Screening for Severe Acute Respiratory Syndrome Coronavirus 2 in Close Contacts of Individuals With Confirmed Infection: Performance and Operational Considerations
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Abstract
Background
Point-of-care and decentralized testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical to inform public health responses. Performance evaluations in priority use cases such as contact tracing can highlight trade-offs in test selection and testing strategies.
Methods
A prospective diagnostic accuracy study was conducted among close contacts of coronavirus disease 2019 (COVID-19) cases in Brazil. Two anterior nares swabs (ANS), a nasopharyngeal swab (NPS), and saliva were collected at all visits. Vaccination history and symptoms were assessed. Household contacts were followed longitudinally. Three rapid antigen tests and 1 molecular method were evaluated for usability and performance against reference reverse-transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swab specimens.
Results
Fifty index cases and 214 contacts (64 household) were enrolled. Sixty-five contacts were RT-PCR positive during ≥1 visit. Vaccination did not influence viral load. Gamma variants were most prevalent; Delta variants emerged increasingly during implementation. The overall sensitivity of evaluated tests ranged from 33% to 76%. Performance was higher among symptomatic cases and those with cycle threshold (Ct) values <34 and lower among oligosymptomatic or asymptomatic cases. Assuming a 24-hour time to results for RT-PCR, the cumulative sensitivity of an anterior nares swab rapid antigen test was >70% and almost 90% after 4 days.
Conclusions
The near-immediate time to results for antigen tests significantly offsets lower analytical sensitivity in settings where RT-PCR results are delayed or unavailable.
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SciScore for 10.1101/2022.01.27.22269904: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical considerations: WCG Institutional Review Board (1301165), the CEPEM ethics committee, and Brazil’s National Research Ethics Commission approved this study (44351421.0.0000.0011).
Consent: Written informed consent was obtained for all participants.Sex as a biological variable not detected. Randomization not detected. Blinding Evaluated tests were conducted per manufacturer instructions and by operators blinded to close contact POC and reference results. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data were collected and managed using REDCap electronic data capture tools hosted at the Institute of Translational Health Sciences [33]. REDCapsuggest…SciScore for 10.1101/2022.01.27.22269904: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical considerations: WCG Institutional Review Board (1301165), the CEPEM ethics committee, and Brazil’s National Research Ethics Commission approved this study (44351421.0.0000.0011).
Consent: Written informed consent was obtained for all participants.Sex as a biological variable not detected. Randomization not detected. Blinding Evaluated tests were conducted per manufacturer instructions and by operators blinded to close contact POC and reference results. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data were collected and managed using REDCap electronic data capture tools hosted at the Institute of Translational Health Sciences [33]. REDCapsuggested: (REDCap, RRID:SCR_003445)Statistical analyses were conducted using Stata 15.0 (StataCorp, College Station, Texas, USA) and R 4.0.3 (R Foundation for Statistical Computing, Vienna, Austria). StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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