2020
DOI: 10.1016/j.jcv.2020.104567
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Challenges in use of saliva for detection of SARS CoV-2 RNA in symptomatic outpatients

Abstract: Highlights Saliva has been recommended as an alternative sample for detection of SARS CoV-2 infection, but data are limited. In this study, SARS CoV-2 was detected by RT-PCR in 35 of 124 patients, 30 (85.7 %) by saliva and 33 (94.3 %) by NP swab. The median cycle threshold value was significantly lower for NPS than for saliva. A third of pure saliva samples were difficult to pipet, which slowed processing.

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Cited by 153 publications
(193 citation statements)
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“…These include severity of disease (asymptomatic to severe disease in hospitalized patients), method of collection (collection upon waking before any food or water intake, versus forced cough collected later in the day, versus drooling technique with no restriction on food/water intake at a random time later in the day), the gold standard or reference method for comparison in each study (NP versus NP/OP, versus MT), healthcare provider collected versus self-collected NP, addition of stabilizing agent, processing steps, RNA extraction process, and testing platform. Each of the studies alone is limited by which group of individuals was tested, the time and method of collection, and processing methods (4,19). Some studies were limited by the inability of individuals to elicit a cough when requested (14), and there is a need to consider potential preanalytical errors caused by home-collected Some studies have shown a lower viral load in saliva (13,16,17), but other studies showed similar viral loads between specimens or better viral loads in saliva (6).…”
Section: Downloaded Frommentioning
confidence: 99%
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“…These include severity of disease (asymptomatic to severe disease in hospitalized patients), method of collection (collection upon waking before any food or water intake, versus forced cough collected later in the day, versus drooling technique with no restriction on food/water intake at a random time later in the day), the gold standard or reference method for comparison in each study (NP versus NP/OP, versus MT), healthcare provider collected versus self-collected NP, addition of stabilizing agent, processing steps, RNA extraction process, and testing platform. Each of the studies alone is limited by which group of individuals was tested, the time and method of collection, and processing methods (4,19). Some studies were limited by the inability of individuals to elicit a cough when requested (14), and there is a need to consider potential preanalytical errors caused by home-collected Some studies have shown a lower viral load in saliva (13,16,17), but other studies showed similar viral loads between specimens or better viral loads in saliva (6).…”
Section: Downloaded Frommentioning
confidence: 99%
“…For symptomatic patients, a highly sensitive, specific, and reliably accurate assay is important, and the choice of specimen type can impact assay performance (2). The Centers for Disease Control and Prevention (CDC) currently lists the following upper respiratory specimen types as acceptable: nasopharyngeal swab, anterior nares, mid-turbinate, oropharyngeal (OP), and NP/nasal wash/aspirates, with the NP swab often considered the preferred method for diagnostic testing and the collection method to which other specimen types have been compared (3)(4)(5). However, there is inconvenience associated with NP and OP swab collection including patient discomfort (3,6), some risk of exposure to healthcare personnel, the requirement for swabs, and the need for personal protective equipment (PPE).…”
mentioning
confidence: 99%
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“…Equivocal results and assay failures were not used in the calculation of sensitivity, nor in the construction of the CRS for each study. Confidence limits for sensitivity were computed using Newcombe’s efficient score method 16 as implemented in the Vassarstats Clinical Calculator 1 ( http://vassarstats.net/ )( Table 1 ) 3 , 4 , 5 , 6 , 7 , 8 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 . Criteria for performing a formal meta-analysis were as follows: 1) studies used the same amplification technology [such as RT-PCR]; 2) studies used the same upper airway sample site (AN, MT and NP could be included together, but not admixed with studies based on OP samples; 3) studies enrolled a similar patient mix (e.g., symptomatic, asymptomatic, hospitalized) and similar clinical environment (drive-through/ community health center or hospital).…”
Section: Methodsmentioning
confidence: 99%
“…Although the use of flocked swabs to obtain nasopharyngeal (NP) specimens for testing has constituted the “gold standard” for upper respiratory system (URS) sampling, use of specimens obtained by swabbing the oropharynx (OP), mid-turbinate (MT) and anterior nares (AN, also known as “nasal”) have all served as alternatives, both as a result of supply shortages and also because these sites can be self-sampled, reducing clinician exposure and the need for personal protective equipment. Saliva, which can also be obtained without clinician assistance, has been proposed as a safe, easy and comfortable way to obtain samples for covid19 testing 2 , but published studies have been based on heterogeneous study populations and have given conflicting results 3 , 4 , 5 , 6 , 7 , 8 . In this paper we set out to answer the question…”
Section: Introductionmentioning
confidence: 99%