Atlanta—Schoolchildren who have not yet reached adolescence are often required to be tested for SARS-CoV-2 testing, but available products have not received Emergency Use Authorization (EUA) for performance with self-collected anterior nares (nasal) swabs from children aged younger than 14 years.

The reason is that the effect of pediatric self-swabbing on SARS-CoV-2 test sensitivity is unknown. That is why researchers from Emory University School of Medicine and Children’s Healthcare of Atlanta and colleagues sought to determine the ability of school-aged children to self-collect nasal swabs for SARS-CoV-2 testing compared with collection by healthcare workers.

The cross-sectional study, published in the Journal of the American Medical Associate, involved 197 symptomatic children and adolescents aged 4 to 14 years. The youngsters were recruited based on results of testing in the Children’s Healthcare of Atlanta system from July 2021 to August 2021.

The researchers explained that the children and adolescents were given instructional material consisting of a short video and a handout with written and visual steps for self-swab collection. For purposes of the study, participants first provided a self-collected nasal swab, with healthcare workers then collecting a second specimen.

The study team was comparing how self- versus healthcare worker–collected nasal swabs compared with the use of a real-time reverse transcriptase polymerase chain reaction test. More than one-half of the study participants (55.7%) were male with a median age of 9 years (interquartile range, 6-11 years).

The results indicated that of the 196 participants, 87 (44.4%) tested positive for SARS-CoV-2 and 105 (53.6%) tested negative by both self- and healthcare worker–collected swabs. Only two children tested positive by self- or healthcare worker–collected swab alone, and one child had an invalid healthcare worker swab.

“Compared with healthcare worker–collected swabs, self-collected swabs had 97.8% (95% CI, 94.7%-100.0%) and 98.1% (95% CI, 95.6%-100.0%) positive and negative percent agreement, respectively, and SARS-CoV-2 Ct values did not differ significantly between groups (mean [SD] Ct, self-swab: 26.7 [5.4] vs. healthcare worker swab: 26.3 [6.0]; P = .65),” the study concluded.

The authors added, “After hearing and seeing simple instructional materials, children and adolescents aged 4 to 14 years self-collected nasal swabs that closely agreed on SARS-CoV-2 detection with swabs collected by healthcare workers.”

The results are important, according to the researchers, because while testing has become widely available for children and adults who may have a SARS-CoV-2 infection, “testing capacity remains insufficient for repeat testing of children and adolescents, particularly in group settings, such as camps and schools, that are less likely to have trained health care workers (HCWs) available for sample collection.”

Even though medical practice historically has involved sample collection by HCWs for respiratory virus testing, the researchers emphasized, “Yet little data exist to suggest that HCW collection is necessary, and it remains a barrier to expanded testing.”

Background information in the study advises that many SARS-CoV-2 tests have been authorized by the FDA under EUA for self-swabbing by adults and children aged 14 years and older and parental swab collection in children aged 2 years and older. Anterior nares (nasal) swabs are generally preferred because they are considered technically less complex.

“However, the age at which nasal self-swabbing would be successful and how it may affect SARS-CoV-2 test performance is unknown. As a result of this knowledge gap, no tests are authorized by the FDA under EUA for self-swabbing by children younger than 14 years,” the authors wrote.

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