Antigen Test Performance Among Children and Adults at a SARS-CoV-2 Community Testing Site
Laura Ford, Melissa Whaley, Melisa M. Shah, Phillip P. Salvatore, Hannah E. Segaloff, Augustina Delaney, Dustin W. Currie, Lauren Boyle-Estheimer, Michelle O’Hegarty, Clint N. Morgan, Jennifer K. Meece, Lynn Ivacic, Natalie J. Thornburg, Azaibi Tamin, Jennifer L. Harcourt, Jennifer Folster, Magdalena Medrzycki, Shilpi Jain, Phili Wong, Kimberly Goffard, Douglas Gieryn, Juliana Kahrs, Kimberly Langolf, Tara Zochert, Jacqueline E. Tate, Christopher H. Hsu, Hannah L. Kirking
Abstract
BACKGROUND: Performance characteristics of SARS-CoV-2 antigen tests among children are limited despite the need for point-of-care testing in school and childcare settings. We describe children seeking SARS-CoV-2 testing at a community site and compare antigen test performance to real-time reverse transcription-polymerase chain reaction (RT-PCR) and viral culture. METHODS: Two anterior nasal specimens were self-collected for BinaxNOW antigen and RT-PCR testing, along with demographics, symptoms, and exposure information from individuals ≥5 years at a community testing site. Viral culture was attempted on residual antigen or RT-PCR-positive specimens. Demographic and clinical characteristics, and the performance of SARS-CoV-2 antigen tests, were compared among children (<18 years) and adults. RESULTS: About 1 in 10 included specimens were from children (225/2110); 16.4% (37/225) were RT-PCR-positive. Cycle threshold values were similar among RT-PCR-positive specimens from children and adults (22.5 vs 21.3, P = .46) and among specimens from symptomatic and asymptomatic children (22.5 vs 23.2, P = .39). Sensitivity of antigen test compared to RT-PCR was 73.0% (27/37) among specimens from children and 80.8% (240/297) among specimens from adults; among specimens from children, specificity was 100% (188/188), positive and negative predictive values were 100% (27/27) and 94.9% (188/198), respectively. Virus was isolated from 51.4% (19/37) of RT-PCR-positive pediatric specimens; all 19 had positive antigen test results. CONCLUSIONS: With lower sensitivity relative to RT-PCR, antigen tests may not diagnose all positive COVID-19 cases; however, antigen testing identified children with live SARS-CoV-2 virus.