title: Home Self-Collection of Nasal Swabs for Diagnosis of Acute Respiratory Virus Infections in Children With Cystic Fibrosis.
abstract: BACKGROUND
  Understanding the importance of respiratory viruses in children with cystic fibrosis (CF) has been limited because of challenges using clinic- or hospital-based diagnostic testing. We conducted a pilot study to assess feasibility of home self- (or parent-) collection of nasal swabs (NS).
  
  
  METHODS
  Cystic fibrosis patients aged 6-18 years with new respiratory illness participated. In clinic, a deep nasal flocked swab was collected by research staff and compared with an anterior foam NS obtained after instillation of saline spray. At home, up to 2 self-collections of paired foam NS (with and without saline) were collected and mailed for real-time polymerase chain reaction (PCR) testing.
  
  
  RESULTS
  Paired swabs were collected from 28 patients: 18 sets in clinic (deep nasal vs saline foam NS) and 43 sets at home (saline vs dry foam NS) with 9 (50%) and 35 (81%) virus detections, respectively. Home-collected NS were obtained closer to illness onset, with a mean difference in symptom days of -2.3 between home and clinic collections (95% confidence interval [CI] -3.5, -1.2; P < .001). Rhinovirus comprised 73% of virus detections; the difference in mean PCR cycle threshold values for rhinovirus between swabs collected at home versus clinic was -3.8 (95% CI -6.8, -0.9; P = .014), indicating significantly higher viral load for home-collected swabs.
  
  
  CONCLUSIONS
  Home-collected foam NS had a higher positivity rate compared with clinic-collected swabs, likely because collection was closer to illness onset. Home self-collection is feasible and well tolerated for timely respiratory virus diagnosis and provides a novel approach for clinical diagnostics and surveillance of respiratory virus infections among CF patients.
authors.affiliation: Department of Pediatrics Seattle Children's Hospital, Seattle, Washington.
authors.forename: Julia
authors.initials: J
authors.lastname: Emerson
authors.affiliation: Seattle Children's Hospital, Seattle, Washington.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cochrane
authors.affiliation: Seattle Children's Hospital, Seattle, Washington.
authors.forename: Sharon
authors.initials: S
authors.lastname: McNamara
authors.affiliation: Department of Laboratory Medicine, University of Washington.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Department of Pediatrics Seattle Children's Hospital, Seattle, Washington.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Gibson
authors.affiliation: Department of Pediatrics Seattle Children's Hospital, Seattle, Washington.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Campbell