Comparable specimen collection from both ends of at-home mid-turbinate swabs.
Comparable specimen collection from both ends of at-home mid-turbinate swabs.
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从家用中鼻甲拭子两端采集的可比样本。
DOI：
10.1101/2020.12.05.20244632
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Starita,
中科院分区：
文献类型：
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作者：
Truong,Melissa;Pfau,Brian;McDermot,Evan;Han,PeterD;Brandstetter,Elisabeth;Richardson,Matthew;Kim,AshleyE;Rieder,MarkJ;Chu,HelenY;Englund,JanetA;Nickerson,DeborahA;Shendure,Jay;Lockwood,ChristinaM;Konnick,EricQ;Starita,
在家中采集呼吸道标本进行病原体检测，可实现社区采样。此外，它既不需要卫生保健工作者的时间，也不需要个人防护设备，有症状的个人可以继续自我隔离。然而，问题仍然存在，个人在家中无监督的上呼吸道标本采集是否可靠地产生足够高质量的病原体检测标本。从2019年10月到2020年5月，西雅图流感研究（1，2）和大西雅图冠状病毒评估网络（SCAN; scanpublichealth. org）对参与者在家中自行采集的16，785个中鼻甲拭子进行了呼吸道病原体筛查。家用试剂盒包含一个植绒中鼻甲拭子（科潘56380 CS 01或56750 CS 01），成人或儿童，一管通用转运培养基（UTM），以及如何自行采集标本或为儿童采集标本并将其返回实验室的说明（2）。在分发给西雅图大都市地区的个人的试剂盒中，大多数试剂盒均按照试剂盒中的说明正确返回拭子，但138/16，785（0.8%）试剂盒返回实验室时，拭子手柄在UTM管中，而不是拭子本身。拭子手柄为非锥形硬塑料，与拭子植绒端相比，表面积减小（图1A）。我们对这种现象感到困惑，并试图评估在分子病原体检测方面，一次性采集的标本是否与植绒拭子本身具有可比性。我们还评估了与拭子采集错误相关的人口统计学协变量。在16，782份标本中，使用我们的TaqMan检测板分析了12，006份标本中是否存在24种呼吸道病原体，包括使用手柄采集的138份标本中的99份（表1）。2020年1月1日之后采集的样本使用单独的逆转录酶PCR（RT-PCR）检测法额外检测了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的存在。作为确定每个样本是否收集了足够的鼻样本的质量控制指标，两种测定平台均测量了具有RNase P相对循环阈值（Crt）的人RNase P样本的量。28个被认为是失败的收集。所有正确采集标本的失败率为2.0%（238/12，142）。我们预计，对于非临床采集的标本，失败率很高，但只有2.9%（3/102）未通过该质量控制指标，无显著差异（P= 0.46，FisherLs精确检验）。非常规采集标本的人标志物RNase P的Crt值高于正常采集标本的值（图1B），平均Crt值为
At-home respiratory specimen collection for pathogen testing enables community sampling. Furthermore, it requires neither a health care workerLs time nor personal protective equipment, and symptomatic individuals can continue to self-isolate. However, questions remain as to whether unsupervised upper respiratory specimen collection by individuals in their homes reliably produce specimens that are of high enough quality for pathogen testing. From October 2019 through May 2020, the Seattle Flu Study (1, 2) and the greater Seattle Coronavirus Assessment Network (SCAN; scanpublichealth. org) screened 16,785 midturbinate swabs that were self-collected by participants at home for respiratory pathogens. The at-home kits contained a flocked, midturbinate swab (Copan 56380CS01 or 56750CS01), either adult or pediatric, a tube of universal transport media (UTM), and instructions on how to self-collect a specimen or collect a specimen for a child and return it to the lab (2). Of the kits distributed to individuals in the Seattle metropolitan area, most resulted in swabs returned appropriately according to the instructions in the kit, but 138/16,785 (0.8%) kits were returned to the lab with the swab handle in the UTM tube rather than the swab itself. The swab handle is nontapered, hard plastic with decreased surface area compared with the flocked end of the swab (Fig. 1A). We were puzzled by this phenomenon and sought to evaluate whether handle-collected specimens were comparable to flocked swabs themselves for molecular pathogen detection. We also assessed demographic covariates associated with errors in swab collection. Of the 16,782 specimens, 12,006 were analyzed for the presence of 24 respiratory pathogens using our TaqMan-based detection panel, including 99 of the 138 specimens collected with the handle (Table 1). Samples collected after 1 January 2020 were additionally tested for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using a separate reverse transcriptase PCR (RT-PCR) assay. As a qualitycontrol metric to determine if a sufficient nasal specimen was collected for each sample, both assay platforms measured the amount of human RNase P. Specimens with RNase P relative cycle threshold (Crt) of. 28 were considered to be a failed collection. The failure rate for all properly collected specimens was 2.0%(238/12,142). We expected a high failure rate for the handle-collected specimens, but only 2.9%(3/102) failed this quality-control metric, a nonsignificant difference (P= 0.46, FisherLs exact test). The Crt values for human marker RNase P for handle-collected specimens were higher than those for properly collected specimens (Fig. 1B), with a mean Crt value of