Comparison of Saliva and Midturbinate Swabs for Detection of SARS-CoV-2

Lai, Jianyu; German, Jennifer; Hong, Felix T.; Tai, S-H Sheldon; McPhaul, Kathleen; Milton, Donald K.

doi:10.1128/spectrum.00128-22

Cited by 34 publications

(42 citation statements)

References 34 publications

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“…The study did confirm higher antigen concentrations in symptomatic cases compared to asymptomatic and oligosymptomatic cases across all three specimen types, as anticipated given the association between viral carriage and symptom onset. While recent studies suggest that early onset of SARS-CoV-2 can be first observed in the saliva by RT-PCR, 4,5,20 the overall lower antigen levels observed in saliva in this study suggests that current rapid antigen tests are not sensitive enough to leverage this opportunity for earlier infection detection.…”

Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

“…[21][22][23] The study did confirm higher antigen concentrations in symptomatic cases compared to asymptomatic and oligosymptomatic cases across all three specimen types, as anticipated given the association between viral carriage and symptom onset. While recent studies suggest that early onset of SARS-CoV-2 can be first observed in the saliva by RT-PCR, 4,5,20 Tables Table 1. Observed sensitivity of the antigen detection tests performed on ANS compared to their predicted performance based on analytical limit-of-detection. The study population were close of their tests for this study.…”

Section: Validation Of Predictive Performance Modeling From Analytica...mentioning

confidence: 99%

“…Viral load varies across different specimen types throughout the progression of COVID-19 disease and between individuals. 4,5 The variant and vaccination status may also influence the relative viral loads. 6,7 However, performance of RDTs has often been compared to RT-PCR results conducted on nasopharyngeal swab (NPS) specimens as a gold standard, and was initially the regulatory reference, regardless of the type of specimen that the RDT is conducted on.…”

Section: Introductionmentioning

confidence: 99%

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Antigen concentration, viral load, and test performance for SARS-CoV-2 in multiple specimen types

Golden¹,

Oliveira-Silva²,

Slater³

et al. 2022

Preprint

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The relationship between N-antigen concentration and viral load within a specimen and across different specimens is essential for interpretation of rapid diagnostic tests (RDT) clinical performance in different use cases. A prospective study was conducted in Porto Velho, Brazil, to investigate RDT performance in different specimen types as a function of the correlation between antigen concentration and viral load. The study included 214 close contacts with recent exposures to confirmed cases, aged 12 years and older and with various levels of vaccination. Antigen concentration was measured in nasopharyngeal swab (NPS), anterior nares swab (ANS), and saliva specimens. Reverse transcriptase (RT)-PCR was conducted on the NPS and saliva specimens, and two RDTs were conducted on ANS and one on saliva. Antigen concentration correlated with viral load when measured in the same specimen type but not across specimen types. Antigen levels were higher in symptomatic cases compared to asymptomatic/oligosymptomatic cases and lower in saliva compared to NPS and ANS samples. Discordant results between the RDTs conducted on ANS and the RT-PCR on NPS were resolved by antigen concentration values. The analytical limit-of-detection of RDTs can be used to predict the performance of the tests in populations for which the antigen concentration is known. The antigen dynamics across different sample types observed in SARS-CoV-2 disease progression support use of RDTs in nasal samples. Given lower antigen concentrations in saliva, tests using saliva is expected to require improved analytical sensitivity to achieve clinical sensitivity similar to testing of nasal samples.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Validation Of Predictive Performance Modeling From Analytica...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Antigen concentration, viral load, and test performance for SARS-CoV-2 in multiple specimen types

Golden¹,

Oliveira-Silva²,

Slater³

et al. 2022

Preprint

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show abstract

“…It is also important to note that variation of several patient and personnel factors related to naso-oropharyngeal swabbing introduces iatrogenic preanalytical variability that may adversely affect testing results 17 , 18 . Furthermore, these findings may be useful in light of recent reports suggesting changing patterns of viral shedding, tissue tropism, and transmission mechanics 19 – 21 , in favor of oral cavity and saliva, depending on the emerging SARS-CoV-2 variant such as Omicron 22 .…”

Section: Discussionmentioning

confidence: 87%

Saliva as alternative to naso-oropharyngeal swab for SARS-CoV-2 detection by RT-qPCR: a multicenter cross-sectional diagnostic validation study

Tee

Abrilla

Tee

et al. 2022

Sci Rep

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Saliva has been demonstrated as feasible alternative to naso-oropharyngeal swab (NOS) for SARS-CoV-2 detection through reverse transcription quantitative/real-time polymerase chain reaction (RT-qPCR). This study compared the diagnostic agreement of conventional NOS, saliva with RNA extraction (SE) and saliva without RNA extraction (SalivaDirect) processing for RT-qPCR in identifying SARS-CoV-2. All techniques were also compared, as separate index tests, to a composite reference standard (CRS) where positive and negative results were defined as SARS-CoV-2 detection in either one or no sample, respectively. Of 517 paired samples, SARS-CoV-2 was detected in 150 (29.01%) NOS and 151 (29.21%) saliva specimens. The saliva-based tests were noted to have a sensitivity, specificity and accuracy (95% confidence interval) of 92.67% (87.26%, 96.28%), 97.55% (95.40%, 98.87%) and 96.13% (94.09%, 97.62%), respectively, for SE RT-qPCR and 91.33% (85.64%, 95.30%), 98.91% (97.23%, 99.70%) and 96.71% (94.79%, 98.07%), respectively, for SalivaDirect RT-qPCR compared to NOS RT-qPCR. Compared to CRS, all platforms demonstrated statistically similar diagnostic performance. These findings suggest that both conventional and streamlined saliva RT-qPCR are at least non-inferior to conventional NOS RT-qPCR in detecting SARS-CoV-2.

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Molecular diagnostic approaches for SARS-CoV-2 detection and pathophysiological consequences

Salazar-Ardiles,

Asserella-Rebollo,

Cornejo

et al. 2023

Mol Biol Rep

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Comparison of Saliva and Midturbinate Swabs for Detection of SARS-CoV-2

Cited by 34 publications

References 34 publications

Antigen concentration, viral load, and test performance for SARS-CoV-2 in multiple specimen types

Antigen concentration, viral load, and test performance for SARS-CoV-2 in multiple specimen types

Saliva as alternative to naso-oropharyngeal swab for SARS-CoV-2 detection by RT-qPCR: a multicenter cross-sectional diagnostic validation study

Molecular diagnostic approaches for SARS-CoV-2 detection and pathophysiological consequences

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