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. 2021 Dec 31;10(12):1052-1061.
doi: 10.1093/jpids/piab081.

Antigen Test Performance Among Children and Adults at a SARS-CoV-2 Community Testing Site

Laura Ford  1   2 , Melissa J Whaley  1 , Melisa M Shah  1   2 , Phillip P Salvatore  1   2 , Hannah E Segaloff  1   2   3 , Augustina Delaney  1 , Dustin W Currie  1   2 , Lauren Boyle-Estheimer  1 , Michelle O'Hegarty  1 , Clint N Morgan  1 , Jennifer Meece  4 , Lynn Ivacic  4 , Natalie J Thornburg  1 , Azaibi Tamin  1 , Jennifer L Harcourt  1 , Jennifer M Folster  1 , Magdalena Medrzycki  1 , Shilpi Jain  1 , Phili Wong  1 , Kimberly Goffard  5 , Douglas Gieryn  5 , Juliana Kahrs  6 , Kimberly Langolf  7 , Tara Zochert  7 , Jacqueline E Tate  1 , Christopher H Hsu  1 , Hannah L Kirking  1
Affiliations

Antigen Test Performance Among Children and Adults at a SARS-CoV-2 Community Testing Site

Laura Ford et al. J Pediatric Infect Dis Soc. .

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.

Keywords: COVID-19; epidemiology; infectious diseases; pediatrics; public health.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
(A) Percentage presenting for testing, exposed, real-time reverse transcription-polymerase chain reaction (RT-PCR) or antigen test-positive and (B) positive and symptomatic by age group, collected at a community testing site – Oshkosh, Wisconsin, November-December 2020. aSx: Symptomatic defined as reporting ≥1 symptom at specimen collection. bSx: Symptomatic defined as reporting symptoms meeting the Council of State and Territorial Epidemiologists (CSTE) clinical criteria for COVID-19.
Figure 2.
Figure 2.
Sensitivity, specificity, positive predictive value, and negative predictive value of antigen test compared with real-time reverse transcription–polymerase chain reaction (RT-PCR) test among pediatric and adult participants overall and by symptom and exposure status, Oshkosh, Wisconsin, November-December 2020.
Figure 3.
Figure 3.
N-gene cycle threshold value distribution and viral isolation among real-time reverse transcription–polymerase chain reaction (RT-PCR) or antigen-positive (A) symptomatic children (B) asymptomatic children, (C) all children by days since symptom onset, Oshkosh, Wisconsin, November-December 2020. A and B are excluding 1 child with unknown symptom status.
See this image and copyright information in PMC

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