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Letter to the Editor
Low sensitivity of rapid antigenic tests as a screening method in an outbreak of SARS-CoV-2 infection in prison
Baja sensibilidad de los test rápidos antigénicos como método de cribado en un brote de infección por SARS-CoV-2 en prisión
Andrés Marcoa,b,
Corresponding author
amarco@gencat.cat

Corresponding author.
, Concepció Soléc, Indiana J. Abdoc, Elisabet Turua
a Programa de Salud Penitenciaria, Instituto Catalán de la Salud, Barcelona, Spain
b CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
c Equipo de Atención Primaria Penitenciaria, Figueres, Girona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At present&#44; the gold standard for the diagnosis of SARS-CoV-2 infection is detection of viral RNA by means of real-time polymerase chain reaction &#40;rt-PCR&#41; testing or an equivalent molecular technique&#46; In Spain&#44; rapid antigen testing &#40;RAT&#41; that is duly validated &#40;sensitivity &#8805;80&#37; and specificity &#8805;97&#37;&#41; can be used within five days of the onset of symptoms in patients with no major immunosuppression and no criteria for intensive care unit &#40;ICU&#41; admission<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; RAT is less sensitive than rt-PCR testing in all stages of the infection&#44; and even less so in asymptomatic cases&#44; but its use in the absence of symptoms has not been ruled out in all cases<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; A recent report from the European Centre for Disease Prevention and Control &#40;ECDC&#41; recommends the use of RAT in patients with or without symptoms if a rate of positive tests &#8805;10&#37; is anticipated<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; It also advises its use in high-risk settings to quickly identify infected individuals and implement prevention and control measures to curb transmission&#44; though it does recommend that negative cases be confirmed with rt-PCR testing<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the results of the use of RAT in a SARS-CoV-2 outbreak that occurred on a residential unit &#40;RU&#41; of Figueras prison in Girona&#44; Spain&#44; in late 2020&#46; Between 23 and 25 December&#44; SARS-CoV-2 infection was diagnosed by RAT &#40;Panbio&#8482; COVID-19 Ag tests&#44; Abbott&#41; in three inmates with mild respiratory symptoms&#46; The RU was isolated&#44; and on the afternoon of 25 December the rest of the population was screened with RAT &#40;n&#8239;&#61;&#8239;81&#41;&#46; Nine inmates &#40;11&#46;1&#37;&#41; tested positive&#46; They were separated from the others&#44; isolation measures were kept in place and the RU was considered a low-complexity COVID unit given the number of asymptomatic and mildly symptomatic cases with no criteria for hospital admission&#46; The unit was equipped with organisational and functional resources to ensure care safety&#44; quality and efficiency&#46; Cleaning&#44; laundry&#44; waste management and distribution of food and medication was organised according to the recommendations of the Catalan Health Department<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; The following were indicated&#58; a&#41; strict isolation of the unit with essential healthcare and non-healthcare personnel entering and exiting&#59; b&#41; mandatory use of personal protective equipment &#40;PPE&#41;&#59; and c&#41; clinical examinations &#40;oxygen saturation&#44; temperature and questions about the possible onset of symptoms&#41; twice daily&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On 28 December&#44; rt-PCR testing was performed in the 72 cases with previously negative RAT&#44; yielding positive results in 27 &#40;37&#46;5&#37;&#41; of them &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; All followed a good clinical course and there were no hospital admissions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The prevalence of infection &#40;46&#46;4&#37;&#41; was high as the outbreak occurred in an enclosed space&#46; In situations of confinement&#44; it is estimated that the contagion rate &#40;R0&#58; mean number of people infected by an infected person&#41; may be five to 14 times higher than usual &#40;normally&#44; 1&#46;5&#8211;3&#46;0&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#59; this explains the high number of infections detected in the outbreak&#46; The measures adopted were satisfactory and rt-PCR testing results were negative in all contacts at seven and 14 days&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding the use of RAT in asymptomatic close contacts&#44; some studies &#40;an original<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; a letter to the editor<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and several preprints<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a>&#41; have shown it to have a specificity equal or close to 100&#37;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a>&#44; but a much lower sensitivity&#44; between 33&#37; and 66&#37;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;10</span></a>&#46; None of these studies was conducted in contacts from an outbreak or in confined groups&#46; In the cases on the RU&#44; the sensitivity was 25&#37; and the negative predictive value&#44; a key indicator in scenarios in which the prevalence can be considered moderate or high&#44; was 63&#37;&#46; Although RAT is appealing as it is a quick and easy technique that does not require qualified operators&#44; the risk of false negatives is high&#44; even in an outbreak in a confined space with a high prevalence of positive results such as the one reported&#46; Consequently&#44; rt-PCR testing should be the test of choice in screening asymptomatic patients&#46; Only if rt-PCR test results cannot be obtained quickly and there is a high risk of transmission could initial screening with RAT be advisable&#46; In those cases&#44; negative results should be confirmed with subsequent rt-PCR testing&#44; as can be deduced from this study and as is suggested by the guidelines and protocols from the Spanish Ministry of Health<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; the ECDC<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and the United States Centers for Disease Control and Prevention &#40;CDC&#41;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they received no funding to conduct this study&#46;</p></span></span>"
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Article information
ISSN: 2529993X
Original language: English
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es en pt

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