Evaluation of self-collection of nasal swab specimens for COVID-19 diagnostic testing in children in the United States, 2020-2023

The COVID-19 pandemic highlighted a critical need for scalable and efficient diagnostic testing strategies to contain the spread of SARS-CoV-2, particularly among children. We evaluated the reliability of self-specimen collection in children aged 5-17 years by analyzing two large data sets. First, we examined 78,844 rapid antigen tests conducted at federal sites from 26 May 2023 to 31 January 2024, comparing rates of positive test results among unaccompanied children with a median age of 16. A generalized linear mixed model accounting for site-level variation found no significant difference associated with self-collection versus healthcare worker (HCW) collection (odds ratio = 1.84, P = 0.212). Symptom status was the strongest predictor of a positive test result, with symptomatic children having over 40 times the odds of a positive result; among symptomatic children, specimen self-collection was associated with higher odds of a positive result. Second, we assessed RNase P internal sample control signal across 981,631 self-collected real-time reverse transcriptase polymerase chain reaction tests at community testing sites. RNase P detection failure rates were low across all age groups, and there were no significant differences among children aged 5-17, adults aged 18-64, and older adults. Together, these findings demonstrate that self-specimen collection by children yields diagnostically adequate and reliable results, comparable to HCW collection and adult self-collection during a pandemic response. Importance: This study provides robust evidence supporting the implementation of self-collection of specimens in children, which could significantly enhance testing accessibility and efficiency in public health responses.