Saliva collected in universal transport media is an effective, simple and high-volume amenable method to detect SARS-CoV-2

Berenger, Byron M.; Conly, John; Fonseca, Kevin; Hu, Jia; Louie, Thomas; Schneider, Angela; Singh, Takshveer; Stokes, William; Ward, Linda; Zelyas, Nathan

doi:10.1016/j.cmi.2020.10.035

Cited by 37 publications

(52 citation statements)

References 7 publications

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“…Previous studies that have directly compared the diagnostic utility of NPS and NS samples have estimated the sensitivity of RT-PCR findings using NS specimens at 82.5–95.8% in the initial test performed for patients with suspected SARS-CoV-2 infection [ 10 , 21 , 22 ]; the corresponding values in this study were higher than those previously reported. This discrepancy may have been due to between-study differences in the patient populations, the type of PCR assays, or the collection media used.…”

Section: Discussioncontrasting

confidence: 67%

Diagnostic accuracy of nasopharyngeal swab, nasal swab and saliva swab samples for the detection of SARS-CoV-2 using RT-PCR

Tsujimoto

Terada

Kimura

et al. 2021

Infectious Diseases

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Background The current gold standard in coronavirus disease (COVID-19) diagnostics is the real-time reverse transcription–polymerase chain reaction (RT-PCR) assay for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in nasopharyngeal swab (NPS) samples. Alternatively, nasal swab (NS) or saliva swab (SS) specimens are used, although available data on test accuracy are limited. We examined the diagnostic accuracy of NPS/NS/SS samples for this purpose. Methods Ten patients were included after being tested positive for SARS-CoV-2 RT-PCR in NPS samples according to the National Institute of Infectious Disease guidelines. In comparison with this conventional diagnostic method, NPS/NS/SS samples were tested using the cobas 6800 systems RT-PCR device. To investigate the usefulness of the cobas method and the difference among sample types, the agreement and sensitivity were calculated. Five to six samples were collected over a total period of 5–6 d from each patient. Results Fifty-seven sets of NPS/NS/SS samples were collected, of which 40 tested positive for COVID-19 by the conventional method. Overall, the concordance rates using the conventional method were 86.0%/70.2%/54.4% for NPS/NS/SS samples (cobas); however, for samples collected up to and including on Day 9 after disease onset (22 negative and one positive specimens), the corresponding rates were 95.7%/87.0%/65.2%. The overall sensitivity estimates were 100.0%/67.5%/37.5% for NPS/NS/SS samples (cobas). For samples up to 9 d after onset, the corresponding values were 100.0%/86.4%/63.6%. Conclusions NS samples are more reliable than SS samples and can be an alternative to NPS samples. They can be a useful diagnostic method in the future.

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Section: Discussioncontrasting

confidence: 67%

Diagnostic accuracy of nasopharyngeal swab, nasal swab and saliva swab samples for the detection of SARS-CoV-2 using RT-PCR

Tsujimoto

Terada

Kimura

et al. 2021

Infectious Diseases

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“…Healthcare workers, previously trained in NP and throat swab collection, were given instructions on how to collect swabs from recruited COVID-19 infected individuals. For reference RT-PCR testing, the YOCON NP swab and universal transport media (UTM) (Yocon, Beijing, China) and ClassiqSwabs for throat in COPAN UTM-RT (COPAN Diagnostics, CA, USA) were used [6]. For Panbio testing, the NP swab provided in the Panbio testing kits (Abbott) was used, and the ClassiqSwab was used for collecting throat and saliva samples.…”

Section: Testing Individuals With Known Covid-19mentioning

confidence: 99%

Clinical performance of the Abbott Panbio with nasopharyngeal, throat, and saliva swabs among symptomatic individuals with COVID-19

Stokes

Berenger

Portnoy

et al. 2021

Eur J Clin Microbiol Infect Dis

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SARS-CoV-2 antigen tests used at the point-of-care, such as the Abbott Panbio, have great potential to help combat the COVID-19 pandemic. The Panbio is Health Canada approved for the detection of SARS-CoV-2 in symptomatic individuals within the first 7 days of COVID-19 symptom onset(s). Symptomatic adults recently diagnosed with COVID-19 in the community were recruited into the study. Paired nasopharyngeal (NP), throat, and saliva swabs were collected, with one paired swab tested immediately with the Panbio, and the other transported in universal transport media and tested using real-time reverse-transcriptase polymerase chain reaction (RT-PCR). We also prospectively evaluated results from assessment centers within the community. For those individuals, an NP swab was collected for Panbio testing and paired with RT-PCR results from parallel NP or throat swabs. One hundred and forty-five individuals were included in the study. Collection of throat and saliva was stopped early due to poorer performance (throat sensitivity 57.7%, n=61, and saliva sensitivity 2.6%, n=41). NP swab sensitivity was 87.7% [n=145, 95% confidence interval (CI) 81.0-92.7%]. There were 1641 symptomatic individuals tested by Panbio in assessment centers with 268/1641 (16.3%) positive for SARS-CoV-2. There were 37 false negatives and 2 false positives, corresponding to a sensitivity and specificity of 86.1% [95% CI 81.3-90.0%] and 99.9% [95% CI 99.5-100.0%], respectively. The Panbio test reliably detects most cases of SARS-CoV-2 from adults in the community setting presenting within 7 days of symptom onset using nasopharyngeal swabs. Throat and saliva swabs are not reliable specimens for the Panbio.

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“…However, viral load in the nasopharynx can wane in later disease stages, while the virus remains detectable in alternate specimens such as bronchioalveolar lavage or sputum, thus necessitating the validation of diagnostics tests in these specimens [ 3 , 4 , 5 ]. In addition, to overcome limitations in mass screening for early detection of SARS-CoV-2, saliva has been considered as alternate material to NPS [ 6 , 7 , 8 , 9 , 10 ]. NPS collection requires trained personnel while saliva collection is comparatively easy, needs little instruction and is amenable for self-collection.…”

Section: Introductionmentioning

confidence: 99%

“…Several recent studies have evaluated saliva as an alternate specimen [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. While these studies generally agree that detection of SARS-CoV-2 in saliva is possible, comparative analyses came to different conclusions, with some studies noting a better performance of saliva while others found a substantially lower sensitivity.…”

Section: Introductionmentioning

confidence: 99%

High Efficacy of Saliva in Detecting SARS-CoV-2 by RT-PCR in Adults and Children

et al. 2021

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Rising demands for repetitive SARS-CoV-2 screens and mass testing necessitate additional test strategies. Saliva may serve as an alternative to nasopharyngeal swab (NPS) as its collection is simple, non-invasive and amenable for mass- and home testing, but its rigorous validation, particularly in children, is missing. We conducted a large-scale head-to-head comparison of SARS-CoV-2 detection by RT-PCR in saliva and NPS of 1270 adults and children reporting to outpatient test centers and an emergency unit. In total, 273 individuals were tested positive for SARS-CoV-2 in either NPS or saliva. SARS-CoV-2 RT-PCR results in the two specimens showed a high agreement (overall percent agreement = 97.8%). Despite lower viral loads in the saliva of both adults and children, detection of SARS-CoV-2 in saliva fared well compared to NPS (positive percent agreement = 92.5%). Importantly, in children, SARS-CoV-2 infections were more often detected in saliva than NPS (positive predictive value = 84.8%), underlining that NPS sampling in children can be challenging. The comprehensive parallel analysis reported here establishes saliva as a generally reliable specimen for the detection of SARS-CoV-2, with particular advantages for testing children, that is readily applicable to increase and facilitate repetitive and mass testing in adults and children.

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Saliva collected in universal transport media is an effective, simple and high-volume amenable method to detect SARS-CoV-2

Cited by 37 publications

References 7 publications

Diagnostic accuracy of nasopharyngeal swab, nasal swab and saliva swab samples for the detection of SARS-CoV-2 using RT-PCR

Diagnostic accuracy of nasopharyngeal swab, nasal swab and saliva swab samples for the detection of SARS-CoV-2 using RT-PCR

Clinical performance of the Abbott Panbio with nasopharyngeal, throat, and saliva swabs among symptomatic individuals with COVID-19

High Efficacy of Saliva in Detecting SARS-CoV-2 by RT-PCR in Adults and Children

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