Self-swab enhanced respiratory pathogen surveillance - A scoping review

Background Self-swab enhanced surveillance of respiratory pathogens is an emerging public health tool that could expand the reach of existing surveillance, providing real-time monitoring of circulating pathogens in the community. Methods We conducted a literature search using terms covering self-swabbing, respiratory infection, and surveillance. For inclusion, publications had to describe a study on the use of serial unsupervised self-swabbing for the purpose of tracking the frequency of respiratory infections in the general population. Results We found 42 publications originating from 27 unique studies on self-swab enhanced surveillance for respiratory infection. Twenty-six studies (96%) were conducted in a high-income setting. Eleven studies (41%) included children under the age of 12 years. Most studies involved a central laboratory conducting polymerase chain reaction testing on returned self-swabs which permitted testing for a wide range of pathogens. Among studies reporting the number of invitees, <20% of invited individuals typically agreed to join. In studies requiring regular symptom reporting, adherence was commonly >75%. Adherence rates for self-swab return were more variable (between 42-96%). Eight studies (30%) explored rapid antigen testing which appears to reduce the time taken between symptom onset and test result notification but limits the number of pathogens that can be evaluated compared with polymerase chain reaction testing. Based on our findings we present a list of suggestions to guide future implementation and investigation. Conclusions Further work is needed to characterise self-swab enhanced surveillance approaches that optimise community participation and protocol adherence, generate as close to real-time data as possible, and minimise costs.