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

Claire A. Woodall*, Hannah V. Thornton, Emma C. Anderson, Suzanne M. Ingle, Peter Muir, Barry Vipond, Denise Longhurst, John P. Leeming, Charles R. Beck, Alastair D. Hay

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Respiratory tract infections (RTIs) are ubiquitous among children in the community. A prospective observational study was performed to evaluate the diagnostic performance and quality of at-home parent-collected (PC) nasal and saliva swab samples, compared to nurse-collected (NC) swab samples, from children with RTI symptoms. Children with RTI symptoms were swabbed at home on the same day by a parent and a nurse. We compared the performance of PC swab samples as the test with NC swab samples as the reference for the detection of respiratory pathogen gene targets by reverse transcriptase PCR, with quality assessment using a human gene. PC and NC paired nasal and saliva swab samples were collected from 91 and 92 children, respectively. Performance and interrater agreement (Cohen’s k) of PC versus NC nasal swab samples for viruses combined showed sensitivity of 91.6% (95% confidence interval [CI], 85.47 to 95.73%) and k of 0.84 (95% CI, 0.79 to 0.88), respectively; the respective values for bacteria combined were 91.4% (95% CI, 86.85 to 94.87%) and k of 0.85 (95% CI, 0.80 to 0.89). In saliva samples, viral and bacterial sensitivities were lower at 69.0% (95% CI, 57.47 to 79.76%) and 78.1% (95% CI, 71.60 to 83.76%), as were k values at 0.64 (95% CI, 0.53 to 0.72) and 0.70 (95% CI, 0.65 to 0.76), respectively. Quality assessment for human biological material (18S rRNA) indicated perfect interrater agreement. At-home PC nasal swab samples performed comparably to NC swab samples, whereas PC saliva swab samples lacked sensitivity for the detection of respiratory microbes. IMPORTANCE 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. The coronavirus disease 2019 (COVID-19) pandemic has seen an increase in the at-home self-collection of upper respiratory tract swab samples without the involvement of health professionals. It is advised that parents conduct or supervise swabbing of children. Surprisingly, few studies have addressed the quality of PC swab samples for subsequent identification of respiratory pathogens. We compared NC and PC nasal and saliva swab samples taken from the same child with RTI symptoms, for detection of respiratory pathogens. The PC nasal swab samples performed comparably to NC samples, whereas saliva swab samples lacked sensitivity for the detection of respiratory microbes. Collection of swab samples by parents would greatly reduce the burden on community nurses without reducing the effectiveness of diagnoses.

Original languageEnglish
Article numbere00164
JournalMicrobiology Spectrum
Volume9
Issue number3
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
The study was supported by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Behavioral Science and Evaluation of Interventions at the University of Bristol, in partnership with Public Health England (PHE) (grant HPRU-2012-10026). A.D.H. is funded by an NIHR Research Professorship (grant NIHR-RP-02-12-012) and Senior Investigator Award (grant NIHR-200151). C.A.W. is funded in part by the Medical Research Council (MRC) and Wellcome Trust Institutional Strategic Support Fund (grant 204813/Z/16/Z) and by the Daphne Jackson Trust in collaboration with the Elizabeth Blackwell Institute at the University of Bristol. We declare no conflicts of interest.

Publisher Copyright:
© Crown copyright 2021.

Keywords

  • Clinical methods
  • Community-based
  • Diagnostics
  • Microbiology
  • Molecular techniques
  • Parent collection
  • Pediatric
  • Public health
  • Respiratory tract infection
  • Self-collection

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