Home Respiratory Infection Testing: An Important Tool to Develop
Amesh A. Adalja, MD, FACP, FACEP, FIDSA | April 22, 2019
Home diagnosis of infectious diseases is not something that is performed with the frequency of home glucose monitoring or pregnancy testing. To date, home diagnostic testing has been limited primarily to sexually transmitted infections such as HIV. However, the broader use of home testing could be important for outbreak management, antibiotic stewardship, situational awareness, and pandemic response.
A new study, published in Influenza and Other Respiratory Viruses, provides evidence that home collection of respiratory viral swabs is feasible and useful.
In this study, Haussig and colleagues from the Robert Koch Institute and ECDC recruited103 participants from Germany’s GrippeWeb flu population surveillance system. Study participants were instructed to take anterior nasal swabs at baseline and also when respiratory symptoms were present. Swabs were analyzed using PCR, and 22 different viral and bacterial microorganisms were targeted. A total of 227 swabs were submitted. The median time between swabbing and symptom onset was 2 days.
All samples were valid as indicated by the presence of the human c-myc gene. Positive swabs yielded 143 pathogen detections, all viral in etiology. Rhinovirus/enterovirus was the most frequent detection, followed by HKU1 and NL63 coronaviruses. Bocaviruses, RSV, parainfluenza, metapneumovirus, adenoviruses, and influenza viruses were also detected. Pathogens were detected in 71% of symptomatic collections and in 14% of asymptomatic collections. More than 1 virus was detected in some samples.
Optimizing Management and Response
This study is important because it demonstrates that at-home nasal swab collection is feasible and yields valuable information. Home diagnosis of respiratory infections has many benefits. Because many of these infections are erroneously treated with antibacterial agents, having patients know that their infection is caused by a virus may diminish the demand for inappropriate antibiotics (if test results are available rapidly). Additionally, the testing can be used to optimize influenza antiviral prescribing. Also, such testing can be used during respiratory virus season to provide a deeper picture of what viruses are circulating, surging, prompting people to seek medical attention, and leading to hospitalization. During an outbreak or pandemic scenario, home testing could be pushed out to the general public to gain some idea of the burden of illness and to help facilitate testing at home, thereby minimizing transmission at healthcare facilities. Further work in this field could assess the feasibility of using CLIA-waived point-of-care respiratory tests that deliver a result directly to patients (as well as electronically transmit the results to healthcare providers) in rapid fashion, rather than having them processed centrally.
Leveraging the rapid advances and simplification in use of diagnostic technologies should be an important part of improving how the world copes with infectious disease emergencies and seasonal outbreaks.
Haussig JM, Targosz A, Engelhart S, et al. Feasibility study for the use of self‐collected nasal swabs to identify pathogens among participants of a population‐based surveillance system for acute respiratory infections (GrippeWeb‐Plus)—Germany, 2016. Influenza Other Respir Viruses 2019. https://onlinelibrary.wiley.com/doi/epdf/10.1111/irv.12644. Accessed April 21, 2019.