Consistent Detection of 2019 Novel Coronavirus in Saliva

To, Kelvin Kai-Wang; Tsang, Owen Tak Yin; Yip, Cyril Chik-Yan; Chan, Kwok Hung; Wu, Tak Chiu; Chan, Jacky Man Chun; Leung, Wai Shing; Chik, Thomas Shiu Hong; Choi, Chris Yau Chung; Kandamby, Darshana Hewa; Lung, David Christopher; Tam, Anthony Raymond; Poon, Rosana W.S.; Fung, Agnes Yim Fong; Hung, Ivan Fan Ngai; Cheng, Vincent Chi-Chung; Chan, Jasper Fuk Woo; Yuen, Kwok Yung

doi:10.1093/cid/ciaa149

Cited by 1,691 publications

(1,868 citation statements)

References 11 publications

Supporting

Mentioning

1,683

Contrasting

Unclassified

Order By: Relevance

“…If patients were intubated, we obtained endotracheal aspirate instead of posterior oropharynx saliva. 6,[9][10][11] Our initial experience showed that such saliva samples are promising in viral load monitoring in patients with COVID-19. 6 We also retrieved serum remnant from blood samples taken for routine bio chemical testing, and refrigerated these samples at -20°C until antibody testing could be done.…”

Section: Methodsmentioning

confidence: 99%

“…Since archived specimens were used, written informed consent was waived. 12 of 23 patients included in this study have been reported previously, 6 but their clinical information, viral load by single copy RNA-dependent RNA polymerasehelicase gene, antibody response, or viral genome analysis has not been reported before.…”

Section: Patientsmentioning

confidence: 99%

“…5 No systematic study of these two important variables with statistical analysis has been done for SARS-CoV-2, although preliminary descriptive studies have been reported. [6][7][8] In most studies of respiratory virus infections, serial sampling of nasopharyngeal or throat swabs is used for viral load monitoring. However, collection of nasopharyngeal or throat swab specimens can induce coughing and sneezing, which generates aerosol and is a potential health hazard for health-care workers.…”

Section: Introductionmentioning

confidence: 99%

“…9 We have reported use of posterior oro pharyngeal (deep throat) saliva for diagnosis and viral load monitoring in a cohort of 12 patients with COVID-19. 6 Here, we report use of self-collected posterior oro pharyn geal saliva samples from patients with COVID-19, which avoids close contact between healthcare workers and patients, for viral load monitoring. We also monitored serial serum antibody levels of patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study

Tsang²,

Leung³

et al. 2020

The Lancet Infectious Diseases

Self Cite

3,070

197

3,366

View full text Add to dashboard Cite

Background Coronavirus disease 2019 (COVID-19) causes severe community and nosocomial outbreaks. Comprehensive data for serial respiratory viral load and serum antibody responses from patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not yet available. Nasopharyngeal and throat swabs are usually obtained for serial viral load monitoring of respiratory infections but gathering these specimens can cause discomfort for patients and put health-care workers at risk. We aimed to ascertain the serial respiratory viral load of SARS-CoV-2 in posterior oropharyngeal (deep throat) saliva samples from patients with COVID-19, and serum antibody responses.Methods We did a cohort study at two hospitals in Hong Kong. We included patients with laboratory-confirmed COVID-19. We obtained samples of blood, urine, posterior oropharyngeal saliva, and rectal swabs. Serial viral load was ascertained by reverse transcriptase quantitative PCR (RT-qPCR). Antibody levels against the SARS-CoV-2 internal nucleoprotein (NP) and surface spike protein receptor binding domain (RBD) were measured using EIA. Whole-genome sequencing was done to identify possible mutations arising during infection.Findings Between Jan 22, 2020, and Feb 12, 2020, 30 patients were screened for inclusion, of whom 23 were included (median age 62 years [range 37-75]). The median viral load in posterior oropharyngeal saliva or other respiratory specimens at presentation was 5·2 log 10 copies per mL (IQR 4·1-7·0). Salivary viral load was highest during the first week after symptom onset and subsequently declined with time (slope -0·15, 95% CI -0·19 to -0·11; R²=0·71). In one patient, viral RNA was detected 25 days after symptom onset. Older age was correlated with higher viral load (Spearman's ρ=0·48, 95% CI 0·074-0·75; p=0·020). For 16 patients with serum samples available 14 days or longer after symptom onset, rates of seropositivity were 94% for anti-NP IgG (n=15), 88% for anti-NP IgM (n=14), 100% for anti-RBD IgG (n=16), and 94% for anti-RBD IgM (n=15). Anti-SARS-CoV-2-NP or anti-SARS-CoV-2-RBD IgG levels correlated with virus neutralisation titre (R²>0·9). No genome mutations were detected on serial samples.Interpretation Posterior oropharyngeal saliva samples are a non-invasive specimen more acceptable to patients and health-care workers. Unlike severe acute respiratory syndrome, patients with COVID-19 had the highest viral load near presentation, which could account for the fast-spreading nature of this epidemic. This finding emphasises the importance of stringent infection control and early use of potent antiviral agents, alone or in combination, for highrisk individuals. Serological assay can complement RT-qPCR for diagnosis.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study

Tsang²,

Leung³

et al. 2020

The Lancet Infectious Diseases

Self Cite

3,070

197

3,366

View full text Add to dashboard Cite

show abstract

“…The false negative rate of oropharyngeal swabs seems high. As we know that, oropharyngeal swabs are the recommended upper respiratory tract specimen types for SARS-CoV-2 diagnostic testing7,8 , so a new detection technique should be developed as soon as possible.…”

mentioning

confidence: 99%

WITHDRAWN: Clinical and CT imaging features of 2019 novel coronavirus disease (COVID-19)

Zhu¹,

Liu²,

Li³

et al. 2020

Journal of Infection

View full text Add to dashboard Cite

Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Nasopharyngeal swab nucleic acid amplification testing (NAAT) is the noninvasive criterion standard for diagnosis of coronavirus disease 2019 . However, it requires trained personnel, limiting its availability. Saliva NAAT represents an attractive alternative, but its diagnostic performance is unclear.OBJECTIVE To assess the diagnostic accuracy of saliva NAAT for COVID-19.DATA SOURCES In this systematic review, a search of the MEDLINE and medRxiv databases was conducted on August 29, 2020, to find studies of diagnostic test accuracy. The final meta-analysis was performed on November 17, 2020.STUDY SELECTION Studies needed to provide enough data to measure salivary NAAT sensitivity and specificity compared with imperfect nasopharyngeal swab NAAT as a reference test. An imperfect reference test does not perfectly reflect the truth (ie, it can give false results). Studies were excluded if the sample contained fewer than 20 participants or was neither random nor consecutive. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias.DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed for the systematic review, with multiple authors involved at each stage of the review. To account for the imperfect reference test sensitivity, we used a bayesian latent class bivariate model for the meta-analysis. MAIN OUTCOMES AND MEASURESThe primary outcome was pooled sensitivity and specificity. Two secondary analyses were performed: one restricted to peer-reviewed studies, and a post hoc analysis limited to ambulatory settings. RESULTSThe search strategy yielded 385 references, and 16 unique studies were identified for quantitative synthesis. Eight peer-reviewed studies and 8 preprints were included in the meta-analyses (5922 unique patients). There was significant variability in patient selection, study design, and stage of illness at which patients were enrolled. Fifteen studies included ambulatory patients, and 9 exclusively enrolled from an outpatient population with mild or no symptoms. In the primary analysis, the saliva NAAT pooled sensitivity was 83.2% (95% credible interval [CrI], 74.7%-91.4%) and the pooled specificity was 99.2% (95% CrI, 98.2%-99.8%). The nasopharyngeal swab NAAT had a sensitivity of 84.8% (95% CrI, 76.8%-92.4%) and a specificity of 98.9% (95% CrI, 97.4%-99.8%). Results were similar in secondary analyses. CONCLUSIONS AND RELEVANCEThese results suggest that saliva NAAT diagnostic accuracy is similar to that of nasopharyngeal swab NAAT, especially in the ambulatory setting. These findings support larger-scale research on the use of saliva NAAT as an alternative to nasopharyngeal swabs.

show abstract

Consistent Detection of 2019 Novel Coronavirus in Saliva

Cited by 1,691 publications

References 11 publications

Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study

Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study

WITHDRAWN: Clinical and CT imaging features of 2019 novel coronavirus disease (COVID-19)

Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2

Contact Info

Product

Resources

About