Characteristics of children and antigen test performance at a SARS-CoV-2 community testing site

Ford, L.; Whaley, M. J.; Shah, M. M.; Salvatore, P. P.; Segaloff, H. E.; Delaney, A.; Currie, D. W.; Boyle-Estheimer, L.; O'Hegarty, M.; Morgan, C. N.; Meece, J.; Ivacic, L.; Thornburg, N. J.; Tamin, A.; Harcourt, J. L.; Folster, J. M.; Medrzycki, M.; Jain, S.; Wong, P.; Goffard, K.; Gieryn, D.; Kahrs, J.; Langolf, K.; Zochert, T.; Tate, J. E.; Hsu, C. H.; Kirking, H. L.

Background: Performance characteristics of SARS-CoV-2 antigen tests among children are limited despite the need for point-of-care testing in school and childcare settings. We describe children seeking SARS-CoV-2 testing at a community site and compare antigen test performance to real-time reverse transcription-polymerase chain reaction (RT-PCR) and viral culture. Methods: Two anterior nasal specimens were self-collected for BinaxNOW antigen and RT-PCR testing, along with demographics, symptoms, and exposure information from individuals [≥]5 years at a community testing site. Viral culture was attempted on residual antigen or RT-PCR positive specimens. Demographic and clinical characteristics, and the performance of SARS-CoV-2 antigen tests, were compared among children (<18 years) and adults. Results: About one in ten included specimens were from children (225/2110); 16.4% (37/225) were RT-PCR positive. Cycle threshold values were similar among RT-PCR positive specimens from children and adults (22.5 vs 21.3, p=0.46) and among specimens from symptomatic and asymptomatic children (22.5 vs 23.2, p=0.39). Sensitivity of antigen test compared to RT-PCR was 73.0% (27/37) among specimens from children and 80.8% (240/297) among specimens from adults; among specimens from children, specificity was 100% (188/188), positive and negative predictive value were 100% (27/27) and 94.9% (188/198) respectively. Virus was isolated from 51.4% (19/37) of RT-PCR positive pediatric specimens; all 19 had positive antigen test results. Conclusions : With lower sensitivity relative to RT-PCR, antigen tests may not diagnose all positive COVID-19 cases; however, antigen testing identified children with live SARS-CoV-2 virus.