Does sampling saliva increase detection of SARS-CoV-2 by RT-PCR? Comparing saliva with oro-nasopharyngeal swabs

Doğan, Özlem Akgün; Kose, Betsi; Ağaoğlu, Nihat Buğra; Yildiz, Jale; Alkurt, Gizem; Demirkol, Yasemin Kendir; İrvem, Arzu; Doğanay, Gizem Dinler; Doğanay, Levent

doi:10.1016/j.jviromet.2020.114049

Cited by 24 publications

(25 citation statements)

References 21 publications

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“…Just as in the present work, in previous comparative studies, some negative NPS samples have been found to be positive in saliva or sputum [ 10 , 15 , 21 , 25 ]. This may result from the existence of false NPS positives, but it must be kept in mind that PCR positivity seems to decrease slower in sputum than in NPS [26] .…”

Section: Discussionsupporting

confidence: 76%

“…A meta-analysis recently performed by Guillaume Butler-Laporte and colleagues [20] using comparative studies of performance between saliva and NPS samples for the detection of SARS-CoV-2 reports that the diagnostic sensitivity for saliva RT-PCR viral detection is approximately 83.2 %, with values ranging from as low as 60.6% [21] to 89.4% [22] . In our study, involving 452 dual samples, an agreement of 83.9% between NPS positive samples and saliva samples used directly in the RT-PCR reaction was observed.…”

Section: Discussionmentioning

confidence: 99%

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Performance of saliva as a specimen to detect SARS-CoV-2

Fernandes¹,

Ferreira²,

Morais³

et al. 2021

Journal of Clinical Virology

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Massive testing to detect SARS-CoV-2 is an imperious need in times of epidemic but also presents challenges in terms of its concretization. The use of saliva as an alternative to nasopharyngeal swabs (NPS) has advantages, being more friendly to the patient and not requiring trained health workers, so much needed in other functions. This study used a total of 452 dual samples (saliva and NPS) of patients suspected of having COVID-19 to compare results obtained for the different specimens when using RT-PCR of RNA extracted from NPS and saliva, as well as saliva directly without RNA extraction. SARS-CoV-2 was not detected in 13 saliva (direct) of the 80 positive NPS samples and in 16 saliva (RNA) of a total of 76 NPS positive samples. Sensitivity of detection of viral genes ORF1ab, E and N in saliva is affected differently and detection of these genes in saliva samples presents great variability when NPS samples present Ct-values above approximately 20, with sensitivities ranging from 76.3% to 86.3%. On average an increase in 7.3 Ct-values (average standard deviation of 4.78) is observed in saliva samples when compared to NPS. The use of this specimen should be carefully considered due to the false negative rate and the system used for detection may be also very relevant since the different viral genes are affected differently in terms of detection sensitivity using saliva.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Performance of saliva as a specimen to detect SARS-CoV-2

Fernandes¹,

Ferreira²,

Morais³

et al. 2021

Journal of Clinical Virology

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“…Other studies have found similar results where sensitivities reflect the timing of symptom onset ( 3 , 23 ). A lower positivity rate (55% to 63%) was also found among the samples collected at the early stage of symptom onset ( 24 ). In contrast, the sensitivity decreased gradually after 5 days of symptom onset (71.4% to 33.3%).…”

Section: Discussionmentioning

confidence: 86%

Diagnostic Performance of Self-Collected Saliva Versus Nasopharyngeal Swab for the Molecular Detection of SARS-CoV-2 in the Clinical Setting

et al. 2021

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“…In addition to ANS and NPS, two different saliva samples were collected for these patients and used in computation of the CRS. Previous studies have suggested that saliva is more sensitive than NPS for SARS-CoV-2 detection in the latter stages of disease [18,19], and exclusion of saliva from the CRS results in an estimate of 100% for NPS sensitivity. This effect is not seen in a study in which testing that included saliva specimens was conducted in a walkup or drive-through setting that focused on initial diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Relative sensitivity of anterior nares and nasopharyngeal swabs for initial detection of SARS-CoV-2 in ambulatory patients: Rapid review and meta-analysis

Zhou

O’Leary

2021

PLoS ONE

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Nasopharyngeal (NP) swabs are considered “gold standard” for diagnosing SARS-CoV-2 infections, but anterior nares or mid-turbinate swabs (nasal swabs) are often used. We performed a meta-analysis comparing the sensitivity of nasal and nasopharyngeal swabs against a composite reference standard for the initial diagnosis of SARS-CoV-2 infection in ambulatory patients. The study is registered on PROSPERO (CRD42020221827). Data sources included studies appearing between January 1, 2020 and March 20, 2021, identified by searches of PubMed, medRxiv and bioRxiv. Studies included at least 20 subjects who simultaneously provided nasal and nasopharyngeal specimens for reverse transcription-polymerase chain reaction testing, and for which confusion matrices could be constructed. Authors individually assessed studies for inclusion and compared assessments. Each author independently extracted all data elements; differences were reconciled by review of initial data sources. Extracted data included specimen site, patient characteristics, collection site, and confusion matrices comparing results for nasal and nasopharyngeal swabs. Assessed against a composite reference standard, anterior nares swabs are less sensitive (82% - 88%) than nasopharyngeal swabs (98%). For populations with 10% specimen positivity, the negative predictive values of all swab types were greater than 98%. Mid-turbinate and anterior nares swabs seem to perform similarly. The lower sensitivity associated with nasal swab SARS-CoV-2 diagnosis is justified by the ability to screen more patients and reduced personal protective equipment requirements. Our conclusions are limited by the small number of studies and the significant heterogeneity of study designs and study outcomes.

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Does sampling saliva increase detection of SARS-CoV-2 by RT-PCR? Comparing saliva with oro-nasopharyngeal swabs

Cited by 24 publications

References 21 publications

Performance of saliva as a specimen to detect SARS-CoV-2

Performance of saliva as a specimen to detect SARS-CoV-2

Diagnostic Performance of Self-Collected Saliva Versus Nasopharyngeal Swab for the Molecular Detection of SARS-CoV-2 in the Clinical Setting

Relative sensitivity of anterior nares and nasopharyngeal swabs for initial detection of SARS-CoV-2 in ambulatory patients: Rapid review and meta-analysis

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