Abstract
This study aimed at assessing the validity of self-collected (self-sampled) oropharyngeal (OP) swabs among healthcare workers compared to those collected by trained sentinel general practitioners (GP-sampled) from individuals with influenza-like illness (ILI), to be implemented in epidemiological studies and/or surveillance programs of viral pathogens involved in community respiratory infections. In our study, OP swabs were collected from adults (>18 years) with ILI during the 2018–2019 influenza season. Two groups of samples were considered: group 1−131 self-sampled OP swabs collected by healthcare workers after being trained on the sampling procedure; group 2−131 GP-sampled OP swabs collected from outpatients by sentinel GPs operating within the Italian Influenza Surveillance Network. To assess swabbing quality, following RNA extraction, each sample was tested for the presence of the human ribonuclease P gene (RNP) by in-house real-time reverse transcriptase–polymerase chain reaction (RT-PCR). Samples with a cycle threshold (Ct) <35 were considered adequate for further virological analysis. Influenza viruses (IVs), respiratory syncytial virus (RSV), and rhinovirus (RV) genomes were detected by in-house real-time RT-PCR. All samples were positive to RNP detection with Ct <35. The mean Ct value was similar in the two groups (group 1 vs. group 2: 25.93 ± 2.22 vs. 25.46 ± 2.40; p = 0.10). IVs, RSV, and RV positivity rates were 26.7 vs. 52.7% (p < 0.01), 7.6 vs. 9.9% (p = 0.52), and 21.4 vs. 19.9% (p = 0.76), respectively. Self-sampled OP swabs resulted as valid as GP-sampled OP swabs for molecular detection of respiratory viruses. Self-swabbing can thus be a worthwhile strategy for sample collection to implement molecular surveillance of respiratory pathogens and carry out epidemiological studies, easily reaching a larger population size.
Highlights
An adequate specimen collection is essential to identify viral pathogens involved in respiratory infections
The positivity for ribonuclease P gene (RNP) in self-sampled OP swabs as well as in the general practitioners (GPs)-sampled OP swabs indicates the presence of human cells in all samples, revealing that all swabs were taken with enough thoroughness to contain exudate fragments from the back walls of the throat and highlighting the good quality of both sampling approaches
As observed in other studies [9, 10], no difference was observed in this human housekeeping gene cycle threshold (Ct) values between the self-sampled and the not self-sampled respiratory swabs (p = 0.93), suggesting that the two swabbing strategies are equivalent in obtaining adequate samples for molecular virological analyses [9, 10]
Summary
An adequate specimen collection is essential to identify viral pathogens involved in respiratory infections. Going to see the doctor to collect a swab could be perceived as a waste of time by the patient, if disease symptoms are mild, and the identification of the etiological agent does not improve treatment or prognosis. Collecting respiratory secretions at home could overcome this negative feeling and may increase patient compliance to epidemiological studies and surveillance programs of respiratory pathogens, especially useful for estimating the circulation of those pathogens causing mild diseases, such as influenza-like illness (ILI). In Europe, influenza surveillance relies mainly on sentinel general practitioners (GPs) in charge of recording the number of ILI cases per week and collecting respiratory specimens from their patients for laboratory tests [2]. Self-sampling of OP swabs could be a successful, time-, and cost-effective approach for the detection of viruses involved in community respiratory infections and could be a valuable sampling strategy to rapidly assess viral community transmission and maximize containment measures such as patient isolation or quarantine during a respiratory outbreak
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