TABLE 3

Sensitivity of respiratory viral detection from different specimen typesa

Specimen typeSensitivity of detectionb of:
FLUA/BcRSVRV/EVADVhMPVPIVsCoVsc
NPS+++++++++++++++
NPA+++++++++++++++++++++
OPS++(+)d++++++++
TS++++++++++++
Sputumf+++++++++++++++(+)++(+)e
BAL fluid+++++++++++++(+)++
Lung biopsy specimen+++++++o+++
  • a For specimen collection, it is important that appropriate infection control practices are followed, as collection can be aerosol generating. FDA clearance and laboratory-based validation/verification of the specimen source for assay need to be considered. Appropriate collection methods should consider downstream testing to ensure that specimens are handled, stored, and shipped properly prior to testing. Preanalytical specimen storage information provided by the laboratory should indicate storage temperature, retention time, and stability of the specimens (123, 178, 179, 370). Combinations of different specimen types can significantly increase the yield for viral detection. Results for nasal specimens are not included in this table because the literature describing their efficacy in detection is variable (372374).

  • b +++, specimen type has high detection rates for the indicated virus; ++, specimen type is acceptable for viral detection, but sensitivity may be reduced due to the sampling or testing method used for detection; +, specimen type has reduced sensitivity for indicated virus; ++(+), minor reduction; +(+), moderate reduction; o, limited utility.

  • c For emerging avian influenza virus strains or for CoVs such as SARS-CoV or MERS-CoV, lower respiratory samples are additionally recommended for enhanced detection.

  • d NPS were more sensitive for detection of FLUB, while OPS were more sensitive for FLUA strains (153).

  • e Sputum sensitivity varies between CoV strains (180).

  • f Sensitivity of sputum results can vary widely depending on the quality of the specimen received. Sputa received for viral testing are not screened for specimen adequacy as for those received for bacterial workup (371).