Posterior Oropharyngeal Saliva for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Wong, Sally Cheuk Ying; Tse, Herman; Siu, H. K.; Kwong, Tsz Shan; Chu, Man Yee; Yau, Felix Yat Sun; Cheung, Ingrid; Tse, Cindy Wing-Sze; Poon, Kin Chiu; Cheung, Kwok Chi; Wu, Tak Chiu; Chan, Johnny Wai Man; Cheuk, Wah; Lung, David Christopher

doi:10.1093/cid/ciaa797

Cited by 86 publications

(90 citation statements)

References 19 publications

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“…The use of saliva to detect SARS-CoV-2 has been extensively analyzed by different authors, showing that saliva can be used as an alternative sample to nasopharyngeal swabs for COVID-19 molecular diagnosis(9, 10). The sensitivity found in their studies varied from 81% to 100% (11,12,(17)(18)(19)(20)(21). The majority of the studies were conducted with hospitalized patients presenting more severe clinical forms of the disease, is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint…”

Section: Discussionmentioning

confidence: 99%

Performance of At-Home Self-Collected Saliva and Nasal-Oropharyngeal Swabs in the Surveillance of COVID-19

Braz‐Silva

Mamana²,

Romano³

et al. 2020

Preprint

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SARS-CoV-2 quickly spread in the worldwide population by contact with oral and respiratory secretions of infected individuals, imposing social restrictions to control the infection. Massive testing is essential to breaking the chain of COVID-19 transmission. The aim of this study was to compare the performance of at-home self-collected samples - saliva and combined nasal-oropharyngeal swabs (NOP) - for SARS-CoV-2 detection in a telemedicine platform for COVID-19 surveillance. We analyzed 201 patients who met the criteria of suspected COVID-19. NOP sampling were combined (nostrils and oropharynx) and saliva collected using a cotton pad device. Detection of SARS-COV-2 was performed by using the Altona RealStar SARS-CoV-2 RT-PCR Kit 1.0. According to our data, there was an overall significant agreement (k coefficient value of 0.58) between the performances of saliva and NOP. Assuming that positive results in either sample represent true infections, 70 patients positive for SARS-CoV-2 were identified, with 52/70 being positive in NOP and 55/70 in saliva. This corresponds to sensitivities of 74.2% (95% CI; 63.7% to 83.1%) for NOP and 78.6% (95% CI; 67.6% to 86.6%) for saliva. We also found a strong correlation (Beta coefficients < 1) between the cycle threshold values in saliva and NOP. Ageusia was the only symptom associated with patients SARS-CoV-2 positive only in NOP (p=0.028). In conclusion, our data show the feasibility of using at-home self-collected samples (especially saliva), as an adequate alternative for SARS-CoV-2 detection. This new approach of testing can be useful to develop strategies for COVID-19 surveillance and for guiding public health decisions.

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Section: Discussionmentioning

confidence: 99%

Performance of At-Home Self-Collected Saliva and Nasal-Oropharyngeal Swabs in the Surveillance of COVID-19

Braz‐Silva

Mamana²,

Romano³

et al. 2020

Preprint

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“…(17,18) When only individuals with symptoms of < 9 days duration were included in the analysis, then the sensitivity of saliva in this study increased to 90%, which is consistent with findings of others. (5,7) This study was limited to adults. Additional studies are needed to determine the acceptability of saliva as an alternate specimen type in children.…”

Section: Downloaded Frommentioning

confidence: 99%

“…(2) Specifically, the shortage in nasopharyngeal swabs (NPS), the standard specimen collection device for the diagnosis of respiratory viral infections, has necessitated the investigation and employment of nasal mid-turbinate swabs, anterior nares swabs and even saliva as alternate specimens for the diagnosis of COVID -19 infection. (3)(4)(5) Several studies have investigated the use of saliva as a specimen for testing for SARS-CoV-2 with mixed results. (3,(5)(6)(7)(8)(9)(10)(11) We, therefore, undertook a direct NPS to saliva specimen comparison to provide further clarification regarding the use of saliva as a potential specimen for testing.…”

Section: Introductionmentioning

confidence: 99%

A Direct Comparison of Enhanced Saliva to Nasopharyngeal Swab for the Detection of SARS-CoV-2 in Symptomatic Patients

et al. 2020

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Background: The ongoing COVID-19 pandemic has resulted in shortages in nasopharyngeal swabs (NPS) and viral transport media, necessitating the search for alternate diagnostic specimens, such as saliva. We directly compared matched saliva and NPS specimens from symptomatic patients suspected of having COVID-19. Methods: An enhanced saliva specimen (ie strong sniff, elicited cough, and collection of saliva/secretions) was collected without transport media prior to NPS from 224 patients with symptoms deemed consistent with COVID-19. Both specimens were tested with the CDC 2019 nCoV Real-Time RT-PCR Diagnostic Panel (4 February 2020 version), with the NPS result used as the reference standard. Results: Of the 216 patients included in the final analysis, there was a 100% Positive Percent Agreement (38/38 positive specimens) and 99.4% Negative Percent Agreement (177/178 negative specimens). The one discrepant specimen had the presence of SARS-CoV-2 confirmed in the saliva specimen using an alternate FDA EUA assay. The overall mean difference in crossing threshold (Ct) values for the positive NPS and saliva specimens was -3.61 (95% C.I. -5.78 to -1.44, p = 0.002). Conclusion: An enhanced saliva specimen performed as well as NPS for the qualitative detection of SARS-CoV-2 in symptomatic patients, albeit the overall mean viral load in saliva was lower.

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“…However, the specificity ranging from 97% to 100% suggests reliable detection limits of current assays for detecting the absence of SARS-CoV-2 viral loads in saliva samples. While 1 study showed that saliva could be considered for diagnosis in the early stages of disease due to the low costs (Wong et al 2020), a cost-effectiveness study should be performed to confirm this recommendation. There are at least 3 possible trajectories for SARS-CoV-2 to be present in saliva (Sabino-Silva et al 2020): 1) from the upper respiratory tract, when liquid droplets derived from these tissues could enter into the oral cavity; 2) from blood, when the virus could access the oral cavity via an exudate containing local proteins derived from the extracellular matrix and proteins derived from serum; and 3) from infection of the major and minor salivary glands, with the release of viral particles into the saliva via salivary ducts.…”

Section: Population-level Employable Rapid Testing Strategy: Advantagmentioning

confidence: 99%

Saliva in the Diagnosis of COVID-19: A Review and New Research Directions

et al. 2020

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This review presents literature that highlights saliva’s utility as a biofluid in the diagnosis and monitoring of COVID-19. A systematic search was performed in 5 electronic databases (PubMed, Embase, LILACS, Scopus, and Web of Science). Studies were eligible for inclusion if they assessed the potential diagnostic value and/or other discriminatory properties of biological markers in the saliva of patients with COVID-19. As of July 22, 2020, a total of 28 studies have investigated the presence of SARS-CoV-2 RNA in saliva. Several of those studies confirmed reliable detection of SARS-CoV-2 in the saliva of patients with COVID-19. Saliva offered sensitivity and specificity for SARS-CoV-2 detection comparable to that of the current standard of nasopharyngeal and throat swabs. However, the utility of saliva in diagnosing COVID-19 infection remains understudied. Clinical studies with larger patient populations that measure recordings at different stages during the disease are still necessary to confirm the accuracy of COVID-19 diagnosis with saliva. Nevertheless, the utility of saliva as a diagnostic tool opens the possibility of using rapid and less invasive diagnostic strategies by targeting bioanalytes rather than the pathogen.

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Posterior Oropharyngeal Saliva for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Cited by 86 publications

References 19 publications

Performance of At-Home Self-Collected Saliva and Nasal-Oropharyngeal Swabs in the Surveillance of COVID-19

Performance of At-Home Self-Collected Saliva and Nasal-Oropharyngeal Swabs in the Surveillance of COVID-19

A Direct Comparison of Enhanced Saliva to Nasopharyngeal Swab for the Detection of SARS-CoV-2 in Symptomatic Patients

Saliva in the Diagnosis of COVID-19: A Review and New Research Directions

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