In a recent study, conducted in southern Africa, COPAN’s innovative flocked swabs (FLOQSwabs^®) have been found to improve the diagnosis for the leading cause of death in young children: Diarrheal Disease. Published originally in the Journal of the Pediatric Infectious Disease Society , stated that by using COPAN’s intuitive and anatomically designed rectal FLOQSwabs^®, a group of scientists from British Columbia Children’s Hospital (Vancouver, BC, Canada), were able to diagnose previously unrecognized pathogens that had caused severe diarrhea to over one-third of the children in a group of hospitals located in southern Africa. Children with severe acute gastroenteritis were enrolled in the study.

Most pediatric gastroenteritis is caused by viral pathogens. Current protocol advises against using routine antibacterial therapy if the children do not have bloody stools. In an effort to prevent the deaths of children and to offer assistance to more impoverished countries, where resources are typically scarce, a simple solution was not only prudent, but necessary. COPAN worked closely with the group of scientists from the Canadian team to develop a flocked swab anatomically designed for rectal use to aid in the diagnosis of diarrheal disease in children. The group used the original technology of COPAN’s flocked swabs, FLOQSwabs^®, which comprise of a solid molded plastic applicator shaft with a tip that can vary in size and shape.  The tip of the applicator is coated with short Nylon fibers that are arranged in perpendicular fashion.  The process in which they are manufactured creates a highly absorbent thin layer with an open structure. This design means the sample is able to stay close to the surface, allowing for easy elution.  For the COPAN rectal FLOQSwab^®, they modified the design of the swab to sample just beyond the anal canal at the columnar epithelium, where most of the bacterial and some of the protozoal pathogens reside, believing it to be the ideal location for sampling. To do this, the engineers lengthened the flocked surface and included a “stopper” at the 3.2 cm mark, which extends just far enough into the surgical anus of most children under the age of 3.

So Why Does the Type of Swab Matter?
Traditional swabs are wound with fiber and act like a mattress, absorbing the specimen, but failing to release entirely. For diagnostics, the release of the specimen is just as important as the collection. Because bacteria count and preservation of the sample are key when it comes to the analysis and proper diagnosis of the specimen, the use of traditional swabs can potentially leave some pathogens undetected. Additionally, the traditional transport containers used in the collection system can be bio-hazardous, containing more sample than necessary and run the risk of accidental exposure. The bulk stool samples they hold contain contents that were derived largely from the small intestine, which may dilute cellular material of interest contained in the colonic mucosal surface.

The study also suggested that the bulk stool samples may contain more inhibitory material, compared to those of the flocked swab. By testing the results of the traditional wound fiber swab against the rectal FLOQSwab^®, the group was able to quantify their results and found that the rectal FLOQSwab^® consistently demonstrated a higher yield for most treatable enteropathogens across several molecular assays. They also found that the samples could be stored at 42 °C for weeks without any transport media! Public response to the rectal swab was also positive, as it had over a 99% acceptability rate for both the patients and their guardians.

The Gastrointestinal Pathogen Panel (GPP) assay on the MAGPIX system (Luminex Molecular Diagnostics; Toronto, Canada) and COPAN’s flocked swab offered more rapid results, as traditional feces containers require transportation and waste time. Instead the system offered instant evaluations with same-day diagnosis, resulting in more immediate and proper treatment. All these findings are especially encouraging for developing countries, as they address a number of instances that can inhibit proper care. Now impoverished countries can take advantage of innovative resources, anatomically designed for safety and optimal pathogen sampling, for a low cost. The swabs are easy to use and found to be widely accepted by both the patients and user. The rectal FLOQSwabs^® were found to reduce the risk of biohazard and improve the detection rate!

Furthermore, the study, also featured on LabMedica.com, showed that children that had been chosen at random for the rapid testing were 55% less likely than the other children to experience the diarrhea return, along with a significant height gain after only 60 days. This means the children were healthy to reach their developmental potential.

As Peter Alexander Singer, OC, MD, MPH, FRSC, a professor and CEO of Grand Challenges Canada (Toronto, ON, Canada) said, “[t]he simple fact is: Diagnostics save lives. If health workers can quickly and accurately pinpoint the cause of a child’s illness, timely help can be administered, preventing many deaths and improving many lives. The flocked swab offers a shining example of the sort of ‘Bold Idea with Big Impact’ in global health.”