Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov-Dec;53(12):947-952.
doi: 10.1080/23744235.2021.1969426. Epub 2021 Aug 27.

Anterior nasal versus nasal mid-turbinate sampling for a SARS-CoV-2 antigen-detecting rapid test: does localisation or professional collection matter?

Olga Nikolai  1 , Chiara Rohardt  1 , Frank Tobian  2 , Andrea Junge  1 , Victor M Corman  3   4 , Terry C Jones  3   4   5 , Mary Gaeddert  2 , Federica Lainati  2 , Jilian A Sacks  6 , Joachim Seybold  7 , Frank P Mockenhaupt  1 , Claudia M Denkinger  2   8 , Andreas K Lindner  1
Affiliations

Anterior nasal versus nasal mid-turbinate sampling for a SARS-CoV-2 antigen-detecting rapid test: does localisation or professional collection matter?

Olga Nikolai et al. Infect Dis (Lond). 2021 Nov-Dec.

Abstract

Introduction: Most SARS-CoV-2 antigen-detecting rapid diagnostic tests require nasopharyngeal sampling, which is frequently perceived as uncomfortable and requires healthcare professionals, thus limiting scale-up. Nasal sampling could enable self-sampling and increase acceptability. The term nasal sampling is often not used uniformly and sampling protocols differ.

Methods: This manufacturer-independent, prospective diagnostic accuracy study, compared professional anterior nasal and nasal mid-turbinate sampling for a WHO-listed SARS-CoV-2 antigen-detecting rapid diagnostic test. The second group of participants collected a nasal mid-turbinate sample themselves and underwent a professional nasopharyngeal swab for comparison. The reference standard was real-time polymerase chain reaction (RT-PCR) using combined oro-/nasopharyngeal sampling. Individuals with high suspicion of SARS-CoV-2 infection were tested. Sensitivity, specificity, and percent agreement were calculated. Self-sampling was observed without intervention. Feasibility was evaluated by observer and participant questionnaires.

Results: Among 132 symptomatic adults, both professional anterior nasal and nasal mid-turbinate sampling yielded a sensitivity of 86.1% (31/36 RT-PCR positives detected; 95%CI: 71.3-93.9) and a specificity of 100.0% (95%CI: 95.7-100). The positive percent agreement was 100% (95%CI: 89.0-100). Among 96 additional adults, self nasal mid-turbinate and professional nasopharyngeal sampling yielded an identical sensitivity of 91.2% (31/34; 95%CI 77.0-97.0). Specificity was 98.4% (95%CI: 91.4-99.9) with nasal mid-turbinate and 100.0% (95%CI: 94.2-100) with nasopharyngeal sampling. The positive percent agreement was 96.8% (95%CI: 83.8-99.8). Most participants (85.3%) considered self-sampling as easy to perform.

Conclusion: Professional anterior nasal and nasal mid-turbinate sampling are of equivalent accuracy for an antigen-detecting rapid diagnostic test in ambulatory symptomatic adults. Participants were able to reliably perform nasal mid-turbinate sampling themselves, following written and illustrated instructions. Nasal self-sampling will facilitate scaling of SARS-CoV-2 antigen testing.

Keywords: COVID-19; SARS-CoV-2; anterior nasal; antigen-detecting rapid test; nasal mid-turbinate; nasal-sampling; self-sampling.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Study flow diagram.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. European Centre for Disease Prevention and Control . Options for the use of rapid antigen tests for COVID-19 in the EU/EEA and the UK. November 19 2020; [cited 2021 Mar 8]. Available from: https://www.ecdc.europa.eu/en/publications-data/options-use-rapid-antige....
    1. European Centre for Disease Prevention and Control . Surveillance of COVID-19 at long-term care facilities in the EU/EEA. May 19 2020; [cited 2021 Mar 8]. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-COVID-19-lo....
    1. CDC . Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19.; [cited 2021 Mar 8]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specim....
    1. Lindner AK, Nikolai O, Rohardt C, et al. . Head-to-head comparison of SARS-CoV-2 antigen-detecting rapid test with professional-collected nasal versus nasopharyngeal swab. Eur Respir J. 2021;57(5):2004430. - PMC - PubMed
    1. Lindner AK, Nikolai O, Kausch F, et al. . Head-to-head comparison of SARS-CoV-2 antigen-detecting rapid test with self-collected nasal swab versus professional-collected nasopharyngeal swab. Eur Respir J. 2020;57(4):2003961. - PMC - PubMed

Publication types

Grants and funding

C.M. Denkinger reports grants from Foundation for Innovative New Diagnostics (FIND), and Ministry of Science, Research and Culture, State of Baden Wuerttemberg, Germany, to conduct of the study. J.A. Sacks reports grants from UK Department for International Development (DFID, recently replaced by FCMO), World Health Organisation (WHO) and Unitaid, to conduct of the study. FIND supplied the test kits for the study. The study was supported by Heidelberg University Hospital and Charité University Hospital internal funds.

LinkOut - more resources