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

Braz‐Silva, Paulo Henrique; Mamana, Ana Carolina; Romano, Camila Malta; Félix, Alvina Clara; A, de Paula; Ferreira, Noeli Evangelista; Buss, Lewis; Tozetto‐Mendoza, Tânia Regina; Caixeta, Rafael Antônio Velôso; Leal, Fábio E.; Grespan, Regina Maura Zetone; BizÃ¡rio, JoÃ£o Carlos da Silva; Ferraz, Andrea de Barros Coscelli; Sapkota, Dipak; Giannecchini, Simone; To, Kelvin Kai‐Wang; Doglio, Alain; Mendes‐Correa, Maria Cássia

doi:10.1101/2020.10.23.20218487

Cited by 10 publications

(18 citation statements)

References 33 publications

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“…Overall, twenty-one studies had low risk of bias (63.6%) [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 35 , 38 , 39 , 40 , 41 , 42 , 43 ], eleven raised some concerns (33.3%) [ 21 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 ] and one had high risk of bias (3.0%) [ 37 ] ( Figure 2 ) (fully detailed in Supplementary S3 , pp. 12).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, as a diagnostic specimen, "saliva" deserves a particular attention, and several considerations need to be taken into account. Firstly, most studies accounted for salivary samples circumscribed to the oral region (anterior to the throat) [ 12 , 13 , 15 , 20 , 22 , 26 , 30 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 42 ], while the remaining studies analyzed DTS/POS with or without pre-throat saliva [ 25 , 27 , 29 , 32 , 41 , 43 ]. This fact is very important as the salivary characteristics and the collection method differ, and the DTS/POS may contain samples other than the oropharyngeal region (naso-pharyngeal or laryngeal-pharyngeal) [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…Aiming at simplifying the sample collection procedure, so that the average person could perform self-sampling, alternative specimens have been tested for the detection of SARS-CoV-2, namely sputum, saliva, tears/conjunctival swab (CS), feces, rectal swab, urine, breast milk, and semen [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. To the best of our knowledge, until now, just one protocol for saliva testing, the SalivaDirect, has been approved by a public health authority, the United States Food and Drug Administration (FDA) [ 44 ].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of SARS-Cov-2 Infection by RT-PCR Using Specimens Other Than Naso- and Oropharyngeal Swabs: A Systematic Review and Meta-Analysis

et al. 2021

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The rapid and accurate testing of SARS-CoV-2 infection is still crucial to mitigate, and eventually halt, the spread of this disease. Currently, nasopharyngeal swab (NPS) and oropharyngeal swab (OPS) are the recommended standard sampling techniques, yet, these have some limitations such as the complexity of collection. Hence, several other types of specimens that are easier to obtain are being tested as alternatives to nasal/throat swabs in nucleic acid assays for SARS-CoV-2 detection. This study aims to critically appraise and compare the clinical performance of RT-PCR tests using oral saliva, deep-throat saliva/posterior oropharyngeal saliva (DTS/POS), sputum, urine, feces, and tears/conjunctival swab (CS) against standard specimens (NPS, OPS, or a combination of both). In this systematic review and meta-analysis, five databases (PubMed, Scopus, Web of Science, ClinicalTrial.gov and NIPH Clinical Trial) were searched up to the 30th of December, 2020. Case-control and cohort studies on the detection of SARS-CoV-2 were included. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2). We identified 1560 entries, 33 of which (1.1%) met all required criteria and were included for the quantitative data analysis. Saliva presented the higher accuracy, 92.1% (95% CI: 70.0–98.3), with an estimated sensitivity of 83.9% (95% CI: 77.4–88.8) and specificity of 96.4% (95% CI: 89.5–98.8). DTS/POS samples had an overall accuracy of 79.7% (95% CI: 43.3–95.3), with an estimated sensitivity of 90.1% (95% CI: 83.3–96.9) and specificity of 63.1% (95% CI: 36.8–89.3). The remaining index specimens could not be adequately assessed given the lack of studies available. Our meta-analysis shows that saliva samples from the oral region provide a high sensitivity and specificity; therefore, these appear to be the best candidates for alternative specimens to NPS/OPS in SARS-CoV-2 detection, with suitable protocols for swab-free sample collection to be determined and validated in the future. The distinction between oral and extra-oral salivary samples will be crucial, since DTS/POS samples may induce a higher rate of false positives. Urine, feces, tears/CS and sputum seem unreliable for diagnosis. Saliva testing may increase testing capacity, ultimately promoting the implementation of truly deployable COVID-19 tests, which could either work at the point-of-care (e.g. hospitals, clinics) or at outbreak control spots (e.g., schools, airports, and nursing homes).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosis of SARS-Cov-2 Infection by RT-PCR Using Specimens Other Than Naso- and Oropharyngeal Swabs: A Systematic Review and Meta-Analysis

et al. 2021

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“…The cost of collecting POS could be 2.59-fold lower than nasopharyngeal specimen (248). The sensitivity is comparable with nasopharyngeal swab in properly collected specimens by cooperative patients (249)(250)(251)(252) . The sensitivity does not vary much between early morning and at least 2 hours after meal (253).…”

Section: Specimen Collectionmentioning

confidence: 95%

Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic

Sridhar

Chiu

et al. 2021

Emerging Microbes & Infections

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257

189

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Without modern medical management and vaccines, the severity of the Coronavirus Disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome(SARS) coronavirus 2 (SARS-CoV-2) might approach the magnitude of 1894-plague (12 million deaths) and 1918-A(H1N1) influenza (50 million deaths) pandemics. The COVID-19 pandemic was heralded by the 2003 SARS epidemic which led to the discovery of human and civet SARS-CoV-1, bat SARS-related-CoVs, Middle East respiratory syndrome(MERS)-related bat CoV HKU4 and HKU5, and other novel animal coronaviruses. The suspected animal-to-human jumping of 4 betacoronaviruses including the human coronaviruses OC43(1890), SARS-CoV-1(2003), MERS-CoV(2012), and SARS-CoV-2(2019) indicates their significant pandemic potential. The presence of a large reservoir of coronaviruses in bats and other wild mammals, culture of mixing and selling them in urban markets with suboptimal hygiene, habit of eating exotic mammals in highly populated areas, and the rapid and frequent air traffic from these areas are perfect ingredients for brewing rapidly exploding epidemics. The possibility of emergence of a hypothetical SARS-CoV-3 or other novel viruses from animals or laboratories, and therefore needs for global preparedness should not be ignored. We reviewed representative publications on the epidemiology, virology, clinical manifestations, pathology, laboratory diagnostics, treatment, vaccination and infection control of COVID-19 as of 20 January 2021, which is one year after person-to-person transmission of SARS-CoV-2 was announced. The difficulties of mass testing, labour-intensive contact tracing, importance of compliance to universal masking, low efficacy of antiviral treatment for severe disease, possibilities of vaccine or antiviral-resistant virus variants and SARS-CoV-2 becoming another common cold coronavirus are discussed. The chronology of the pandemic An outbreak of acute community-acquired atypical pneumonia of unknown aetiology was reported in Wuhan, the capital of Hubei province in central China, in December 2019. The initial cluster of cases was related to the Huanan seafood wholesale market where wild game animals were also sold (1). During subsequent investigation, severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) was detected in 33 out of 585 environmental samples taken from the market (2). However, 45% of the cases with onset before 1 January 2020 had no apparent link to this market (3). Retrospective molecular clock inference studies using phylogenetic analysis suggested that the earliest cases likely emerged between October and November 2019 (4, 5). The culprit virus was identified using next-generation sequencing on bronchoalveolar lavage fluids of three Wuhan patients (6). The complete genome sequences of SARS-CoV-2 clustered in a distinct clade from SARS-CoV within the genus Sarbecovirus. The draft genome sequence was released on 10 Jan 2020, 10 days after the outbreak was announced. As an escalating number of local cases was reported in Wuhan, a f...

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“…126 Self-collected saliva and nasopharyngeal swabs are potentially viable for testing. 136 All RT-PCR methods have the benefit of testing based on the viral genome, and hence can show that a patient is presented with a viral load at the time of testing. RT-PCR also appears to be able to detect viral loads the earliest out of the traditionally-used methods, and gives the highest accuracy.…”

Section: Reverse Transcription Polymerase Chain Reaction (Rt-pcr)mentioning

confidence: 99%

Science’s Response to COVID-19

Aye¹,

Long²

2021

Preprint

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CoVID-19 is a multi-symptomatic disease which has made a global impact due to its ability to spread rapidly, and its relatively high mortality rate. Beyond the heroic efforts to develop vaccines, which we will not discuss, the response of scientists and clinicians to this complex problem has reflected the need to detect CoVID-19 rapidly, to diagnose patients likely to show adverse symptoms, and to treat severe and critical CoVID-19. Here we aim to encapsulate these varied and sometimes conflicting approaches and the resulting data in terms of chemistry and biology. In the process we highlight emerging concepts, and potential future applications that may arise out of this immense effort.

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

Cited by 10 publications

References 33 publications

Diagnosis of SARS-Cov-2 Infection by RT-PCR Using Specimens Other Than Naso- and Oropharyngeal Swabs: A Systematic Review and Meta-Analysis

Diagnosis of SARS-Cov-2 Infection by RT-PCR Using Specimens Other Than Naso- and Oropharyngeal Swabs: A Systematic Review and Meta-Analysis

Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic

Science’s Response to COVID-19

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