Kids Can Learn to Self-Collect Specimens for SARS-CoV-2 Surveillance

NEW YORK (Reuters Health) – Children aged 5 and up can learn to self-collect nasal swabs for COVID-19 surveillance in educational settings, a new study suggests.

Data from a prospective pilot cohort study that included nearly 300 children from a K-8 school in California who self-collected samples weekly revealed that within four weeks the children’s error rates had been reduced to less than 3%, researchers report in JAMA Network Open.

“We found that anterior nasal swabbing is well tolerated and relatively error free among young children, making implementation of on-site testing a feasible way to conduct SARS-CoV-2 surveillance,” Jonathan Altamirano of Stanford University School of Medicine in California write. “With time and resource constraints in mind, we believe our model is scalable to larger schools as a way of keeping students and teachers safe during in-person learning during these dynamic times.”

To discover whether young children could be taught to self-collect nasal swabs for COVID-19 surveillance, the researchers conducted a cohort study at an independent K-8 school in San Mateo County, California, which remained open for on-site learning during the 2020-2021 academic year.

The researchers chose anterior nares specimen self-collection rather than the more invasive nasopharyngeal swabs. They instructed all the students on proper technique for specimen self-collection and observed them to make sure the samples were collected properly.

Included in the study were 296 children, half of whom were boys. Among the participants were 29% children who identified as Asian, less than 1% who identified as Black or African American, 4% who identified as Hispanic/Latinx, 35% who identified as non-Hispanic white, 29% who identified as multiracial and six 2% who identified as other.

The researchers collected 4,203 samples from 221 students between 2020 and 2021; they found errors occurred in 2.7% of the student encounters, with the highest rate (10.2%) on the first day of testing. Errors decreased over time.

Once the samples were collected they were placed in 3-mL tubes of phosphate-buffered saline and submitted to Stanford’s Clinical Virology Lab for pooled RT-PCR analysis within four hours of collection. If SARS-CoV-2 genetic material was found in a pooled sample then the pooled samples were separated out and the rerun through the same process. The lab notified parents/guardians within 24 to 72 hours after testing.

This “interesting” new study is “really well designed,” said Dr. C. Anthoney Lim, director of pediatric emergency medicine for the Mount Sinai Health System and an associate professor of emergency medicine and pediatrics and medical education at the Icahn School of Medicine at Mount Sinai in New York.

“It supports the fact that children can, with a very small amount of practice, do self-testing very well,” Dr. Lim told Reuters Health by phone. “Despite the lower sensitivity and lower specificity, this can be fairly robust testing if you’re doing it on a regular basis. Repetitiveness makes up for the slightly lower test characteristics.”

And for many kids, being able to collect the samples themselves “makes it more tolerable for them, I think,” Dr. Lim said.

The study has limitations, Dr. Lim said. “Without delving into the school district, or the school, it may not have a broad application to other districts that have children of different socioeconomic backgrounds.”

Altamirano did not respond to a request for comments.

SOURCE: JAMA Network Open, online February 17, 2022.

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