Saliva sampling for chasing SARS-CoV-2: A Game-changing strategy

Borghi, Elisa; Massa, Valentina; Carmagnola, Daniela; Dellavia, Claudia; Parodi, Chiara; Ottaviano, Emerenziana; Sangiorgio, Arianna; Barcellini, Lucia; Gambacorta, Greta; Forlanini, Federica; Zuccotti, Gian Vincenzo

doi:10.1016/j.phrs.2020.105380

Cited by 19 publications

(33 citation statements)

References 7 publications

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“…In the context of mass screening, most participants are asymptomatic. Among the 50 studies analysed, only one included exclusively asymptomatic participants [ 63 ] and 8 studies included both symptomatic and asymptomatic participants but it was impossible to separate the data between the two populations [ 17 , 20 , 25 , 29 , 51 , 56 , 58 , 65 ]. One study of contact cases included a larger number of asymptomatic subjects as compared to study of symptomatic subjects [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background 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 In contrast, saliva sampling can be self-administered. Methods 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 OR COVID19) AND (salivary OR saliva OR oral fluid)) NOT (review[Publication Type]) NOT (PrePrint[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. Findings A total of 377 studies were retrieved, of which 50 were eligible, reporting on 16,473 pairs of nasopharyngeal/oropharyngeal and saliva samples. Meta-analysis showed high concordance, 92.5% (95%CI: 89.5–94.7), across studies and pooled sensitivities of 86.5% (95%CI: 83.4–89.1) and 92.0% (95%CI: 89.1–94.2) from saliva and nasopharyngeal/oropharyngeal swabs respectively. Heterogeneity across studies was 72.0% for saliva and 85.0% for nasopharyngeal/oropharyngeal swabs. Interpretation 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? Rapid review and meta-analysis

et al. 2021

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“…Studies in adults have found variable concordance between saliva and other upper respiratory tract sample types, with saliva usually reported as slightly less sensitive than other samples types ( 7 ). The relatively few studies done specifically in children ( 8 , 9 , 10 ), or that included children within a larger cohort ( 10 , 11 ) are summarised in table 1 .…”

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confidence: 99%

“…of participants (No. positive a ) Age Severity of disease (Setting) Saliva collection method (volume) Platform Saliva sensitivitycompared with NPS Saliva sensitivity compared with all positive tests Positive Comments Total NPS only Saliva only Al Suwaidi et al 2021 ( 5 ) UAE 476 (87 positive) Mean 10.8 y Range 3-18y 39/87 mild symptoms (Screening clinic) Dribble pot (1-3mL) 200μl undiluted saliva EZ1 extraction ( Qiagen ) Allplex 2019-nCoV Assay kit ( Seegene ) [n, e and RdRp genes] Positive = >2 genes detected; ‘presumptive positive’ = E-gene detected 71/81 (88%) 77/87 (89%) 87 10 6 Ct values significantly higher in saliva Borghi et al 2020 ( 11 ) Italy 109 (27 positive) Range 0-17y Not stated (Attending hospital) Sterile dental role SalivaDirect TM process ( 19 ) using N1, RDRP primers/probes (CDC) Applied Biosystem 7500 Fast platform Positive = N1-gene detected at ct <40 20/21 (95%) 26/27 (96%) 27 1 6 Yee et al 2021 ( 15 ) USA 43 cases <18y positive Part of larger study Median 12 y Range 4-18y Variable (Inpatients, outpatients & household contacts) Dribble pot (3mL) 250μl undiluted saliva Applied Biosystems MagMAX extraction kit ( Thermo Fisher ) TaqPath COVID-19 Combo kit ( Thermo Fisher ) Positive = ≥1 of N, S, & ORF-1 genes 29/38 (76%) 34/43 (79%) 43 9 5 Performance superior for saliva in asymptomatic compared to symptomatic children Han et al 2020 ( 8 ) Korea (11 positive) Median 6.5 y ...…”

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confidence: 99%

“…Although small, these studies suggest that the sensitivity of saliva as a paediatric diagnostic sample type is acceptable compared to nasopharyngeal swabs, but not perfect. Interestingly, whilst missing a few cases detected in nasopharyngeal swab samples, SARS-CoV-2 may be additionally detected in some saliva samples where nasopharyngeal swab is negative ( 10 , 11 , 12 ). Interpreting these positive NAT results from saliva samples remains difficult in the absence of a defined gold standard comparator test.…”

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confidence: 99%

“…In a small study in children hospitalised with COVID-19 in Singapore, the majority of saliva and nasopharyngeal swab samples were concordant in the first few days after onset of symptoms, but the sensitivity of saliva testing declined rapidly after that ( 13 ). Test sensitivity is also impacted by the method used to collect saliva: published studies have used a variety of methods including dribble pots, suck swabs and specialised saliva collection kits ( 11 ). Location of sampling (buccal swabs ( 14 ) versus posterior oropharynx saliva ( 15 )) may also affect test sensitivity.…”

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Saliva testing for severe acute respiratory syndrome coronavirus 2 in children

Clifford

Curtis

2021

Clinical Microbiology and Infection

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If found to have adequate sensitivity and specificity, saliva would be an ideal sample type for identifying SARS-CoV-2 and other respiratory viruses in children, as its collection is less invasive than other standard upper respiratory tract sample types such as nasopharyngeal swab (NPS), deep nasal/oropharyngeal swab or nasopharyngeal aspirate (NPA). At present, the majority of commercial SARS-CoV-2 assays do not list saliva as an acceptable sample type for nucleic acid testing (NAT) and therefore validation studies assessing the use of this sample type are welcome.

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