Acceptability and Feasibility of Saliva-delivered PCR Coronavirus 2019 Tests for Young Children

Abstract

OBJECTIVES Access to readily available, reliable, and easy-to-use coronavirus disease 2019 (COVID-19) tests remains critical, despite great vaccination progress. Universal back-to-school testing offered at early care and education ([ECE]; ie, preschool) sites to screen for positive cases may help preschoolers safely return to, and stay in, ECE. We examined the acceptability and feasibility of using a quantitative polymerase chain reaction COVID-19 saliva test for young children (n = 227, 54.0% girls: mean age = 52.3 ± 8.1 months) and their caregivers (n = 70 teachers: mean = 36.6 ± 14.7 years; n = 227 parents: mean = 35.5 ± 9.1 years) to mitigate the spread of COVID-19 and reduce days of school and work missed for households with children who test positive. METHODS Participants were recruited at ECE sites serving low-income communities as part of the Rapid Acceleration of Diagnostic Testing–Underserved Populations Back to Early Care and Education Safely with Sustainability via Active Garden Education project (NCT05178290). RESULTS Surveys in English or Spanish administered at testing events to children and caregivers at ECE sites showed child and adult acceptability and feasibility ratings were generally high. More favorable child and parent ratings were positively associated with child age and whether the child was able to produce a saliva sample. Language preference was not associated with any outcomes. CONCLUSIONS Saliva sampling for COVID-19 at ECE sites is an acceptable strategy as an additional layer of protection for 4- and 5-year-olds; however, alternate testing strategies may be needed for younger children.

Diagnostic testing preferences can help inform future public health response efforts: Global insights from an international survey

“…highlights that many saliva testing programs across the globe were successful [ 12 ], following its extensive validation as a reliable sample type for the detection of SARS-CoV-2 [ 15 ]. Studies have shown that when robust collection and processing methods are applied, saliva has a high concordance with nasopharyngeal swabs [ 12 , 15 ], saliva-based tests are lower costs than swab-based approaches [ 16 , 17 ], and that saliva is both feasible and acceptable for routine testing at early care and education sites across the US [ 18 , 19 ]. Additionally, studies from the University of Illinois [ 20 ], University of Maryland [ 21 ], and CalTech [ 22 ] all found that viral loads in saliva samples often peaked days earlier than those in nasal swabs and had a higher sensitivity during early symptom onset, indicating that saliva serves as a more reliable sample type for the early detection of SARS-CoV-2.…”

Influence parental- and child-related factors on the acceptance of SARS-CoV-2 test methods in schools and daycare facilities

“…Our study is primarily related to those studies that either included the perspective of parents or of parents/school staff and children ( 38 , 57–60 ). In terms of the evaluation of saliva-based COVID-19 tests, other studies indicated a high level of acceptance and feasibility among parents and their children ( 59 ). Only one study specifically aimed to provide a comparison of different COVID-19 test methods (nasal swab testing vs. salvia-based testing) and included the perspective of children and adolescents ( 38 ).…”