title: Results of a pilot study using self-collected mid-turbinate nasal swabs for detection of influenza virus infection among pregnant women.
abstract: BACKGROUND
  We evaluated the feasibility of asking pregnant women to self-collect and ship respiratory specimens.
  
  
  METHODS
  In a preliminary laboratory study, we compared the RT-PCR cycle threshold (CT) values of influenza A and B viruses incubated at 4 storage temperatures (from 4 to 35°C) for 6 time periods (8, 24, 48, 72, and 168 hours and 30 days), resulting in 24 conditions that were compared to an aliquot tested after standard freezing (-20°C) (baseline condition). In a subsequent pilot study, during January-February, 2014, we delivered respiratory specimen collection kits to 53 pregnant women with a medically attended acute respiratory illness using three delivery methods.
  
  
  RESULTS
  CT values were stable after storage at temperatures <27°C for up to 72 hours for influenza A viruses and 48 hours for influenza B viruses. Of 53 women who received kits during the pilot, 89% collected and shipped nasal swabs as requested. However, 30% (14/47) of the women took over 2 days to collect and ship their specimen. The human control gene, ribonuclease P (RNase P), was detected in 100% of nasal swab specimens. However, the mean CT values for RNase P (26.5, 95% confidence interval [CI] = 26.0-27.1) and for the 8 influenza A virus positives in our pilot (32.2, 95% CI = 28.9-35.5) were significantly higher than the CTs observed in our 2010-2012 study using staff-collected nasal pharyngeal swabs (P-values < 0.01).
  
  
  CONCLUSIONS
  Self-collection of respiratory specimens is a promising research method, but further research is needed to quantify the sensitivity and specificity of the approach.
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Thompson
authors.forename: Jeannette R
authors.initials: JR
authors.lastname: Ferber
authors.forename: Roxana
authors.initials: R
authors.lastname: Odouli
authors.forename: Donna
authors.initials: D
authors.lastname: David
authors.forename: Pat
authors.initials: P
authors.lastname: Shifflett
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Meece
authors.forename: Allison L
authors.initials: AL
authors.lastname: Naleway
authors.forename: Sam
authors.initials: S
authors.lastname: Bozeman
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Spencer
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Fry
authors.forename: De-Kun
authors.initials: DK
authors.lastname: Li
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D009980:Influenza A virus / Q000302:isolation & purification; D009981:Influenza B virus / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis*; D009666:Nose / Q000821:virology*; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D043262:Ribonuclease P / Q000235:genetics; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D014420:Turbinates / Q000821:virology*
chemical_list: D043262:Ribonuclease P
keywords: Acute respiratory illness; influenza; nasal swab; pregnancy; self-collection