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Rapid Antigen Test Sensitivity for Asymptomatic COVID-19 Screening.

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Diagnostic Test Evaluation

Background:

  • Institutions of higher education (IHEs) faced challenges operating during the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) pandemic.
  • Identifying asymptomatic SARS-CoV-2 cases in students is critical to prevent widespread transmission.
  • Rapid antigen tests (RATs) have shown limitations in detecting infections in asymptomatic populations.

Purpose of the Study:

  • To evaluate the performance of RATs in identifying asymptomatic SARS-CoV-2 infections among students at IHEs.
  • To review published data on the sensitivity and specificity of RATs used with asymptomatic individuals in the United States.
  • To determine the appropriateness of using RATs for screening asymptomatic populations in IHE settings.

Main Methods:

  • A rapid review of published evaluations of RATs was conducted.
  • Studies reporting sensitivity and specificity specifically for asymptomatic populations in the United States were included.
  • Data were extracted and presented narratively, as a meta-analysis was not feasible due to heterogeneity.

Main Results:

  • Eleven articles representing four manufacturers were analyzed.
  • Sensitivity of RATs in asymptomatic individuals ranged from 35.8% to approximately 71%.
  • Specificity was high, ranging from 97.8% to 100%, but RATs identified only about half of infected individuals compared to RT-PCR.

Conclusions:

  • RATs demonstrate significant limitations in accurately identifying asymptomatic SARS-CoV-2 infections.
  • The low sensitivity of RATs poses a risk of misclassifying infected individuals as negative.
  • This finding has critical implications for infection control strategies in IHEs and other settings with asymptomatic populations.