• Jesse J Waggoner, Miriam B Vos, Erika A Tyburski, Phuong-Vi Nguyen, Jessica M Ingersoll, Candace Miller, Julie Sullivan, Mark Griffiths, Cheryl Stone, Macarthur Benoit, Laura Benedit, Brooke Seitter, Robert Jerris, Joshua M Levy, Colleen S Kraft, Sarah Farmer, Amanda Peagler, Anna Wood, Adrianna L Westbrook, Claudia R Morris, Usha N Sathian, William Heetderks, Li Li, Kristian Roth, Mary Barcus, Timothy Stenzel, Greg S Martin, and Wilbur A Lam.
• Emory University School of Medicine, Atlanta, Georgia.
• JAMA. 2022 Sep 13; 328 (10): 935940935-940.

ImportanceDespite the expansion of SARS-CoV-2 testing, available tests have not received Emergency Use Authorization for performance with self-collected anterior nares (nasal) swabs from children younger than 14 years because the effect of pediatric self-swabbing on SARS-CoV-2 test sensitivity is unknown.ObjectiveTo characterize the ability of school-aged children to self-collect nasal swabs for SARS-CoV-2 testing compared with collection by health care workers.Design, Setting, And ParticipantsCross-sectional study of 197 symptomatic children and adolescents aged 4 to 14 years old. Individuals were recruited based on results of testing in the Children's Healthcare of Atlanta system from July to August 2021.ExposuresChildren and adolescents were given instructional material consisting of a short instructional video and a handout with written and visual steps for self-swab collection. Participants first provided a self-collected nasal swab. Health care workers then collected a second specimen.Main Outcomes And MeasuresThe primary outcome was SARS-CoV-2 detection and relative quantitation by cycle threshold (Ct) in self- vs health care worker-collected nasal swabs when tested with a real-time reverse transcriptase-polymerase chain reaction test with Emergency Use Authorization.ResultsAmong the study participants, 108 of 194 (55.7%) were male and the median age was 9 years (IQR, 6-11). Of the 196 participants, 87 (44.4%) tested positive for SARS-CoV-2 and 105 (53.6%) tested negative by both self- and health care worker-collected swabs. Two children tested positive by self- or health care worker-collected swab alone; 1 child had an invalid health care worker swab. Compared with health care worker-collected swabs, self-collected swabs had 97.8% (95% CI, 94.7%-100.0%) and 98.1% (95% CI, 95.6%-100.0%) positive and negative percent agreement, respectively, and SARS-CoV-2 Ct values did not differ significantly between groups (mean [SD] Ct, self-swab: 26.7 [5.4] vs health care worker swab: 26.3 [6.0]; P = .65).Conclusions And RelevanceAfter hearing and seeing simple instructional materials, children and adolescents aged 4 to 14 years self-collected nasal swabs that closely agreed on SARS-CoV-2 detection with swabs collected by health care workers.

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