Saliva as a Reliable Sample for COVID-19 Diagnosis in Paediatric Patients

Félix, Alvina Clara; A, de Paula; Ribeiro, A; Silva, Francini C da; Inemami, Marta; Costa, André Oliveira; Leal, Cibele O D; Figueiredo, Walter Manso; Sarmento, Dmitry José de Santana; Sassaki, Tatiana A; Pannuti, Cláudio Sérgio; Braz‐Silva, Paulo Henrique; Romano, Camila Malta

doi:10.1101/2021.03.29.21254566

Cited by 3 publications

(6 citation statements)

References 8 publications

(19 reference statements)

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“…We included cases in our PPA denominator for which positive test results were obtained with either specimen, recognising that there is no gold standard test specimen. We would have missed 37% of SARS‐CoV‐2‐positive children under 10 had paired saliva specimens not been added to the oropharyngeal‐nasal swab for testing, consistent with other recent studies in children 13,14 …”

Section: Discussionsupporting

confidence: 85%

“…We would have missed 37% of SARS-CoV-2-positive children under 10 had paired saliva specimens not been added to the oropharyngeal-nasal swab for testing, consistent with other recent studies in children. 13,14 Several studies with nasopharyngeal swabs as the comparator have reported higher PPAs for children than ours for saliva (80.0-93.9%; 11,12,15 our study, 47%) and upper respiratory swab testing (86.7%; 11 our study, 63%). Our study included 14 children under four years of age, while nearly all participants in other investigations were over four years old.…”

Section: Discussionmentioning

confidence: 41%

“…An American study including 43 participants aged 4–18 years with COVID‐19 found that positive percent agreement was 79.1% for saliva and 88.4% for nasopharyngeal swabs; 11 in a Swiss study including 170 children, positive percent agreement was 93.3% for saliva and 84.4% for nasopharyngeal swabs 12 . A further three studies have reported similar SARS‐CoV‐2 detection measures in saliva and nasopharyngeal swabs from children 13‐15 . The diagnostic value of saliva testing is promising, but further validation, including by age group, is needed.…”

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confidence: 99%

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confidence: 99%

“…12 A further three studies have reported similar SARS-CoV-2 detection measures in saliva and nasopharyngeal swabs from children. [13][14][15] The diagnostic value of saliva testing is promising, but further validation, including by age group, is needed.In Australia, respiratory clinics have been established in general practices and hospitals to provide free SARS-CoV-2 testing to people meeting testing criteria. 16 We compared the concordance and acceptability of saliva testing and standard-of-care oropharyngeal-nasal swab testing in general practices and at a children's hospital.…”

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confidence: 99%

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Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

Oliver

Tosif

Lee

et al. 2021

Medical Journal of Australia

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Objective To compare the concordance and acceptability of saliva testing with standard‐of‐care oropharyngeal and bilateral deep nasal swab testing for severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in children and in general practice. Design Prospective multicentre diagnostic validation study. Setting Royal Children’s Hospital, and two general practices (cohealth, West Melbourne; Cirqit Health, Altona North) in Melbourne, July–October 2020. Participants 1050 people who provided paired saliva and oropharyngeal‐nasal swabs for SARS‐CoV‐2 testing. Main outcome measures Numbers of cases in which SARS‐CoV‐2 was detected in either specimen type by real‐time polymerase chain reaction; concordance of results for paired specimens; positive percent agreement (PPA) for virus detection, by specimen type. Results SARS‐CoV‐2 was detected in 54 of 1050 people with assessable specimens (5%), including 19 cases (35%) in which both specimens were positive. The overall PPA was 72% (95% CI, 58–84%) for saliva and 63% (95% CI, 49–76%) for oropharyngeal‐nasal swabs. For the 35 positive specimens from people aged 10 years or more, PPA was 86% (95% CI, 70–95%) for saliva and 63% (95% CI, 45–79%) for oropharyngeal‐nasal swabs. Adding saliva testing to standard‐of‐care oropharyngeal‐nasal swab testing increased overall case detection by 59% (95% CI, 29–95%). Providing saliva was preferred to an oropharyngeal‐nasal swab by most participants (75%), including 141 of 153 children under 10 years of age (92%). Conclusion In children over 10 years of age and adults, saliva testing alone may be suitable for SARS‐CoV‐2 detection, while for children under 10, saliva testing may be suitable as an adjunct to oropharyngeal‐nasal swab testing for increasing case detection.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 41%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

Oliver

Tosif

Lee

et al. 2021

Medical Journal of Australia

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The accuracy of saliva versus nasopharyngeal and/or oropharyngeal samples for the detection of SARS-CoV-2 in children – A rapid systematic review and meta-analysis

Dhillon

Schelstraete

Cornelissen

et al. 2021

Preprint

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Background The comparative performance of saliva and nasopharyngeal samples for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by reverse transcriptase polymerase chain reaction (RT-PCR) in children remains unclear. As schools reopen around the world, there is an interest in the use of saliva samples for detection of SARS-CoV-2 in children to circumvent barriers with nasopharyngeal sampling. We systematically reviewed the literature to understand the performance of saliva sampling using RT-PCR on naso- and/or oropharyngeal swabs as the reference standard. Methods Articles from PubMed/MEDLINE and Living Evidence were accessed until 28th April 2021. A search method without restriction to children population was applied and during the review phase, if a study included patients <18 years old, authors were contacted to provide additional information on the subset of children. Studies were eligible if they reported on matched saliva and naso- and/or oropharyngeal samples, taken from the same patient on the same day. Studies using other respiratory samples such as sputum samples were excluded. Each paired patient sample had to be tested on the same RT-PCR platform. Results Ten studies were included, comprising 1486 matched saliva and on naso- and/or oropharyngeal pairs from children aged 0 to 18 years old. The pooled absolute sensitivity and specificity of saliva sampling using RT-PCR on nasopharyngeal samples as the reference standard was 84.5% (95% CI; 78.0%-90.3%) and 99.5% (95% CI; 98.2%-100.0%). Comparable performance of saliva to nasopharyngeal samples was shown in both symptomatic and asymptomatic children. Stratified analyses of various covariates showed no significant differences. Discussion Our pooled accuracy estimates of RT-PCR SARS-CoV-2 testing on saliva in children did not seem to be different from meta-analyses of studies that enrolled mainly adults. Saliva could potentially be considered an alternative sampling method for screening in children and to pick up those with high viral load.

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Saliva for molecular detection of SARS‐CoV‐2 in pre‐school and school‐age children

Delaunay‐Moisan

Guilleminot

Semeraro

et al. 2022

Environmental Microbiology

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SARS‐CoV‐2 diagnosis is a cornerstone for the management of coronavirus disease 2019 (COVID‐19). Numerous studies have assessed saliva performance over nasopharyngeal sampling (NPS), but data in young children are still rare. We explored saliva performance for SARS‐CoV‐2 detection by RT‐PCR according to the time interval from initial symptoms or patient serological status. We collected 509 NPS and saliva paired samples at initial diagnosis from 166 children under 12 years of age (including 57 children under 6), 106 between 12 and 17, and 237 adults. In children under 12, overall detection rate for SARS‐CoV‐2 was comparable in saliva and NPS, with an overall agreement of 89.8%. Saliva sensitivity was significantly lower than that of NPS (77.1% compared to 95.8%) in pre‐school and school‐age children but regained 96% when considering seronegative children only. This pattern was also observed to a lesser degree in adolescents but not in adults. Sensitivity of saliva was independent of symptoms, in contrary to NPS, whose sensitivity decreased significantly in asymptomatic subjects. Performance of saliva is excellent in children under 12 at early stages of infection. This reinforces saliva as a collection method for early and unbiased SARS‐CoV‐2 detection and a less invasive alternative for young children.

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Saliva as a Reliable Sample for COVID-19 Diagnosis in Paediatric Patients

Cited by 3 publications

References 8 publications

Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

The accuracy of saliva versus nasopharyngeal and/or oropharyngeal samples for the detection of SARS-CoV-2 in children – A rapid systematic review and meta-analysis

Saliva for molecular detection of SARS‐CoV‐2 in pre‐school and school‐age children

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