Saliva‐based testing for diagnosis of SARS‐CoV‐2 infection: A meta‐analysis

Kivelä, Jesper M.; Jarva, Hanna; Lappalainen, Maija; Kurkela, Satu

doi:10.1002/jmv.26613

Cited by 14 publications

(25 citation statements)

References 18 publications

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“…Our meta-analysis showed large heterogeneity between studies. [73][74][75] . However, these studies used nasopharyngeal positivity as the reference, which did not seem relevant in our context.…”

Section: Discussionmentioning

confidence: 99%

Screening for SARS-CoV-2 by RT-PCR: saliva or nasopharyngeal swab? Systematic review and meta-analysis

Ibrahimi

Delaunay‐Moisan

Hill

et al. 2021

Preprint

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Diagnosis of COVID-19 in symptomatic patients and screening of populations for SARS-CoV-2 infection require access to straightforward, low-cost and high-throughput testing. The recommended nasopharyngeal swab tests are limited by the need of trained professionals and specific consumables and this procedure is poorly accepted as a screening method. The use of alternative validated samples such as saliva is thus much awaited. In order to compare saliva and nasopharyngeal/oropharyngeal samples for the detection of SARS-CoV-2, we designed a meta-analysis searching in PubMed up to December 29th, 2020 with the key words ((SARS-CoV-2 OR COVID-19) AND (saliva OR oral fluid)) NOT (review[Publication Type] applying the following criteria: records published in peer reviewed scientific journals, in English, with at least 15 nasopharyngeal/orapharyngeal swabs and saliva paired samples tested by RT-PCR, studies with available raw data including numbers of positive and negative tests with the two sampling methods. For all studies, concordance and sensitivity were calculated and then pooled in a random-effects model. A total of 318 studies were retrieved, of which 49 were eligible, reporting on 16,272 pairs of nasopharyngeal/oropharyngeal and saliva samples. Meta-analysis showed high concordance, 92.6% (95%CI: 89.6-94.8), across studies and pooled sensitivities of 86.7% (95%CI: 83.5-89.3) and 92.2 (95%CI: 89.4-94.4) from saliva and nasopharyngeal/oropharyngeal swabs respectively. Heterogeneity across studies was 80.0% for saliva and 84.0% for nasopharyngeal/oropharyngeal swabs. Our meta-analysis strongly suggests that saliva could be used for frequent testing of COVID-19 patients and en masse screening of populations.

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Section: Discussionmentioning

confidence: 99%

Screening for SARS-CoV-2 by RT-PCR: saliva or nasopharyngeal swab? Systematic review and meta-analysis

Ibrahimi

Delaunay‐Moisan

Hill

et al. 2021

Preprint

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“…Collecting saliva specimens for SARS-CoV-2 testing has several advantages over nasopharyngeal swab (NPS): less patient discomfort, is amenable to self-collection and poses less risk to HCWs. 27 There are 17 US FDA Emergency Use Authorisation assays for SARS-CoV-2 RNA detection in saliva: four are authorised for use in asymptomatic populations. The limit of detection (LOD) for evaluated assays ranges from 600 NDU/mL to 180,000 NDU/mL in FDA Reference Panel data, 15 but limited clinical performance evaluations are available.…”

Section: Innovations In Molecular Assaysmentioning

confidence: 99%

“…Six published meta-analyses using various RT-PCR assays have generally found saliva testing to be less sensitive than testing of nasopharyngeal swabs. 27 , 28 , 29 , 30 , 31 , 32 Studies using saliva testing for SARS-CoV-2 detection have employed various collection methods, processing methods, assays and patient populations and therefore have yielded variable results. 33 , 34 , 35 , 36 , 37 , 38 , 39 …”

Section: Innovations In Molecular Assaysmentioning

confidence: 99%

Use of emerging testing technologies and approaches for SARS-CoV-2: review of literature and global experience in an Australian context

et al. 2021

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Emerging testing technologies for detection of SARS-CoV-2 include those that are rapid and can be used at point-of-care (POC), and those facilitating high throughput laboratory-based testing. Tests designed to be performed at POC (such as antigen tests and molecular assays) have the potential to expedite isolation of infectious patients and their contacts, but most are less sensitive than standard-of-care reverse transcription polymerase chain reaction (RT-PCR). Data on clinical performance of the majority of emerging assays is limited with most evaluations performed on contrived or stored laboratory samples. Further evaluations of these assays are required, particularly when performed at POC on symptomatic and asymptomatic patients and at various time-points after symptom onset. A few studies have so far shown several of these assays have high specificity. However, large prospective evaluations are needed to confirm specificity, particularly before the assays are implemented in low prevalence settings or asymptomatic populations. High throughput laboratory-based testing includes the use of new sample types (e.g., saliva to increase acceptability) or innovative uses of existing technology (e.g., sample pooling). Information detailing population-wide testing strategies for SARS-COV-2 is largely missing from peer-reviewed literature. Logistics and supply chains are key considerations in any plan to ‘scale up’ testing in the Australian context. The strategic use of novel assays will help strike the balance between achieving adequate test numbers without overwhelming laboratory capacity. To protect testing of high-risk populations, the aims of testing with respect to the phase of the pandemic must be considered.

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“…Meta-analyses of saliva testing studies have consistently shown that the sensitivity is inferior to nose and throat swabs, at 83–85% when compared by qPCR. 9 , 10 The lower sensitivity of saliva, in addition to an assay with significantly inferior sensitivity, is of concern to us. Saliva may be acceptable for community mass testing, but not in the health care setting, where a missed positive sample can lead to an outbreak with significant consequences for patients.…”

mentioning

confidence: 99%

Concerning the OptiGene Direct LAMP assay, and it’s use in at-risk groups and hospital staff

Wilson-Davies¹,

Mahanama²,

Samaraweera³

et al. 2021

Journal of Infection

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Saliva‐based testing for diagnosis of SARS‐CoV‐2 infection: A meta‐analysis

Cited by 14 publications

References 18 publications

Screening for SARS-CoV-2 by RT-PCR: saliva or nasopharyngeal swab? Systematic review and meta-analysis

Screening for SARS-CoV-2 by RT-PCR: saliva or nasopharyngeal swab? Systematic review and meta-analysis

Use of emerging testing technologies and approaches for SARS-CoV-2: review of literature and global experience in an Australian context

Concerning the OptiGene Direct LAMP assay, and it’s use in at-risk groups and hospital staff

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