TY - JOUR
T1 - Rapid, early and accurate SARS-CoV-2 detection using RT-qPCR in primary care
T2 - A prospective cohort study (REAP-1)
AU - Leber, Werner
AU - Lammel, Oliver
AU - Redlberger-Fritz, Monika
AU - Mustafa-Korninger, Maria Elisabeth
AU - Glehr, Reingard Christina
AU - Camp, Jeremy
AU - Agerer, Benedikt
AU - Lercher, Alexander
AU - Popa, Alexandra
AU - Genger, Jakob Wendelin
AU - Penz, Thomas
AU - Aberle, Stephan
AU - Bock, Christoph
AU - Bergthaler, Andreas
AU - Stiasny, Karin
AU - Hochstrasser, Eva Maria
AU - Hoellinger, Christian
AU - Siebenhofer, Andrea
AU - Griffiths, Chris
AU - Panovska-Griffiths, Jasmina
N1 - Publisher Copyright:
©
PY - 2021/8/2
Y1 - 2021/8/2
N2 - Objectives We explore the importance of SARS-CoV-2 sentinel surveillance testing in primary care during a regional COVID-19 outbreak in Austria. Design Prospective cohort study. Setting A single sentinel practice serving 22 829 people in the ski-resort of Schladming-Dachstein. Participants All 73 patients presenting with mild-to-moderate flu-like symptoms between 24 February and 03 April, 2020. Intervention Nasopharyngeal sampling to detect SARS-CoV-2 using real-time reverse transcriptase-quantitative PCR (RT-qPCR). Outcome measures We compared RT-qPCR at presentation with confirmed antibody status. We split the outbreak in two parts, by halving the period from the first to the last case, to characterise three cohorts of patients with confirmed infection: early acute (RT-qPCR reactive) in the first half; and late acute (reactive) and late convalescent (non-reactive) in the second half. For each cohort, we report the number of cases detected, the accuracy of RT-qPCR, the duration and variety of symptoms, and the number of viral clades present. Results Twenty-two patients were diagnosed with COVID-19 (eight early acute, seven late acute and seven late convalescent), 44 patients tested SARS-CoV-2 negative and 7 were excluded. The sensitivity of RT-qPCR was 100% among all acute cases, dropping to 68.1% when including convalescent. Test specificity was 100%. Mean duration of symptoms for each group were 2 days (range 1-4) among early acute, 4.4 days (1-7) among late acute and 8 days (2-12) among late convalescent. Confirmed infection was associated with loss of taste. Acute infection was associated with loss of taste, nausea/vomiting, breathlessness, sore throat and myalgia; but not anosmia, fever or cough. Transmission clusters of three viral clades (G, GR and L) were identified. Conclusions RT-qPCR testing in primary care can rapidly and accurately detect SARS-CoV-2 among people with flu-like illness in a heterogeneous viral outbreak. Targeted testing in primary care can support national sentinel surveillance of COVID-19.
AB - Objectives We explore the importance of SARS-CoV-2 sentinel surveillance testing in primary care during a regional COVID-19 outbreak in Austria. Design Prospective cohort study. Setting A single sentinel practice serving 22 829 people in the ski-resort of Schladming-Dachstein. Participants All 73 patients presenting with mild-to-moderate flu-like symptoms between 24 February and 03 April, 2020. Intervention Nasopharyngeal sampling to detect SARS-CoV-2 using real-time reverse transcriptase-quantitative PCR (RT-qPCR). Outcome measures We compared RT-qPCR at presentation with confirmed antibody status. We split the outbreak in two parts, by halving the period from the first to the last case, to characterise three cohorts of patients with confirmed infection: early acute (RT-qPCR reactive) in the first half; and late acute (reactive) and late convalescent (non-reactive) in the second half. For each cohort, we report the number of cases detected, the accuracy of RT-qPCR, the duration and variety of symptoms, and the number of viral clades present. Results Twenty-two patients were diagnosed with COVID-19 (eight early acute, seven late acute and seven late convalescent), 44 patients tested SARS-CoV-2 negative and 7 were excluded. The sensitivity of RT-qPCR was 100% among all acute cases, dropping to 68.1% when including convalescent. Test specificity was 100%. Mean duration of symptoms for each group were 2 days (range 1-4) among early acute, 4.4 days (1-7) among late acute and 8 days (2-12) among late convalescent. Confirmed infection was associated with loss of taste. Acute infection was associated with loss of taste, nausea/vomiting, breathlessness, sore throat and myalgia; but not anosmia, fever or cough. Transmission clusters of three viral clades (G, GR and L) were identified. Conclusions RT-qPCR testing in primary care can rapidly and accurately detect SARS-CoV-2 among people with flu-like illness in a heterogeneous viral outbreak. Targeted testing in primary care can support national sentinel surveillance of COVID-19.
KW - COVID-19
KW - primary care
KW - public health
KW - virology
UR - http://www.scopus.com/inward/record.url?scp=85112620639&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-045225
DO - 10.1136/bmjopen-2020-045225
M3 - Article
C2 - 34341034
AN - SCOPUS:85112620639
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - 045225
ER -