Variation in SARS-CoV-2 molecular test sensitivity by specimen types in a large sample of emergency department patients.

BACKGROUND: Provider-collected nasopharyngeal specimens for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular testing are the standard of care in many clinical settings, but patient-collected saliva and anterior nares specimens are less invasive and more flexible alternatives. Prior studies comparing specimen types for SARS-CoV-2 molecular testing have been limited by small sample sizes and low pretest probability. We conducted a large observational study among symptomatic adults at 7 emergency departments of Kaiser Permanente Southern California to examine sensitivity of SARS-CoV-2 molecular tests by specimen type and patient characteristics. METHODS: Provider-collected nasopharyngeal/oropharyngeal (NP/OP) specimens and patient-collected saliva and anterior nares specimens were collected at the same visit and analyzed with the Roche cobas® SARS-CoV-2 assay. Patients were considered truly positive for SARS-CoV-2 if any of the three specimens was positive and negative if all three specimens were negative. Factors associated with discordant and missed positive results were examined with multivariable logistic regression. RESULTS: Of 2112 patients, 350 (16.6%) were positive for SARS-CoV-2. Sensitivity of NP/OP was 93.7% (95% confidence interval [CI] 90.6%-96.0%), sensitivity of saliva was 87.7% (83.8%-91.0%), and sensitivity of anterior nares was 85.4% (81.3%-89.0%). Patients ages 18-39 years versus ≥40 years were more likely to have discordant results [adjusted odds ratio (aOR) 1.97 (1.12-3.45)], as were patients with <4 symptoms versus ≥4 [aOR 2.43 (1.39-4.25)]. Cycle threshold values were higher for saliva and anterior nares than NP/OP specimens, as well as for specimens in discordant versus concordant sets and patients with fewer symptoms. CONCLUSION: This study provides robust evidence that patient-collected saliva and anterior nares are sensitive for SARS-CoV-2 molecular testing in emergency department settings, particularly among adults ages ≥40 years and those with multiple symptoms. Higher sensitivity of provider-collected NP/OP specimens must be weighed against the benefits of patient-collected specimens in tailored strategies for SARS-CoV-2 testing.

Pediatric Vaccination During the COVID-19 Pandemic.

OBJECTIVES: The impact of the coronavirus disease 2019 pandemic on vaccination coverage, critical to preventing vaccine-preventable diseases, has not been assessed during the reopening period. METHODS: Vaccine uptake and vaccination coverage for recommended vaccines and for measles-containing vaccines at milestone ages were assessed in a large cohort of children aged 0 to 18 years in Southern California during January to August 2020 and were compared with those in the same period in 2019. Differences in vaccine uptake and vaccination coverage (recommended vaccines and measles-containing vaccines) in prepandemic (January to March), stay-at-home (April to May), and reopening (June to August) periods in 2020 and 2019 were compared. RESULTS: Total and measles-containing vaccine uptake declined markedly in all children during the pandemic period in 2020 compared with 2019, but recovered in children aged 0 to 23 months. Among children aged 2 to 18 years, measles-containing vaccine uptake recovered, but total vaccine uptake remained lower. Vaccination coverage (recommended and measles-containing vaccines) declined and remained reduced among most milestone age cohorts ≤24 months during the pandemic period, whereas recommended vaccination coverage in older children decreased during the reopening period in 2020 compared with 2019. CONCLUSIONS: Pediatric vaccine uptake decreased dramatically during the pandemic, resulting in decreased vaccination coverage that persisted or worsened among several age cohorts during the reopening period. Additional strategies, including immunization tracking, reminders, and recall for needed vaccinations, particularly during virtual visits, will be required to increase vaccine uptake and vaccination coverage and reduce the risk of outbreaks of vaccine-preventable diseases.

The training value of a low-fidelity cervical biopsy workshop.

INTRODUCTION: Cervical biopsy increases diagnostic yield compared with cytology and reduces time between presentation with and diagnosis of cervical cancer. Procedural training however needs to evolve in line with legislated working time restrictions and patient safety concerns. This makes gynecologic procedures ideal for simulation training. To date, no studies have looked at the use of low-fidelity simulation models to teach cervical punch biopsy. METHODS: A cervical punch biopsy model was created using home and departmental waste products. The simulation model was tested by expert colposcopists and used during a gynecology trainee cervical study day. Twenty-one trainees attended a lecture that showed photographs of normal and abnormal cervices and a workshop where colposcopists demonstrated the technique before direct hands-on training with the simulator. Participants were asked to complete a survey, using a 5-point Likert scale, outlining the educational value of the workshop. RESULTS: Five low-fidelity cervical biopsy simulation models were created, these cost nothing, took an hour to make, and were easily transported. Of the different "cervix" materials tested, sponge provided the most realistic traction and the least fragmented biopsies (3-5 mm). Eighteen trainees completed the survey of whom all strongly agreed that learning was enhanced compared with didactics alone. The mean score for the value of the simulation in preparing trainees to perform future cervical biopsies was 4.7 (SD = 0.42) (95% confidence interval, 4.49-4.90). CONCLUSIONS: Our low-fidelity cervical biopsy models are easy to make, portable, and low cost. Trainees have reported the significant educational value of this simulation model in teaching an outpatient gynecologic/colposcopy procedure in a nonclinical environment.