Published online August 25, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. e615-e620 (doi:10.1542/10.1542/peds.2008-0691)
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ARTICLE

Comparing Nose-Throat Swabs and Nasopharyngeal Aspirates Collected From Children With Symptoms for Respiratory Virus Identification Using Real-Time Polymerase Chain Reaction

Stephen B. Lambert, MBBSa,b, David M. Whiley, PhDa,b, Nicholas T. O'Neill, BNursa, Emily C. Andrews, BNursa, Fiona M. Canavan, BNursa, Cheryl Bletchly, PhDc, David J. Siebert, MBBSc, Theo P. Sloots, PhDa,b,c,d and Michael D. Nissen, MBBSa,b,c,d

a Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital and Health Service District, Herston, Queensland, Australia
b Clinical Medical Virology Centre
d Department of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
c Microbiology Division, Clinical and Statewide Services Division, Pathology Queensland, Royal Brisbane Hospital Campus, Herston, Queensland, Australia

OBJECTIVES. The objective of this study was to calculate sensitivity values for the detection of major respiratory viruses of childhood by using combined nose-throat swabs and nasopharyngeal aspirates.

METHODS. Children who had symptoms and presented to a pediatric teaching hospital and had a diagnostic respiratory specimen collected were enrolled, and paired nose-throat swab and nasopharyngeal aspirate specimens were collected. Parents were asked to collect the nose-throat swab specimen in the first instance but could defer to a health care worker if unwilling. Nose-throat swab collectors were asked to rate perceived quality of collection. All nasopharyngeal aspirates were collected by a health care worker by using a standard protocol. Real-time polymerase chain reaction for 8 respiratory viruses was performed in our hospital's diagnostic laboratory.

RESULTS. Paired nose-throat swab/nasopharyngeal aspirate specimens were collected during 303 illnesses, with at least 1 respiratory virus identified in 186 (61%). For the major pathogens of childhood, influenza A virus and respiratory syncytial virus, collection by using the nose-throat swab had a sensitivity of 91.9% and 93.1%, respectively. A health care worker collected 219 (72%) of the nose-throat swab specimens; concordance with the nasopharyngeal aspirate was not related to health care worker collection or perceived quality of collection.

CONCLUSIONS. Nose-throat swab specimens, in combination with sensitive molecular testing, are a less invasive diagnostic respiratory specimen with adequate sensitivity for use in the clinic and hospital outpatient settings and large-scale community studies through parent collection. For children who present to a hospital in which an avian or pandemic strain of influenza virus is reasonably part of the differential diagnosis, nasopharyngeal aspirates or a similar collection technique (eg, nasal washes) should continue to be used.

Key Words: respiratory viruses • real-time PCR • diagnostic methods • children

Abbreviations: NTS—nose-throat swab • NPA—nasopharyngeal aspirate • ARI—acute respiratory infection • PCR—polymerase chain reaction • RSV—respiratory syncytial virus • PIV—parainfluenza virus • CI—confidence interval • NAAT—nucleic acid–amplification test

Accepted Apr 30, 2008.


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