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

Abstract

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.

Update of European Society of Clinical Microbiology and Infectious Diseases coronavirus disease 2019 guidelines: diagnostic testing for severe acute respiratory syndrome coronavirus 2

“… In patients with signs and symptoms compatible with COVID-19 of equal or less than 7 days-onset, we suggest the use of rapid antigen detection testing versus laboratory-based NAAT for the diagnosis of COVID-19. Weak for Very low [ 3 , 7 , 39 , 41 , 46 , 53 , 60 , 61 , 63 , 65 , 73 , 78 , 9 , 79 , 83 , [91] , [92] , [93] , 96 , 97 , 100 , 101 , 104 , 11 , 106 , 108 , 109 , 114 , 118 , 119 , 126 , [129] , [130] , [131] , 13 , [132] , [133] , [134] , [135] , [136] , 14 , 17 , 21 , 36 , 37 ] 16 In patients with signs and symptoms compatible with COVID-19 of more than 7 days-onset , should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? In patients with signs and symptoms compatible with COVID-19 of more than 7 days-onset, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for the diagnosis of COVID-19.…”

“… In children <12 years old with signs and symptoms compatible with COVID-19, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for the diagnosis of COVID-19. Weak against Very low [ 5 , 9 , 119 , 127 , 131 , 141 , 142 , 13 , 36 , 39 , 73 , 91 , 97 , 101 , 114 ] 18 In patients ≥12 years old with signs and symptoms compatible with COVID-19, should rapid antigen detection testing be used, compared with standard NAAT (commercial and/or in house) for diagnosis of COVID-19? In patients ≥ 12 years old with signs and symptoms compatible with COVID-19, we suggest the use of laboratory-based NAAT versus rapid antigen detection testing for the diagnosis of COVID-19.…”

The COVID-19 Pandemic Response System at University Level: The Case of Safe Campus Model at Ewha Womans University

“…In addition to NPS, the US Centers for Disease Control and Prevention (CDC) permits the use of numerous other upper respiratory specimens, such as oropharyngeal swab, nasal swab, saliva, and nasal wash [6]. Numerous prior publications indicate that saliva is a suitable alternative specimen for COVID-19 diagnosis [6][7][8][9] and that combination specimens such as oropharyngeal swab and nasal swab have diagnostic performance comparable to NPS [7,10].…”