. Our results demonstrate that the relative effectiveness of RA and RT-PCR tests in reducing post-quarantine transmission depends on the duration of quarantine and the turnaround time of testing results. When quarantines are shorter than five days, our results suggest that an RA test on entry to and on exit from quarantine would reduce onward transmission more than a single RT-PCR test conducted upon exit. Conducting surveillance via serial RT-PCR testing with a 24-h turnaround time, the testing frequency paired with isolation of positives that is required to suppress the effective reproduction number (RE) below one was found to require a minimum frequency of every six days. RA tests reduce RE below one when conducted at a minimum frequency that ranges from every six days to every eight days—depending on the type of RA test—with a median of seven days. Our analysis also highlights that the risk of onward transmission during serial testing increases with the delay in obtaining the results. False-positives were found to be more frequent with RA tests, an issue that could be mitigated with clinical and RT-PCR follow-up. Accounting for the specific diagnostic traits of RA tests, they are an important component of the tool set for policy decision-making, and can serve as a viable alternative to RT-PCR in efforts to control the spread of disease.

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“…Due to the challenges of using RT-PCR, antigen-rapid diagnostic tests (Ag-RDTs) are now utilized in several countries for epidemiological surveillance and even diagnostic purposes in symptomatic individuals [ 4 ]. An observational study in Australian schools found these tests to be a power tool in suppressing the pandemic [ 5 ]. In Africa, the low number of COVID-19 cases compared to other continents have been attributed to factors such as low testing due to the high-cost of RT-PCR [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Laboratory and field evaluation of the STANDARD Q and Panbio™ SARS-CoV-2 antigen rapid test in Namibia using nasopharyngeal samples

et al. 2022

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Background As new SARS-CoV-2 variants of concern emerge, there is a need to scale up testing to minimize transmission of the Coronavirus disease 2019 (COVID-19). Many countries especially those in the developing world continue to struggle with scaling up reverse transcriptase polymerase reaction (RT-PCR) to detect SARS-CoV-2 due to scarcity of resources. Alternatives such as antigen rapid diagnostics tests (Ag-RDTs) may provide a solution to enable countries scale up testing. Methods In this study, we evaluated the Panbio™ and STANDARD Q Ag-RDTs in the laboratory using 80 COVID-19 RT-PCR confirmed and 80 negative nasopharyngeal swabs. The STANDARD Q was further evaluated in the field on 112 symptomatic and 61 asymptomatic participants. Results For the laboratory evaluation, both tests had a sensitivity above 80% (Panbio™ = 86% vs STANDARD Q = 88%). The specificity of the Panbio™ was 100%, while that of the STANDARD Q was 99%. When evaluated in the field, the STANDARD Q maintained a high specificity of 99%, however the sensitivity was reduced to 56%. Conclusion Using Ag-RDTs in low resource settings will be helpful in scaling-up SARS-CoV-2 testing, however, negative results should be confirmed by RT-PCR where possible to rule out COVID-19 infection.

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SARS-CoV-2 rapid antigen tests provide benefits for epidemic control – observations from Austrian schools

Cited by 24 publications

References 46 publications

Comparative analyses of eighteen rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation

Comparative analyses of eighteen rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation

Comparative analyses of FDA EUA-approved rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation

Laboratory and field evaluation of the STANDARD Q and Panbio™ SARS-CoV-2 antigen rapid test in Namibia using nasopharyngeal samples

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