Pan Daniel, Williams Caroline, Decker Jonathan, Fletcher Eve, Grolmusova Natalia, Bird Paul W, Martin Christopher A, Nazareth Joshua, Rahman Latif, O'Kelly Kate, Panchal Rakesh, Musa Irfana, Dhutia Harshil, Sze Shirley, Pareek Manish, Barer Michael R
Development Centre for Population Health, University of Leicester, UK.
Department of Respiratory Sciences, University of Leicester, UK.
Future Healthc J. 2024 Sep 5;11(4):100175. doi: 10.1016/j.fhj.2024.100175. eCollection 2024 Dec.
SARS-CoV-2 may transmit across vaccinated cohorts during practical clinical examinations. We sought to assess the feasibility of facemask sampling (FMS) to identify individuals emitting SARS-CoV-2 during a mock PACES exam.
In May 2022 we recruited participants from a mock PACES examination in Leicester, UK. Following a negative lateral flow test assay, all participants wore modified facemasks able to capture exhaled virus during the assessment (FMS). A concomitant upper respiratory tract sample (URTS) was provided prior to FMS. Exposed facemasks were processed by removal and dissolution of sampling matrices fixed within the mask and cycle thresholds values quantified by RT-qPCR. Participants were asked to grade statements regarding the comfort, effort, ethics and communication when providing FMS; laboratory technicians were asked to grade key statements surrounding suitability of samples for processing.
34 participants provided concomitant URTS and FMS during the examination. One participant was positive for SARS-CoV-2, with a cycle threshold value of 22.5 on URTS, but negative (no viral RNA detected) on FMS; no transmission to others was identified from this individual. Participants responded positively to statements regarding FMS describing all four domains; however, 69% of participants felt that a positive result from FMS alone was insufficient for diagnosis and that further tests were required. All but one FMS sample was suitable for processing.
FMS during PACES exams are acceptable among participants and samples provided are suitable for processing. Our results demonstrate feasibility of FMS within practical examination settings and support the further assessment of FMS as a scalable tool that can be compared with URTS to identify those who are infectious.
在实际临床检查期间，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可能在接种疫苗的人群中传播。我们试图评估面罩采样（FMS）在模拟内科医师临床技能考试（PACES）中识别SARS-CoV-2感染者的可行性。
2022年5月，我们从英国莱斯特的一次模拟PACES考试中招募了参与者。在侧向流动检测呈阴性后，所有参与者在评估期间佩戴能够捕获呼出病毒的改良面罩（FMS）。在FMS之前提供一份上呼吸道样本（URTS）。通过移除和溶解固定在面罩内的采样基质来处理暴露的面罩，并通过逆转录定量聚合酶链反应（RT-qPCR）对循环阈值进行量化。要求参与者对提供FMS时关于舒适度、努力程度、伦理和沟通方面的陈述进行评分；要求实验室技术人员对围绕样本处理适用性的关键陈述进行评分。
34名参与者在检查期间提供了URTS和FMS。一名参与者的SARS-CoV-2检测呈阳性，URTS的循环阈值为22.5，但FMS检测呈阴性（未检测到病毒RNA）；未发现该个体将病毒传播给其他人。参与者对关于FMS描述所有四个领域的陈述给予了积极回应；然而，69%的参与者认为仅FMS的阳性结果不足以诊断，还需要进一步检测。除一个样本外，所有FMS样本都适合处理。
PACES考试期间的FMS在参与者中是可以接受的，并且提供的样本适合处理。我们的结果证明了FMS在实际检查环境中的可行性，并支持将FMS作为一种可扩展工具进行进一步评估，该工具可与URTS进行比较以识别具有传染性的人。
