Rapid Antigen Test Sensitivity for Asymptomatic COVID-19 Screening.

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.