Equivalence of Self- and Staff-Collected Nasal Swabs for the Detection of Viral Respiratory Pathogens

Manas K Akmatov,Anja Gatzemeier,Klaus Schughart,Frank Pessler,Emma S Mcbryde

doi:10.1371/journal.pone.0048508

Abstract

BackgroundThe need for the timely collection of diagnostic biosamples during symptomatic episodes represents a major obstacle to large-scale studies on acute respiratory infection (ARI) epidemiology. This may be circumvented by having the participants collect their own nasal swabs. We compared self- and staff-collected swabs in terms of swabbing quality and detection of viral respiratory pathogens.Methodology/Principal FindingsWe conducted a prospective study among employees of our institution during the ARI season 2010/2011 (December-March). Weekly emails were sent to the participants (n = 84), reminding them to come to the study center in case of new symptoms. The participants self-collected an anterior nasal swab from one nostril, and trained study personnel collected one from the other nostril. The participants self-collected another two swabs (one from each nostril) on a subsequent day. Human β-actin DNA concentration was determined in the swabs as a quality control. Viral respiratory pathogens were detected by multiplex RT-PCR (Seeplex RV15 kit, Seegene, Eschborn, Germany). Of 84 participants, 56 (67%) reported at least one ARI episode, 18 participants two, and one participant three. Self-swabbing was highly accepted by the participants. The amount of β-actin DNA per swab was higher in the self- than in the staff-collected swabs (p = 0.008). β-actin concentration was lower in the self-swabs collected on day 1 than in those collected on a subsequent day (p<0.0001). A respiratory viral pathogen was detected in 31% (23/75) of staff- and in 35% (26/75) of self-collected swabs (p = 0.36). With both approaches, the most frequently identified pathogens were human rhinoviruses A/B/C (12/75 swabs, 16%) and human coronavirus OC43 (4/75 swabs, 5%). There was almost perfect agreement between self- and staff-collected swabs in terms of pathogen detection (agreement = 93%, kappa = 0.85, p<0.0001).Conclusions/SignificanceNasal self-swabbing for identification of viral ARI pathogens proved to be equivalent to staff-swabbing in this population in terms of acceptance and pathogen detection.

Highlights

The need for the timely collection of diagnostic biosamples during acute symptomatic episodes represents a major obstacle to large-scale studies on acute respiratory infection (ARI) epidemiology
Luinstra et al found similar detection rates for respiratory pathogens between self- and staffcollected midturbinate swabs when one staff-collected and one selfcollected swab were taken from opposite nostrils during the same visit to a campus health center [5]
Ip et al investigated the validity of self-collected nasal and pharyngeal swabs to detect influenza virus infection and came to the conclusion that self-swabs may be a good alternative [6]. While these results do provide substantial evidence for the validity of selfcollected midturbinate swabs, anterior nasal swabs have not been evaluated in this respect

Summary

Introduction

The need for the timely collection of diagnostic biosamples (such as nasal swabs) during acute symptomatic episodes represents a major obstacle to large-scale studies on acute respiratory infection (ARI) epidemiology. This may be circumvented by having the participants collect their own nasal swabs (‘‘selfcollected nasal swabs’’ or ‘‘self-swabbing’’). The need for the timely collection of diagnostic biosamples during symptomatic episodes represents a major obstacle to large-scale studies on acute respiratory infection (ARI) epidemiology. This may be circumvented by having the participants collect their own nasal swabs. We compared self- and staff-collected swabs in terms of swabbing quality and detection of viral respiratory pathogens

Methods

Results

Conclusion