Air sampling for facility-based respiratory pathogen surveillance in rural Zambia: a prospective comparison with human surveillance

In rural Zambia at Macha Hospital, same-week detection of Influenza A in air matched nasopharyngeal samples with 80.4% overall agreement and Cohen’s Kappa = 0.5.

• Why it matters: Facility-based respiratory surveillance is standard but limited in low- and middle-income settings, so non-invasive environmental sampling could strengthen monitoring where capacity is constrained.
• What they did: From July 2025 to June 2026, continuous air sampling in the outpatient department and three inpatient wards was compared with year-round nasopharyngeal testing for influenza A/B, RSV, and SARS-CoV-2 using Cepheid GeneXpert.
• The result: Across 12 months (596 air, 701 human samples), Influenza A showed strong concordance, while SARS-CoV-2 had limited concordance (Cohen’s Kappa = 0.2); air sampling was feasible despite power and awareness challenges.

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