Self-Collected Anterior Nasal and Saliva Specimens versus Health Care Worker-Collected Nasopharyngeal Swabs for the Molecular Detection of SARS-CoV-2

Abstract

We prospectively compared healthcare worker-collected nasopharyngeal swabs (NPS) to self-collected anterior nasal swabs (ANS) and straight saliva for the diagnosis of COVID-19 in 354 patients. The positive percent agreement between NPS and ANS or saliva was 86.3% (95% CI: 76.7-92.9) and 93.8% (95% CI: 86.0-97.9), respectively. Negative percent agreement was 99.6% (95% CI: 98-100) for NPS vs. ANS and 97.8% (95% CI: 95.3 – 99.2) for NPS vs. saliva. NPS (n=80) and saliva (n=81) detected more cases than ANS (n=70), but no single specimen type detected all SARS-CoV-2 infections.

Performance of at-home self-collected saliva and nasal-oropharyngeal swabs in the surveillance of COVID-19

“…Recent studies comparing samples collected by specialized health-workers and self-collected by the patients for COVID-19 molecular diagnosis showed that both methods had similar sensitivity, which highlights the reliability of self-collection as a public health strategy for COVID-19 surveillance [6][7][8]. Our results corroborated these findings as they showed that both self-collected samples had good sensitivity, especially the saliva, with 78.6% (95% CI; 67.6% to 86.6%).…”

“…The possibility to use self-collected samples for COVID-19 testing offers several advantages, especially to minimize the risk of exposing health-care workers to the virus, since self-collection does not require direct involvement of trained personnel in the sample collection [4,5]. Recently, publications have been shown a similar sensitivity between saliva samples and nasal swabs collected by health-care workers and those collected by a patient for COVID-19 molecular diagnosis, thus providing an important background for the choice of this strategy for surveillance of COVID-19 [6][7][8]. Saliva sampling has been described as a good alternative for SARS-CoV-2 detection, showing additional advantages compared to swab collection [9][10][11][12].…”

Combined Self-Collected Anterior Nasal and Oropharyngeal Specimens versus Provider-Collected Nasopharyngeal Swabs for the Detection of SARS-CoV-2

“…However, published reports have observed variable ANS sensitivities compared to NPS ( 3 – 5 ). We previously observed that self-collected ANS missed 15% of positive detections compared to NPS or saliva ( 6 ) and hypothesized that self-collected swabs from multiple anatomic sites may improve diagnostic sensitivity.…”

Saliva Is a Promising Alternative Specimen for the Detection of SARS-CoV-2 in Children and Adults

“…To-date, the U.S. Food and Drug Administration has issued several emergency use authorizations for laboratory-developed diagnostic tests using saliva. More recent studies have shown use of saliva has moderate-to-high sensitivity and specificity when compared to NP swabs for detection of SARS-CoV-2 in sample-to-answer as well as traditional assays that require extraction prior to PCR (6)(7)(8)(9)(10)(11)(12)(13)(14). These studies vary widely in sample collection method and testing platforms, and more data is needed to standardize best collection and processing practices.…”