title: Equivalence of self- and staff-collected nasal swabs for the detection of viral respiratory pathogens.
abstract: BACKGROUND
  The need for the timely collection of diagnostic biosamples during symptomatic episodes represents a major obstacle to large-scale studies on acute respiratory infection (ARI) epidemiology. This may be circumvented by having the participants collect their own nasal swabs. We compared self- and staff-collected swabs in terms of swabbing quality and detection of viral respiratory pathogens.
  
  
  RESULTS
  We conducted a prospective study among employees of our institution during the ARI season 2010/2011 (December-March). Weekly emails were sent to the participants (n = 84), reminding them to come to the study center in case of new symptoms. The participants self-collected an anterior nasal swab from one nostril, and trained study personnel collected one from the other nostril. The participants self-collected another two swabs (one from each nostril) on a subsequent day. Human β-actin DNA concentration was determined in the swabs as a quality control. Viral respiratory pathogens were detected by multiplex RT-PCR (Seeplex RV15 kit, Seegene, Eschborn, Germany). Of 84 participants, 56 (67%) reported at least one ARI episode, 18 participants two, and one participant three. Self-swabbing was highly accepted by the participants. The amount of β-actin DNA per swab was higher in the self- than in the staff-collected swabs (p = 0.008). β-actin concentration was lower in the self-swabs collected on day 1 than in those collected on a subsequent day (p<0.0001). A respiratory viral pathogen was detected in 31% (23/75) of staff- and in 35% (26/75) of self-collected swabs (p = 0.36). With both approaches, the most frequently identified pathogens were human rhinoviruses A/B/C (12/75 swabs, 16%) and human coronavirus OC43 (4/75 swabs, 5%). There was almost perfect agreement between self- and staff-collected swabs in terms of pathogen detection (agreement = 93%, kappa = 0.85, p<0.0001).
  
  
  CONCLUSIONS
  Nasal self-swabbing for identification of viral ARI pathogens proved to be equivalent to staff-swabbing in this population in terms of acceptance and pathogen detection.
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany. manas.akmatov@helmholtz-hzi.de
authors.forename: Manas K
authors.initials: MK
authors.lastname: Akmatov
authors.forename: Anja
authors.initials: A
authors.lastname: Gatzemeier
authors.forename: Klaus
authors.initials: K
authors.lastname: Schughart
authors.forename: Frank
authors.initials: F
authors.lastname: Pessler
mesh_terms: D017934:Coronavirus / Q000302:isolation & purification*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D009666:Nose / Q000821:virology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000821:virology; D012229:Rhinovirus / Q000302:isolation & purification*; D013048:Specimen Handling