Antigen Test Performance Among Children and Adults at a SARS-CoV-2 Community Testing Site.

Ford, Laura; Whaley, Melissa J; Shah, Melisa M; Salvatore, Phillip P; Segaloff, Hannah E; Delaney, Augustina; Currie, Dustin W; Boyle-Estheimer, Lauren; O'Hegarty, Michelle; Morgan, Clint N; Meece, Jennifer; Ivacic, Lynn; Thornburg, Natalie J; Tamin, Azaibi; Harcourt, Jennifer L; Folster, Jennifer M; Medrzycki, Magdalena; Jain, Shilpi; Wong, Phili; Goffard, Kimberly; Gieryn, Douglas; Kahrs, Juliana; Langolf, Kimberly; Zochert, Tara; Tate, Jacqueline E; Hsu, Christopher H; Kirking, Hannah 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 1 in 10 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 = .46) and among specimens from symptomatic and asymptomatic children (22.5 vs 23.2, P = .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 values 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.