SARS-CoV-2 antigen rapid tests and universal screening for COVID-19 Omicron variant among hospitalized children

Background: Clinical utility of universal antigen rapid test (ART) in the pediatric setting is unknown. We aimed to assess the performance and utility of universal ART in hospitalized children (>= 5-year-old) to pre-vent nosocomial COVID-19 transmission.Methods: Cross-sectional study involving all hospitalized pediatric patients aged >= 5-year-old from 2 periods during Omicron wave. Clinical data, ART and polymerase chain reaction test results were collected.Results: A total of 444 patients were included from the 2 study periods, and 416 patients (93.7%) had concor-dant results between ART and polymerase chain reaction. The overall sensitivity and specificity of ART were 83.3% (95% CI: 75.2-89.3) and 97.5% (95% CI: 95.0-98.8), respectively. Negative predictive values of ART between the Omicron emergence and Omicron peak periods for a probable case group were 71.4% and 66.7%, respectively, and for a suspect case group 91.4% and 75.0%, respectively. Negative predictive values for an unlikely case group was >95% in both periods. Positive predictive value of ART was >85% for probable and suspect case groups in both periods. Seventy-five percent of patients (n = 15) who were incorrectly classified as SARS-CoV-2 negative by ART had potentially viable virus. No large nosocomial transmission clusters were detected.Conclusions: Universal ART screening may limit nosocomial outbreaks in hospitalized children. The perfor-mance can be optimized by considering clinical symptoms, exposure and periods within COVID waves.(c) 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.