Leila C Sahni1,2, Vasanthi Avadhanula3, Camerin S Ortiz2, Karen E Feliz3, Rebekah E John2, Cameron A Brown4, Joana Y Lively5,6, Brian Rha5, Flor M Munoz1,3, Pedro A Piedra1,3, James J Dunn4, Julie A Boom1,2. 1. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. 2. Immunization Project, Texas Children's Hospital, Houston, Texas, USA. 3. Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA. 4. Department of Pathology, Texas Children's Hospital, Houston, Texas, USA. 5. Centers for Disease Control and Prevention COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 6. IHRC, Inc., Atlanta, Georgia, USA.
Abstract
BACKGROUND: Nasopharyngeal (NP) specimen testing by reverse transcriptase polymerase chain reaction (RT-PCR) is the standard of care for detecting SARS-CoV-2. Data comparing the sensitivity and specificity of the NP specimen to the less invasive, mid-turbinate (MT) nasal specimen in children are limited. METHODS: Paired clinical NP and research MT specimens were collected from children <18 years with respiratory symptoms and tested by molecular assays to detect SARS-CoV-2 RNA. Sensitivity, specificity, and agreement (Cohen's kappa [κ]) were calculated for research MT specimens compared to the clinical NP specimens. RESULTS: Out of 907 children, 569 (62.7%) had parental consent and child assent when appropriate to participate and provided paired MT and NP specimens a median of 4 days after symptom onset (range 1-14 days). 16.5% (n = 94) of MT specimens were positive for SARS-CoV-2 compared with 20.0% (n = 114) of NP specimens. The sensitivity of research MT compared to clinical NP specimens was 82.5% (95% CI: 74.2%, 88.9%), specificity was 100.0% (95% CI: 99.2%, 100.0%), and overall agreement was 96.1% (κ = 0.87). The sensitivity of MT specimens decreased with time from 100% (95% CI: 59.0%, 100.0%) on day 1 of illness to 82.1% (95% CI: 73.8%, 88.7%) within 14 days of illness onset; sensitivity was generally >90% when specimens were collected within the first week of illness. CONCLUSION: MT specimens, particularly those collected within the first week of illness, have moderately reduced sensitivity and equivalent specificity to less-tolerated NP specimens in pediatric outpatients. MT specimen use in children may represent a viable alternative to NP specimen collection.
BACKGROUND: Nasopharyngeal (NP) specimen testing by reverse transcriptase polymerase chain reaction (RT-PCR) is the standard of care for detecting SARS-CoV-2. Data comparing the sensitivity and specificity of the NP specimen to the less invasive, mid-turbinate (MT) nasal specimen in children are limited. METHODS: Paired clinical NP and research MT specimens were collected from children <18 years with respiratory symptoms and tested by molecular assays to detect SARS-CoV-2 RNA. Sensitivity, specificity, and agreement (Cohen's kappa [κ]) were calculated for research MT specimens compared to the clinical NP specimens. RESULTS: Out of 907 children, 569 (62.7%) had parental consent and child assent when appropriate to participate and provided paired MT and NP specimens a median of 4 days after symptom onset (range 1-14 days). 16.5% (n = 94) of MT specimens were positive for SARS-CoV-2 compared with 20.0% (n = 114) of NP specimens. The sensitivity of research MT compared to clinical NP specimens was 82.5% (95% CI: 74.2%, 88.9%), specificity was 100.0% (95% CI: 99.2%, 100.0%), and overall agreement was 96.1% (κ = 0.87). The sensitivity of MT specimens decreased with time from 100% (95% CI: 59.0%, 100.0%) on day 1 of illness to 82.1% (95% CI: 73.8%, 88.7%) within 14 days of illness onset; sensitivity was generally >90% when specimens were collected within the first week of illness. CONCLUSION: MT specimens, particularly those collected within the first week of illness, have moderately reduced sensitivity and equivalent specificity to less-tolerated NP specimens in pediatric outpatients. MT specimen use in children may represent a viable alternative to NP specimen collection.
Authors: Ariana Perez; Joana Y Lively; Aaron Curns; Geoffrey A Weinberg; Natasha B Halasa; Mary Allen Staat; Peter G Szilagyi; Laura S Stewart; Monica M McNeal; Benjamin Clopper; Yingtao Zhou; Brett L Whitaker; Elizabeth LeMasters; Elizabeth Harker; Janet A Englund; Eileen J Klein; Rangaraj Selvarangan; Christopher J Harrison; Julie A Boom; Leila C Sahni; Marian G Michaels; John V Williams; Gayle E Langley; Susan I Gerber; Angela Campbell; Aron J Hall; Brian Rha; Meredith McMorrow Journal: MMWR Morb Mortal Wkly Rep Date: 2022-10-07 Impact factor: 35.301