Dr. Paul Walsh
Department of Emergency Medicine
As an academic pediatric emergency physician working in the busy general emergency department of a county hospital, I have a particular interest in pathogenesis, diagnosis and treatment of respiratory virus infections.
Previously, our department used nasal aspirates for sample collection. This is because traditional Dacron and Rayon fiber wrapped swabs fail to release virus into the testing medium. In our recent studies, Copan Flocked Swabs, together with Universal Virus Transport Medium, significantly outperformed nasal aspirates in terms of improved viral detection rates and increased pathogen stability for PCR-based virus testing.
Soon after the invention of flocked swabs by Copan, we began extensive side-by-side studies of aspirates and flocked swabs, starting with minitip flocked swabs, and then transitioning to an anatomically optimized mid-turbinate flocked swab designed by COPAN in collaboration with physicians like myself. In addition to providing better performance, typical infants and toddlers patients preferred flocked swabs to nasal aspirates using the preverbal FLACC (Face, Legs, Activity, Crying, Consolability) score.
Copan has collaborated with us closely as a research partner by providing us with collection and transport systems, but has never interfered in the design of the studies, the statistical analysis, or how we interpret or report the results.
Prof. Susanna Esposito
Department of Maternal and Pediatric Sciences
We first found out about Copan flocked swabs from a poster presented at the ASM 2007 in Toronto Canada.
At that time, we were about to start a 3 year study on the "Impact of Influenza Infections in the First Years of Life: Hospital's Clinical and Socio-economical Evaluation". This was a multicenter study that involved specimen collection from hospital in-patient, ambulatory and pediatrician offices. Collecting respiratory secretions using nasopharyngeal aspiration or nasopharyngeal washing are too complex, invasive and time-consuming and most of the parents refuse to have their children undergo these procedures.
We decided to use both the Copan pernasal and the nasal mid-turbinate flocked swabs for our study. Copan supplied us with all flocked swabs, trained all the staff involved in specimen collection, and prepared a pictorial collection guide and a video on the collection of nasopharyngeal and nasal specimen collection.
We validated the flocked nasal mid-turbinate swab for parental collection for the diagnosis of respiratory virus by real time PCR and published the results (Esposito et al. Virology Journal 2010, 7:85). Since 2007, the Copan flocked swab have became the collection devices that we use for all our many studies including the multi country study on Community Acquired Pneumonia Paediatric Research Initiative.
We found in Copan an excellent collaboration and have been providing us with the best collection devices and we commend the innovation that they have brought to the pre-analytics.
Marek Smieja, MD Ph.D.
Infectious Diseases Physician and Microbiologist
Thank-you for the opportunity to comment on the Copan flocked nasopharyngeal and nasal mid-turbinate swabs for respiratory virus diagnosis.
Our laboratory performed the initial study to demonstrate that flocked swabs sample respiratory epithelial cells better than standard rayon swabs. In a methodologically robust, blind comparison between flocked and rayon swabs, we found that the flocked swab sampled 50% more respiratory epithelial cells. The initial study was done with laboratory volunteers, and we validated our findings with a before-after study design looking at clinical samples before and after our clinical virology laboratory converted from rayon to flocked nasopharyngeal swabs for routine diagnosis of respiratory infections. This study validated improved collection of cells with the flocked swab compared with the rayon swab. These results were published in the Journal of Clinical Microbiology 2006 (Daley et al). Our clinical virology laboratory has been using only flocked nasopharyngeal swabs for routine clinical diagnosis of respiratory viruses since that study. They yield excellent quality cells for immunofluorescence and for molecular diagnosis.
We subsequently collaborated with Copan Italia to develop a nasal mid-turbinate swab for respiratory virus sampling in children and in adults. We have recently published data demonstrating excellent respiratory epithelial cell sampling with the flocked nasal mid-turbinate swab, comparable to a flocked nasopharyngeal swab. We also demonstrated feasibility of self collection, and excellent cell sampling. Finally, we validated flocked nasal swab self-collection coupled with respiratory virus multiplex PCR for the diagnosis of respiratory infections. We have published these results (Journal of Clinical Microbiology 2010, Smieja et al).
We commend Copan Italia for its excellent collaborative spirit. We believe that the flocking process coupled with imaginative swab design will dramatically improve sample collection for microbiologic diagnosis. The improved collection and release of infected cells, together with novel swab designs to enable high-quality self-sampling, have been a key component of several of our cohort studies and randomized clinical trials. The use of highly-reproducible, sensitive technologies and quality production enables highly successful respiratory virus diagnosis.
Christine C. Ginocchio,
Senior Director, Division of Microbiology,
We use Copan flocked nasopharyngeal (NP) swabs for the collection of all respiratory specimens. Our studies have determined that Copan swabs are far superior when compared to traditional NP swabs and NP aspirates/washes for the recovery of cellular material, resulting in the increased detection of all types of respiratory viruses.
Fausto Baldanti, M.D.
Molecular Virology Unit
We became familiar with the Copan flocked swabs from posters presented at the 2005 Clinical Virology Symposium in Clearwater as well as an article published in JCM March 2006. The article stated that Significantly more epithelial cells were collected by flocked swabs by nasopharyngeal or nasal swabs from volunteers and symptomatic patients providing better clinical specimens for diagnosis. We obtained flocked swabs samples from Copan and compared nasopharyngeal swabs to nasopharyngeal aspirate collection in 30 patients and found that the performance of the flocked swabs was as good as the aspirate for the number of positive and negative cells present in the DFA smears. We also found that the cell pellets of the flocked swabs specimens didn't need a washing step prior smear preparation. This resulted in faster results, turn-around-time and the morphology of the epithelial cells was well preserved, making it easy to read the DFA results under the UV microscope.
In our institution nasopharyngeal aspirates were replaced by Copan's flocked nasopharyngeal swabs for specimen collection for the diagnosis of respiratory infections. We also discovered that the flocked swabs used with molecular assays are excellent for monitoring viral load following antiviral treatment, since they collect a constant cells numbers from the appropriate anatomical site. We discovered that the flocked swabs have both qualitative and quantitative sample collection capability for improving diagnostics assay sensitivity.
Diane Leland Ph.D.
Since we switched to Copan flocked swabs, we are receiving fewer specimens with insufficient numbers of cells. Since we do a lot of direct immunofluorescent testing for viral antigens, the presence of cells is critical. It also seems that there are more intact cells that actually demonstrate the classic morphology of ciliated columnar epithelial cells. We also like it that it is easy to break off the top of the shaft of the swab when the swab is placed into transport medium. We previously used swabs with wire shafts. Because the folks who collected the samples couldn't figure out what to do with the wire shaft, we often received transport medium tubes that had the entire wire shaft crammed into the tube�causing the cap of the tube to lift up and let the transport medium leak out!
Dr Carballal Guadalupe
Clinical Virology Unit
The Copan flocked swabs are useful to obtain rapid and non invasive nasopharyngeal respiratory samples.
They proved to be adequate in all age groups and they are particularly very useful and convenient for the outpatient population. We have been using them since 2008 for the detection of classical and emerging respiratory viruses in young children and adults.
Dr. Janne O. Koskinen, Ph.D.
Director, Test Development and Production
Copan FLOQSwabs� and mariPOC�
As a director of the product development for the mariPOC� I was in charge of evaluating different sampling devices for collecting respiratory tract specimens. Early on it became clear that most customers and patients prefer swab sampling over nasopharyngeal aspiration. Based on the available literature and user experiences we found Copan's FLOQSwabs� very suitable candidates for our test system. After thorough evaluation, the FLOQSwabs� were shown to provide optimized performance for our test system. Not only because they are superior in collecting and releasing of sample material in comparison to conventional cotton or fiber swabs but also because, importantly, they do not release particulate material in the sample buffer. Many of the conventional swab products release excessive amounts of fibers upon sample suspension in buffer. In addition, FLOQSwabs� do not seem to release substances that would interfere with fluorescent measurement.
During the product development project we had interactive relationship with the representatives of Copan. They provided us with valuable comments and advice, and kindly sent us different swabs and sample buffers for testing and for methodological validation.
For these reasons, we chose to recommend that our customers use Copan FLOQSwabs� as the first choice in our novel mariPOC� respiratory infection test system. In addition, we aim to continue the fruitful co-operation also in the future development projects.
Scientific studies show that Copan Flocked Swabs significantly improve the quantity of sample collected and released into various culture and assay systems, improving the sensitivity of tests and the quality of diagnostics.