Antigen Test Performance Among Children and Adults at a SARS-CoV-2 Community Testing Site
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Abstract
Background
Performance characteristics of SARS-CoV-2 antigen tests among children are limited despite the need for point-of-care testing in school and childcare settings. We describe children seeking SARS-CoV-2 testing at a community site and compare antigen test performance to real-time reverse transcription-polymerase chain reaction (RT-PCR) and viral culture.
Methods
Two anterior nasal specimens were self-collected for BinaxNOW antigen and RT-PCR testing, along with demographics, symptoms, and exposure information from individuals ≥5 years at a community testing site. Viral culture was attempted on residual antigen or RT-PCR-positive specimens. Demographic and clinical characteristics, and the performance of SARS-CoV-2 antigen tests, were compared among children (<18 years) and adults.
Results
About 1 in 10 included specimens were from children (225/2110); 16.4% (37/225) were RT-PCR-positive. Cycle threshold values were similar among RT-PCR-positive specimens from children and adults (22.5 vs 21.3, P = .46) and among specimens from symptomatic and asymptomatic children (22.5 vs 23.2, P = .39). Sensitivity of antigen test compared to RT-PCR was 73.0% (27/37) among specimens from children and 80.8% (240/297) among specimens from adults; among specimens from children, specificity was 100% (188/188), positive and negative predictive values were 100% (27/27) and 94.9% (188/198), respectively. Virus was isolated from 51.4% (19/37) of RT-PCR-positive pediatric specimens; all 19 had positive antigen test results.
Conclusions
With lower sensitivity relative to RT-PCR, antigen tests may not diagnose all positive COVID-19 cases; however, antigen testing identified children with live SARS-CoV-2 virus.
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SciScore for 10.1101/2021.07.06.21259792: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources 23 Virus isolation was attempted using Vero CCL-81 cell suspension in 96-well format from residual RT-PCR specimens from all patients who tested positive by either RT-PCR or antigen testing [24]. Vero CCL-81suggested: NoneSoftware and Algorithms Sentences Resources Statistical analysis was performed in SAS 9.4, SAS Institute Inc. SAS Institutesuggested: (Statistical Analysis System, RRID:SCR_008567)Results from OddPub: We did not detect open data. We also did not …
SciScore for 10.1101/2021.07.06.21259792: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources 23 Virus isolation was attempted using Vero CCL-81 cell suspension in 96-well format from residual RT-PCR specimens from all patients who tested positive by either RT-PCR or antigen testing [24]. Vero CCL-81suggested: NoneSoftware and Algorithms Sentences Resources Statistical analysis was performed in SAS 9.4, SAS Institute Inc. SAS Institutesuggested: (Statistical Analysis System, RRID:SCR_008567)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:As widespread antigen testing in K-12 schools is considered [9], the advantages and limitations of antigen tests should be taken into account when designing testing strategies. Our investigation was subject to several limitations. Investigation participants were a convenience sample of largely non-Hispanic White participants and the findings might not be generalizable to other settings. The sample size may have affected the ability to detect significant differences. Furthermore, exposures and symptoms were self-reported, so they may not be accurate or may be symptoms of other respiratory viral infections. Similarly, not many children had a symptom onset >7 days prior to testing, and we were unable to draw conclusions on test performance in this group. Finally, we limited our antigen testing to the BinaxNOW antigen platform, so it is unclear how these results may be generalizable to other antigen platforms. In conclusion, while children reported fewer symptoms than adults, RT-PCR Ct values and virus isolation results were similar to adults, further supporting that children play a role in transmission [5, 30, 34-36]. Antigen testing was highly specific; estimates suggest that test sensitivity may be highest among exposed children and could be useful in this population regardless of where testing may occur. From this study and others, antigen tests had lower, although not necessarily statistically significant, sensitivity among children compared with adults; this lower sensitivi...
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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