Best Practices for Sample Collection for Respiratory Specimens, Including Novel Coronavirus (COVID-19)

February 10, 2020

colds and viral diseases. family with runny nose and fever in bed at home

With the current rise in flu cases and possible spread of emerging respiratory viruses, like the novel coronavirus (COVID-19), laboratories and healthcare providers can expect another very busy flu season. The  2019-2020 flu season is on track to be one of the worst in years and is estimated to be similar in severity to the 2017-2018 flu season. By the end of that 2017–2018 season, the Centers for Disease Control (CDC) reported that the total burden of illness showed an estimated 48.8 million people became ill with influenza, 22.7 million people visited a health care provider, there were 959,000 hospitalizations, and 79,400 fatalities [1].

New data from the CDC estimates at least 6.4 million people have already acquired the flu so far this season. Over 55,000 people have been hospitalized, and 2,900 people have died. With a severe flu season upon us and the possible emergence of other respiratory viruses, like the novel coronavirus (2019-nCoV), it is essential to revisit the topic of respiratory virus detection and consider the best methods for sample collection and transport for testing.

Accurate respiratory virus detection is dependent on the quality of the sampling method, storage, and transportation to the testing site. A successful diagnostic test begins at sample collection because improper sampling can result in an inadequate specimen, rendering a diagnostic test inconclusive or incorrect.  There are several upper respiratory tract sampling methods currently being utilized prior to testing, including nasopharyngeal aspirates/washes, nasal washes, and a combination of synthetic swabs.  

The article “Current Best Practices for Respiratory Virus Testing” published in the Journal of Clinical Microbiology, by Christine Ginocchio and Alexander MacAdam, considers issues in diagnostic testing for respiratory viruses, including best methods for detection, sample handling and testing for antiviral resistance. It is as relevant today as it was in 2011 when it was first published. One of the methods tested was COPAN’s FLOQSwabs® flocked swabs  combined with COPAN’s  UTM®: Universal Transport Medium (UTM®) as a solution for a superior collection of upper respiratory specimens. 

UTM® is an FDA cleared universal transport system suitable for collection, transport, maintenance, and long-term freeze storage of clinical specimens containing viruses, chlamydia and mycoplasma or ureaplasma organisms. The UTM® collection and transport kits consists of two components: one or two FLOQSwabs® or traditional fiber swabs and 1mL or 3 mL of UTM® medium in a self-standing tube capable of maintaining organism viability for 48 hours at room or refrigerated temperature. COPAN’s  FLOQSwabs® consist of a molded plastic applicator stick with variable sized tips, anatomically designed, and coated with Nylon® fibers to create a thin absorbent layer that allows for quick specimen uptake and complete specimen elution into COPAN’s UTM®. COPAN soft flocked swabs are easy to use and their anatomic design is less invasive for the patient, when compared to nasopharyngeal washes/aspirates or nasal washes.

The authors of the Best Practices article concluded that COPAN’s nasopharyngeal flocked swabs have been found to yield specimens comparable to the gold standard nasopharyngeal wash for detection of respiratory viruses by NAAT or DNA [2]. Additional clinical studies have also shown that UTM® paired with COPAN FLOQSwabs® significantly outperform the use of traditional nasal aspirates and are comparable to nasopharyngeal aspirates in a variety of PCR-based viral assays and that the COPAN specimens were easier to store, transport and rapidly test [3, 4, 5, 6, 7, 8, 9, 10, 11]. 

As testing methods evolve, it is important for clinicians to keep current with the techniques like those outlined in the best practice article. Specimen collection should be performed by health care personnel who have completed training and demonstrated competency.  Always read the manufacturer’s package insert for specific instruction regarding specimen collection and transport for the type of test kit being used. COPAN has collaborated with many healthcare professionals to develop free educational videos on sample collection that can provide some of the support you need for specimen collection.   Particularly interesting at this point in time, click here to see video demonstrations of proper sample collection techniques for different respiratory samples. Click here for an in-depth look at nasopharyngeal synthetic flocked swab sample collection practice. A library of scientific studies is also available at COPAN’s website.

The performance of a diagnostic test starts with sound sampling techniques and the quality of the specimen collection and transport device. Having an appropriate and less invasive collection and transport devices like UTM®, enables healthcare professionals to better care for sick patients, while ensuring the integrity of the sample provided to the laboratory.  As we continue through our current influenza season, COPAN’s UTM®/ FLOQSwabs® will provide for specimen collections with high sensitivity in diagnostic testing for influenza and other respiratory infections, whether using culture, antigen, or molecular assays.  

References:

  1. Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season. https://www.cdc.gov/flu/about/burden/2017-2018.htm.  February 10, 2020.
  2. Ginocchio CC, et al. Current best practices for respiratory virus testing. J Clin Microbiol 2011;49:S44–S
  3. Walsh P, Overmyer CL, Pham K, Michaelson S, Gofman L, DeSalvia L, Tran T, Gonzalez D, Pusavat J, Feola M, Iacono KT, Mordechai E, Adelson ME.  2008. J Clin Microbiol. 46(7):2374-6.
  4. Esposito S, Molteni CG, Daleno C, Valzano A, Cesati L, Gualtieri L, Tagliabue C, Bosis S and Principi N.  2010. Comparison of nasopharyngeal nylon flocked swabs with universal transport medium and rayon bud swabs with a sponge reservoir of viral transport medium in the diagnosis of paediatric influenza.  Journal of Medical Microbiology 59, 96–99
  5. Hansen KB1, Westin J2, Andersson LM2, Lindh M2, Widell A3, Nilsson AC1. Flocked nasal swab versus nasopharyngeal aspirate in adult emergency room patients: similar multiplex PCR respiratory pathogen results and patient discomfort.   2016. Infect Dis (Lond).48(3):246-50.
  6. Silva A, LaCount R, Ballard L, Milham B.  Performance and Cost-Effectiveness of VERIGENE RP Flex.  2016. ASM Microbe meeting. https://www.luminexcorp.com/?wpdmdl=20028
  7. J. Jeremiah Bella,b and Rangaraj Selvarangan. 2014.  Evaluation of the Alere i Influenza A&B Nucleic Acid Amplification Test by Use of Respiratory Specimens Collected in Viral Transport Medium.  J Clin Microbiol 52(11): 3992–3995.
  8. ThomasValentin, PetraKieslinger, EvelynStelzl, Brigitte I.Santner, AndreaGroselj-Strele, Harald H.Kessler, BeateTiran.  2019. Prospective evaluation of three rapid molecular tests for seasonal influenza in patients presenting at an emergency unit.  Journal of Clinical Virology. Vol.111; 29-32.
  9. XiaohuiZouabKangChangabYemingWangabMengxueLiaWangZhangaChunleiWangaBinghuaiLuaZhujiaXiongaJiajingHanaYulinZhangaJiankangZhaoaBinCaoabcfor CAP-China Network.  2018. Comparison of the Cepheid Xpert Xpress Flu/RSV assay and commercial real-time PCR for the detection of influenza A and influenza B in a prospective cohort from China.  International Journal of Infectious Diseases, Vol. 80;92-97
  10. Daniel M. Cohen, Jennifer Kline, Larissa S. May, Glenn Eric Harnett, Jane Gibson, Stephen Y. Liang, Zubaid Rafique, Carina A. Rodriguez, Kevin M. McGann, Sr., Charlotte A. Gaydos, Donna Mayne, David Phillips, Jason Cohen.  2018. Accurate PCR Detection of Influenza A/B and Respiratory Syncytial Viruses by Use of Cepheid Xpert Flu+RSV Xpress Assay in Point-of-Care Settings: Comparison to Prodesse ProFlu+. J Clin Microbiol. 56(2) e01237-17.  
  11. Bharti Malhotra,  M. Anjaneya Swamy, P. V. Janardhan Reddy, Neeraj Kumar, and Jitendra Kumar Tiwari.  2016. Evaluation of custom multiplex real – time RT – PCR in comparison to fast – track diagnostics respiratory 21 pathogens kit for detection of multiple respiratory viruses. Virol J. 2016; 13: 91.