Sensitivity of the Molecular Test in Saliva for Detection of COVID-19 in Pediatric Patients With Concurrent Conditions

G, Laura; Josué, Nevárez-Ramírez Abraham; Briceida, López-Martínez; Parra-Ortega, Israel; Ángeles-Floriano, Tania; Nancy, Martínez-Rodríguez; Jamaica-Balderas, Lourdes; Daniela, De la Rosa-Zamboni; Ortega-Riosvelasco, Fernando; Mauricio, Jaramillo-Esparza Carlos; René, Bonilla-Pellegrini Sergio; Irineo, Reyna-Trinidad; Horacio, Márquez-González; Medina-Contreras, Óscar; Quezada, Héctor

doi:10.3389/fped.2021.642781

Cited by 13 publications

(9 citation statements)

References 36 publications

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“…To our knowledge, this study is the largest paediatric study comparing OSS with the established gold standard. The results are in concordance with the few studies performed on children 5 7 9 10 24. A recent study performed in Dubai with 476 children demonstrated a sensitivity even higher (87.7%) than found here; however, the authors used a saliva sample rather than saliva swabs, and the children were older (mean 10.8 years old) 10.…”

Section: Discussionsupporting

confidence: 91%

“…We found that OSS RT-PCR could detect some cases that were missed by the NPS RT-PCR; four cases were positive for OSS RT-PCR but negative for NPS RT-PCR, as has been described previously 7–9. Also, three of those four cases had positive serology but were negative for the Ag-RDT.…”

Section: Discussionsupporting

confidence: 83%

“…Data from a recent systematic review showed that given a proper RT-PCR kit is chosen, the accuracy of RT-PCR on saliva and NPS is similar, particularly in ambulatory patients,4 yet saliva tests have not been widely implemented in children. Indeed, studies in this population are scarce, particularly in preschoolers 5–10…”

Section: Introductionmentioning

confidence: 99%

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Oral saliva swab reverse transcription PCR for Covid-19 in the paediatric population

et al. 2022

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ObjectivesTo evaluate the performance of oral saliva swab (OSS) reverse transcription PCR (RT-PCR) compared with RT-PCR and antigen rapid diagnostic test (Ag-RDT) on nasopharyngeal swabs (NPS) for SARS-CoV-2 in children.DesignCross-sectional multicentre diagnostic study.SettingStudy nested in a prospective, observational cohort (EPICO-AEP) performed between February and March 2021 including 10 hospitals in Spain.PatientsChildren from 0 to 18 years with symptoms compatible with Covid-19 of ≤5 days of duration were included. Two NPS samples (Ag-RDT and RT-PCR) and one OSS sample for RT-PCR were collected.Main outcomePerformance of Ag-RDT and RT-PCR on NPS and RT-PCR on OSS sample for SARS-CoV-2.Results1174 children were included, aged 3.8 years (IQR 1.7–9.0); 73/1174 (6.2%) patients tested positive by at least one of the techniques. Sensitivity and specificity of OSS RT-PCR were 72.1% (95% CI 59.7 to 81.9) and 99.6% (95% CI 99 to 99.9), respectively, versus 61.8% (95% CI 49.1 to 73) and 99.9% (95% CI 99.4 to 100) for the Ag-RDT. Kappa index was 0.79 (95% CI 0.72 to 0.88) for OSS RT-PCR and 0.74 (95% CI 0.65 to 0.84) for Ag-RDT versus NPS RT-PCR.ConclusionsRT-PCR on the OSS sample is an accurate option for SARS-CoV-2 testing in children. A less intrusive technique for younger patients, who usually are tested frequently, might increase the number of patients tested.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 83%

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Oral saliva swab reverse transcription PCR for Covid-19 in the paediatric population

et al. 2022

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“…Notably, it has been previously shown that throat swab specimens might have lower viral loads than nasopharyngeal samples (29), and that nasopharyngeal samples are best at sensitivity detection, especially in early stages of disease and in asymptomatic individuals (30). The non-invasive specimen saliva/sputum also exhibited high sensitivity (87%) and specificity (98%) for the detection of SARS-COV-2 (31), and had similar sensitivity for detecting SARS-CoV-2 with nasopharyngeal samples (32); however, in a pediatric population, the sensibility of the saliva test was not high enough to replace the use of swab for COVID-19 diagnosis (33). In this study, we used respiratory specimens of both throat swab and sputum.…”

Section: Discussionmentioning

confidence: 99%

Swab and Sputum SARS-CoV-2 RNA-Negative, CT-Positive, Symptomatic Contacts of COVID-19 Cases: A Hypothesis-Generating Prospective Population-Based Cohort Study of Eight Clusters

Huang

Zhang

et al. 2021

Front. Med.

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Background: While some contacts of COVID-19 cases become symptomatic and radiographically abnormal, their SARS-CoV-2 RNA tests remain negative throughout the disease course. This prospective population-based cohort study aimed to explore their characteristics and significances.Methods: From January 22, 2020, when the first COVID-19 case was identified in Hefei, China, until July 3, a total of 14,839 people in Feidong, Hefei, with a population of ~1,081,000 underwent SARS-CoV-2 RNA testing, where 36 cases (0.2%) with confirmed COVID-19 infection (Group 1) and 27 close contacts (0.2%) testing negative for SARS-CoV-2 RNA but having both positive COVID-19 exposure histories and CT findings (Group 2) from eight clusters were prospectively identified. Another 62 non-COVID-19 pneumonia cases without any exposure history (Group 3) were enrolled, and characteristics of the three groups were described and compared. We further described a cluster with an unusual transmission pattern.Results: Fever was more common in Group 2 than Groups 1 and 3. Frequency of diarrhea in Group 1 was higher than in Groups 2 and 3. Median leucocyte, neutrophil, monocyte, and eosinophil counts were all lower in Groups 1 and 2 than in Group 3. Median D-dimer level was lower in Group 1 than in Groups 2 and 3. Total protein and albumin levels were higher in Groups 1 and 2 than in Group 3. C-reactive protein level was lower and erythrocyte sedimentation rate slower in Groups 1 and 2 than in Group 3. Combination antibacterial therapy and levofloxacin were more often used in Group 3 than in Groups 1 and 2. Lopinavir/ritonavir was more often administered in Groups 1 and 2 than in Group 3. Group 1 received more often corticosteroids than Groups 2 and 3. Group 2 received less often oxygen therapy than Groups 1 and 3. Median duration from illness onset to discharge was longer in Group 1 (27 d) than Groups 2 and 3 (both 17 d). Among contacts of a confirmed COVID-19 patient, only one had a positive virus RNA test but remained asymptomatic and had negative CT findings, and three had negative virus RNA tests but had symptoms and positive CT findings, one of whom transmitted COVID-19 to another asymptomatic laboratory-confirmed patient who had no other exposures.Conclusions: Among close contacts of confirmed COVID-19 cases, some present with positive symptoms and CT findings but test negative for SARS-CoV-2 RNA using common respiratory (throat swab and sputum) specimens; they have features more similar to confirmed COVID-19 cases than non-COVID-19 pneumonia cases and might have transmitted SARS-CoV-2 to others. Such cases might add to the complexity and difficulty of COVID-19 control. Our hypothesis-generating study might suggest that SARS-CoV-2 RNA testing by rRT-PCR assays of common respiratory (throat swab and sputum) specimens alone, the widely accepted “golden standard” for diagnosing COVID-19, might be sometimes insufficient, and that further studies with some further procedures (e.g., testing via bronchoalveolar lavage or specific antibodies) would be warranted for Group 2-like patients, namely, the SARS-CoV-2 RNA-negative (tested using common respiratory specimens), radiographically positive, symptomatic contacts of COVID-19 cases, to further reveal their nature.

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“…Although small, these studies suggest that the sensitivity of saliva as a paediatric diagnostic sample type is acceptable compared to nasopharyngeal swabs, but not perfect. Interestingly, whilst missing a few cases detected in nasopharyngeal swab samples, SARS-CoV-2 may be additionally detected in some saliva samples where nasopharyngeal swab is negative ( 10 , 11 , 12 ). Interpreting these positive NAT results from saliva samples remains difficult in the absence of a defined gold standard comparator test.…”

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confidence: 99%

Saliva testing for severe acute respiratory syndrome coronavirus 2 in children

Clifford

Curtis

2021

Clinical Microbiology and Infection

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If found to have adequate sensitivity and specificity, saliva would be an ideal sample type for identifying SARS-CoV-2 and other respiratory viruses in children, as its collection is less invasive than other standard upper respiratory tract sample types such as nasopharyngeal swab (NPS), deep nasal/oropharyngeal swab or nasopharyngeal aspirate (NPA). At present, the majority of commercial SARS-CoV-2 assays do not list saliva as an acceptable sample type for nucleic acid testing (NAT) and therefore validation studies assessing the use of this sample type are welcome.

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Sensitivity of the Molecular Test in Saliva for Detection of COVID-19 in Pediatric Patients With Concurrent Conditions

Cited by 13 publications

References 36 publications

Oral saliva swab reverse transcription PCR for Covid-19 in the paediatric population

Oral saliva swab reverse transcription PCR for Covid-19 in the paediatric population

Swab and Sputum SARS-CoV-2 RNA-Negative, CT-Positive, Symptomatic Contacts of COVID-19 Cases: A Hypothesis-Generating Prospective Population-Based Cohort Study of Eight Clusters

Saliva testing for severe acute respiratory syndrome coronavirus 2 in children

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