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Comparative Study
. 2025 Jun:178:105801.
doi: 10.1016/j.jcv.2025.105801. Epub 2025 Apr 29.

Comparison of mid-turbinate nasal and combined nasal-throat specimen types for detection of respiratory viruses in children

Irem Onalan  1 , Zheyi Teoh  2 , Sarah L Steele  1 , Eileen J Klein  3 , Bonnie Strelitz  1 , Kirsten Lacombe  1 , Erin M Sullivan  1 , Arun K Nalla  4 , Danielle M Zerr  2 , Janet A Englund  5
Affiliations
Comparative Study

Comparison of mid-turbinate nasal and combined nasal-throat specimen types for detection of respiratory viruses in children

Irem Onalan et al. J Clin Virol. 2025 Jun.

Abstract

Background: The source of respiratory specimens may impact the detection of respiratory viruses. It may also have implications for research participant recruitment, caregiver acceptability due to concerns for patient comfort, and potential risk of aerosolization during epidemics/pandemics.

Objective: To determine the impact of collecting a throat swab (TS) in addition to a mid-turbinate nasal swab (MTS) by comparing agreement of viral detection and relative viral loads.

Study design: We reviewed molecular detection results from 2548 children enrolled in the New Vaccine Surveillance Network at Seattle Children's Hospital from 11/2015-05/2019. Participants with a clinical MTS who agreed to collection of a combined TS and MTS (TS&MTS) for research were included. All specimens were tested using FilmArrayR Respiratory Panel (Biofire Diagnostics). Viral detection from MTS and TS&MTS were compared. Relative viral loads were compared between specimens with concordant (same viruses detected) and discordant (different or additional viruses detected) results.

Results: Results from 743 participants with clinical MTS and research TS&MTS specimens were compared; Viral detections were similar between the two groups, including 596 (80.2 %) paired results that were concordant. The most common discordant viruses were rhinovirus/enterovirus, respiratory syncytial virus, and adenovirus. Mean relative viral loads were lower in discordant specimens compared to concordant specimens, regardless of specimen source.

Conclusion: Comparison of clinical and research specimens revealed that respiratory viral detection was similar with or without an added TS. Lower relative viral loads of discordant specimens suggest that a combined TS&MTS may not improve viral detection for clinically significant pathogens.

Keywords: Acute respiratory infection; Nasal swab; Respiratory viral infection; Respiratory virus; Specimen collection; Throat swab.

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Conflict of interest statement

Declaration of Competing Interest Janet A Englund receives research support from AstraZeneca, Moderna, Pfizer, Shionogi, and is a consultant for AstraZeneca, Abbvie, GSK, Meissa Vaccines, Merck, Moderna, Pfizer, SanofiPasteur.

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